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The carpal tunnel is the passageway in the wrist, made up of the arching carpal bones and the ligament connecting the pillars of the arch (the transverse carpal ligament).


Most commonly, symptoms are tingling, numbness, weakness, hand pain (except in the little finger). You might also feel shooting pain from your hand up the arm and into the shoulder. Patients also report a swollen feeling in fingers, as symptoms worsen by night. With carpal tunnel syndrome, hands feel stiff in the morning. Patients also complain they have trouble grasping objects. The symptoms also include numbness and tingling of the hand, wrist pain, and a pins-and-needles feeling at night. Sometimes the symptoms are also weakness in the grip and a feeling of in-coordination.
Symptoms of carpal tunnel syndrome progress gradually over weeks and months and, in some cases, years.

Connection between carpal tunnel syndrome and arthritis

In many people, the cause of carpal tunnel syndrome is unknown. Injuries, such as a wrist or forearm fracture could lead to this problem. Moreover, doctors are sure that diseases such as rheumatoid arthritis are related to the carpal tunnel syndrome. Work activities that require repetitive wrist or finger motion could also lead to carpal tunnel syndrome. Anything that causes swelling or irritation of the synovial membranes around the tendons in the carpal tunnel can result in pressure on the median nerve and cause this problem. Some doctors claim that thyroid problems, diabetes, hormonal changes of pregnancy and menopause could also lead to carpal tunnel syndrome.

Diagnosis

To diagnose the carpal tunnel syndrome, doctors require a detailed medical history and some additional tests. Most common tests are Tinel's sign, where the front of the wrists is tapped to check for tingling or pain. To confirm Phalen's sign, bend wrist down and hold, then release, also to check for tingling or pain. Nerve-conduction velocity study measures the nerves’ ability to send electrical impulses. Blood test and X-rays are also common, to check for other medical conditions.
For suspected carpal tunnel syndrome, diagnosis should be based on symptoms, supported by physical examination, and confirmed by a nerve conduction testing. It is important to have the exam conducted by an orthopedic surgeon or a neurologist, in order to make sure you do have carpal tunnel syndrome, and not something else. Magnetic resonance imaging (MRI) is also accurate in determining the severity of carpal tunnel syndrome.
Furthermore, there are two very simple tests, which most doctors do during the initial exam. For one, about two-thirds of individuals with carpal tunnel syndrome will have an electric-like sensation when the doctor taps over the median nerve at the wrist. The other test is more specific to the carpal tunnel syndrome. It is a reproduction of the symptoms on flexion of the wrist with the forearm held vertically.

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