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Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome ?

Carpal tunnel syndrome is a condition of the tight space, between the joints that support the fibrous tissues and the wrist bone.

The median nerve which passes through the carpal tunnel, receives the sensations from the thumb, index, middle and ring fingers. A condition that squeezes and irritates the median nerve of the carpal tunnel, causes the syndrome. Under this syndrome, tingling and numbness of fingers is experienced, except the little finger. A number of factors such as anatomy of wrist, presence of certain disorders or health conditions, and the pattern of hand use, may contribute to developing carpal tunnel syndrome.

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Carpal tunnel is a narrow passageway, bound by bones and ligaments, located on palm side of the wrist. This tunnel protects the hand nerves and nine tendons that control the movements of fingers. Any compression caused on this portion of nerves, causes pain, tingling and numbness in palm and fingers, which is called as carpal tunnel syndrome.

Appropriate treatment can give relief from pain and numbness and restore normal condition, otherwise it may extend slowly to hand and forearm.

Symptoms of carpal tunnel syndrome

The signs and symptoms of carpal tunnel syndrome are discussed below:

  • Tingling and numbness of the hand and fingers, except little finger. Numbness may become constant, if it is not treated.
  • Pain may grow from the wrist to hand, upper arm and to shoulder; and to the palm while radiating downwards, when the affected wrist is often repeatedly used with force
  • Weakness in hands and loss of strength in arm to hold things is felt.

Causes of carpal tunnel syndrome

Carpal tunnel syndrome develops due to compression or increased tightness of the median nerve.

A single factor or a combination of several factors may increase the risk to developing carpal tunnel syndrome. Some of such risk factors are listed below:

  • Inflammatory conditions: Inflammatory conditions caused by illnesses such as rheumatoid arthritis and infections affecting the tendons of wrist, may exert extra pressure on the median nerve.
  • Working conditions: Unusual working conditions where one has to work with vibrating tools, or a particular type of work which needs repetitive flexing of wrist, may harm median nerve.
  • Anatomic factors: Extraordinary pressure may be created in median nerve, by a wrist fracture, or by dislocation, which may compress or alter the space in carpal tunnel, causing the syndrome. Women are more affected by this syndrome, because they possess a narrow carpal tunnel as compared to men.
  • Conditions that cause nerve damage: Chronic illness such as, diabetes, and alcoholic habits enhance the risk for this syndrome, as it can damage the nerves including the median nerve.
  • Changes in the balance of body fluids: Balance levels of fluids in the body can be altered by certain conditions such as pregnancy, menopause, obesity, thyroid disorders, kidney failures, etc. which cause pressure on carpal tunnel. The carpal tunnel syndrome due to pregnancy vanishes on its own after the delivery.

Diagnosis of carpal tunnel syndrome

  • Physical exam: Feeling the fingers, palm muscles, bending the wrist, tapping on the nerve will expose the symptoms of carpal tunnel syndrome.
  • X-ray: X-ray of wrist can expose the syndrome, caused by fracture, arthritis etc.
  • Pattern of symptoms: If the little has also lost sensations or feelings, then it may indicate the presence of another condition as carpal tunnel syndrome does not affect the little finger. The timing of the symptoms of carpal tunnel syndrome also helps in diagnosis of the condition. When one experiences problems while holding a phone, reading a book, waking up in night, or while holding a steering wheel etc., then in may indicate the presence of carpal tunnel syndrome
  • Nerve conduction study: After tapping two electrodes over the skin, little amount of shock is passed on the median nerve to confirm the slowdown of electrical impulses in carpal tunnel, which in turn confirms the syndrome.
  • Electromyogram: In electromyography, inserting a thin needle electrode into the muscles, while at rest and in action, the electrical activity of muscles is studied to determine the damage to muscles.

Nerve conduction and the electromyogram tests help to identify the possible disorders that elicit symptoms similar to those experienced with carpal tunnel syndrome.

Carpal Tunnel Syndrome treatment

Some of the treatment methods for carpal tunnel syndrome are as follows:

  • For reducing occasional swelling: Giving frequent rest to hands and applying cold packs. If it does not give relief, the additional treatment options are; wrist splinting, medications and surgery. Conservative treatments such as splinting can help only in mild and moderate symptoms that last for less than 10 months.
  • Following nonsurgical therapies may help to improve the syndrome:
    • The use of nonsteroidal anti-inflammatory drugs. It is good for short term treatment. It can improve the syndrome.
    • Wrist splinting: This method helps to control tingling and numbness. Nocturnal splinting will be more suitable option for pregnant women.
    • Corticosteroids: It controls pain, inflammation, swelling, and relieves pressure on median nerve. It is considered that corticosteroids given through injection are more effective for carpal tunnel syndrome.
    • Surgery: If nonsurgical therapy does not bring relief, the pressure on the median nerve is relieved either by endoscopic or by open surgery. Cutting of pressing ligament is performed, which grow back gradually during the healing process, while allowing more room for the nerve.

Carpal Tunnel Syndrome pictures

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