Carpal Tunnel Syndrome

November 12, 2012

Carpal Tunnel Syndrome

This syndrome is caused when the median nerve becomes squeezed or pressed at the wrist. This is the nerve that is in control of the sensations and impulses to the small muscles at palm side of the fingers and thumb. The little finger is not controlled by this nerve. Because of the compression of these nerves, numbness, weakness and pain may be experienced in the wrist, hand and even travelling upwards to the arm.

Carpal tunnel syndrome is a progressive and painful condition. The symptoms tend to begin slowly. It may be numbness, itchiness, tingling or a burning sensation which is felt in the palms and fingers, particularly the index and middle fingers and the thumb.

When the symptoms begin to deteriorate tingling sensations may be experienced. It may also be difficult to carry out tasks which involve holding very small objects or other manual activities.

Carpal tunnel syndrome may be caused by a variety of reasons. It may be caused by a congenital condition. Other reasons may include the following:

  • Hypothyroidism and Hyperthyroidism

  • Work stress

  • Fracture or sprain to the wrist

  • Rheumatoid arthritis

  • Frequently using hand tools which vibrate

  • Problems in the joint of the wrist

  • Possible tumor or cyst developing

  • Fluid retention caused by menopause or pregnancy

No conclusive evidence is available to prove if forceful and repetitive movements of the wrist and hand may be connected to carpal tunnel syndrome.

People who have diabetes and people who suffer from disorders which affect the metabolism may be more at risk.

To prevent permanent damage to the median nerve it is essential to get treatment and a diagnosis early. The wrist will be examined for discoloration, warmth, swelling and tenderness. The fingers will be examined one by one and the sensation experienced will be tested. The hand muscles will be checked for atrophy signs and strength.

A Tinel test can be carried out. This involves the doctor tapping on or pressing the median nerve. Should tingling or a sensation of shock be produced the test is positive.

The Phalen test which is also known as the wrist-flexion test may be carried out. This involves the patient holding the forearms upright, pointing the fingers downward and pressing the backs of the hands together. If after one minute, numbness or tingling is experienced it is more than likely carpal tunnel syndrome.

Sometimes confirmation of a diagnosis is required by using an electrodiagnostic test. This involves electrodes being placed on the wrist and hand and small electric shocks are applied.

Treatments for carpal tunnel syndrome should begin as early as possible, under a doctor’s direction. Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms, and immobilizing the wrist in a splint to avoid further damage from twisting or bending. If there is inflammation, applying cool packs can help reduce swelling.

Treatments for relieving the symptoms of carpal tunnel syndrome without surgery are listed:

  • Drugs

    – In special circumstances, various drugs can ease the pain and swelling associated with carpal tunnel syndrome. Injections in the wrist may be given to provide immediate relief.

  • Exercise

    – Strengthening and stretching exercises can help people whose symptoms have abated.

  • Alternative therapies

    – Care from a chiropractor and acupuncture may benefit some people. But there is no conclusive evidence to support this.

Types of surgery used to cure the condition:

  • Carpal tunnel release is carried out under local anesthesia and no overnight stay at a hospital is necessary.

  • Open release surgery involves an incision to the wrist of approximately 2 inches. Unless there are medical reasons this is normally done under local anesthetic as an outpatient.

  • Endoscopic surgery in which two half inch incisions in the palm and wrist are carried out and a camera connected to a tube looks at the tissue on the screen. The carpal ligament is cut. This is performed under local anesthetic and can lead to a quicker recovery.

There is a very low risk of carpal tunnel recurring and most patients make a complete recovery.

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