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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).


The median nerve and the tendons that connect the fingers to the muscles of the forearm pass through the tightly spaced carpal tunnel. The carpal tunnel syndrome occurs when the median nerve is pinched due to swelling of the nerve, the tendons, or both. The median nerve provides sensation to the palm side of the thumb, index, middle fingers, and inside half of the ring finger, and also provides muscle power to the thumb. When this nerve becomes pinched, numbness, tingling, and sometimes pain of the affected fingers and hand may occur. There is also a connection between carpal tunnel syndrome and arthritis.

What is the carpal tunnel syndrome?

Carpal tunnel syndrome is a condition that can cause pain, tingling, numbness, and weakness in fingers and thumbs. It results from pressure on the median nerve in the wrist. This disorder is a type of compression neuropathy that refers to nerve damage, caused by compression and irritation of the median nerve in the wrist. The nerve compresses within the carpal tunnel, a bony canal in the palm side of the wrist that provides passage for the median nerve to your hand. The irritation of the median nerve is specifically due to pressure from the transverse carpal ligament. Carpal tunnel syndrome can be caused by trauma from repetitive work such as that of checkers in supermarkets and other types of stores, assembly line workers, meat packers, typists, word processors, accountants, writers, and so on. Other predisposing factors include obesity, pregnancy, hypothyroidism, arthritis, and diabetes.

It may be interesting to describe how wrist bones form the bottom and sides of the carpal tunnel. A ligament covers the top of the tunnel. This tunnel also contains nine tendons that connect muscles to bones and bend fingers and thumb. These tendons have a lubricating membrane called synovium above, which may enlarge and swell under some circumstances. This swelling may cause the median nerve to press up against this strong ligament, which may result in numbness, tingling in the hand, clumsiness, or pain.

What are the symptoms of carpal tunnel syndrome?


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.

Treatment options


Carpal tunnel syndrome can range from a minor inconvenience to a disabling condition, depending on its cause and persistence. Many cases of CTS are mild, and some resolve on their own, so the treatment will be dependent on the severity of each individual case. It is critical to begin treating the early phases of carpal tunnel syndrome, before the damage progresses. If possible, the patient should avoid activities at work or home that may aggravate the condition.

Conservative treatment seems to work best for carpal tunnel syndrome in men under 40, and is less effective in young women. The affected hand and wrist should have rest for at least two weeks. This allows the swollen, inflamed tissues to shrink, and relieves pressure on the median nerve; ice may also provide relief.

Exercise could help, in the form of a supervised hand-and-wrist strengthening exercise program offered by physical or occupational therapists. One study found that most people with carpal tunnel syndrome felt an improvement after two months of physical therapy that included exercises to improve balance and posture.

Medications are also a choice for carpal tunnel syndrome treatment in some patients. Non-steroidal anti-inflammatory drugs are commonly used to treat the condition. Available over the counter or by prescription, they fight inflammation or swelling and relieve pain.

Cortisone injections into the area may lessen the swelling, ease pressure on the nerve, and relieve some symptoms for CTS.


Vitamin deficiencies, especially of vitamin B6, have been associated with carpal tunnel syndrome. One study supported this association and reported that high levels of vitamin B6 were associated with fewer CTS symptoms.

Surgery is the best treatment option in more severe cases, as it helps widen the carpal tunnel. Surgery consists of releasing the ligament that forms the tight roof of the carpal tunnel. This opens and widens the tunnel, allowing plenty of room for everything in it and relieving pressure on the nerve, resolving the problematic symptoms of CTS. There are several methods to this, but the standard surgery involves a 2-3 inch incision.

What happens in severe cases of carpal tunnel syndrome?


When chronic irritation occurs around the median nerve, it becomes constricted and pushes against the ligament above it. The nerve may be continually constricted and pressed to the point of deterioration. This results in a slowing of nerve impulses, which may cause a loss of feeling in the fingers. It could also cause a loss of strength and coordination at the base of the thumb. If the condition is left untreated, it could result in permanent deterioration of muscle tissue. People with rheumatoid arthritis, diabetes, or other metabolic conditions (such as thyroid disease) may be more likely to develop carpal tunnel syndrome because of their previous problem. These conditions affect the nerves directly, making them more vulnerable to compression and previously mentioned symptoms. If needed, an electromyogram can be taken to document the extent of nerve damage. An electromyogram is a test that measures the electrical activity in nerves and muscles. Nerve conduction studies measure the ability of specific nerves to transmit electrical impulses or messages, so they will not come out positive until there is significant nerve damage. However, the severity of a patient’s symptoms often does not correlate with the findings of a nerve conduction study.

Is it possible to prevent carpal tunnel syndrome?

To help prevent carpal tunnel syndrome, you could sleep with your wrists straight or use a splint. You could also keeping your wrists straight when using tools, without using splints. Try to avoid Flexing and extending your wrists repeatedly.

To prevent carpal tunnel syndrome, perform conditioning and stretching exercises. You must learn how to cope with arthritis because there is a significant connection between those two conditions. Get support and find resources for people with carpal tunnel syndrome. View the full table of contents for the arthritis guide, because it might provide valuable info about your condition.

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