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Carpal Tunnel Syndrome
Carpal Tunnel Syndrome occurs when the median nerve that runs
from the forearm through the wrist and into the hand becomes pressed
or squeezed within the wrist compartment. Carpal Tunnel Syndrome is
responsible for hours of lost work in the United States among
specific job categories.
The median nerve, that runs through the wrist compartment controls
the sensation to the palm side of the thumb and the first three
fingers but not the last pinkie finger. Patients with Carpal Tunnel
Syndrome often complain that their fingers feel swollen even though
there is no apparent swelling to the joints or fingers. There is
however, pain, weakness or numbness in the hand and wrist, which
radiates up the arm.
Carpal Tunnel Syndrome is a form of entrapment neuropathy.
Neuropathy is a fancy way of saying that there is nerve involvement
and often nerve pain that is difficult to control.
The carpal tunnel is a narrow rigid passageway of ligaments and
bones at the base of the hand. This is where the tendons, ligaments
and nerves pass through the wrist and expand to the hand.
Compression happens when the area becomes irritated and there is
swelling squeezing both the nerve and the tendons.
Symptoms start gradually. Patients feel burning, tingling, itching
and numbness in the palm of the hand and first three fingers.
Symptoms appear in one or both hands at night. People may wake up
feeling the need to “shake out” their hands. Patients report that
their grip strength is decreased and they find it difficult to make
a fist, grasp objects or perform fine motor tasks (those tasks that
require fine finger control).
If Carpal Tunnel Syndrome is left untreated the muscles as the base
of the thumb will atrophy or become smaller. Carpal Tunnel Syndrome
is often the result of repetitive motions and a combination of
pressure on the nerve from swelling. There can be a congenital
predisposition to a smaller tunnel in the wrist and some believe
that women are more prone because their wrists are smaller. However
their tendons, ligaments and muscles are also smaller.
Other factors that cause Carpal Tunnel Syndrome are injury, over
activity of the pituitary gland; hypothyroidism, rheumatoid
arthritis, mechanical problems, work stress, fluid retention or the
development of a cyst in the tunnel. Women are three times more
likely to develop carpal tunnel. The dominant hand is affected first
and produces the most severe pain.
The risk is higher in people performing assembly line work –
manufacturing, finishing, cleaning, and meat packing. However in a
2001 study by the Mayo Clinic researchers found that heavy computer
use (up to 7 hours per day) did not increase a risk of carpal
tunnel.
Early diagnosis and treatment are important to avoid permanent
damage to the median nerve. A physical exam of the hands, arms,
shoulders, and neck can help determine if the complaints are related
to daily activities or to an underlying disorder; and can rule out
other painful conditions.
Each finger should be tested for sensation, and the muscles at the
base of the hand for strength and signs of atrophy. The diagnosis is
confirmed with electrodiagnositics. A nerve conduction test is
performed to evaluate the function of the nerves. A small electric
shocks are applied and the speed the nerve transmits the impulses is
measured. With Carpal Tunnel Syndrome the speed is decreased. An MRI
can show the anatomy of the wrist but this isn’t especially useful
in diagnosis of Carpal Tunnel Syndrome. Ultrasound imaging can show
impaired movement of the nerve.
Carpal Tunnel Syndrome is common and not without it’s disadvantages.
The best specific treatment is to rest the muscles, tendons and hand
from the repetitive motion that cause the problem in the first place
and once the condition has been resolved it is important not to
return to your previous habits.
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