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Carpal Tunnel Syndrome

carpal-tunnelCarpal tunnel syndrome, also abbreviated as CTS is a condition (median entrapment neuropathy) responsible for the cause of pain, parenthesia, numbness, among other symptoms in the median nerve as a result of a compression occurring at the carpal tunnel in the wrist area. The mechanism of the condition is not understood but is considered to be as a result of the median nerve compression in the carpal tunnel.

This condition appears to be caused by a combination of environmental and genetic factors. There are factors that are termed as predisposing such as obesity, diabetes, hypothyroidism, pregnancy, working with vibrating tools, or heavy manual works. There is little clinical evidence showing light repetitive tasks as being causes of the carpal tunnel syndrome.

Signs and Symptoms of Carpal Tunnel Syndrome

Patients suffering from carpal tunnel syndrome will experience tingling, numbness and sometimes a burning sensation in the fingers and thumb. The most affected fingers are the fiddle finger, the index finger and radial half of the ring finger. These fingers are affected because they are innervated by the median nerve which is affected by the compassion. There are less specific symptoms which may include loss of strength in a grip, pain in the hand and wrist. These are also characteristics of other conditions like arthritis.

There are suggestions that median nerve symptoms might be as a result of a compression at the thoracic outlet or at the point where the nerve is between the two pronator teres heads located in the forearm. This suggestion is still debatable.  This suggestion is aimed at explaining the plain and symptoms that are experience and are not associated by carpal tunnel syndrome. The carpal tunnel syndrome is diagnosed using reliable, objective and verifiable pathophysiology while pronator syndrome and thoracic outlet syndrome are defined by the absence of a verifiable pathophysiology and are applied in cases of nonspecific pain in the upper extremity.

Causes of Carpal Tunnel Syndrome

Most of the carpal tunnel syndrome causes are not known or are idiopathic. This condition can be linked to anything that causes compression on the median nerve at the wrist. Some of the common conditions which can cause carpal tunnel syndrome include arthritis, diabetes, prediabetes also known as impaired glucose tolerance, oral contraceptive, trauma, and hypothyroidism.

Other causes of carpal tunnel syndrome include factors that lead to pressure within the tunnel or factors exerting pressure from outside the tunnel. These factors may include ganglion, lipomas, and vascular malformation. This condition has been found to be a symptom of transthyretin amyloidosis-associated polyneuropathy. In normal cases, the median nerve will move about 9.6 millimeters to allow the flexion of the wrist and to some extent during extension. The compression will inhibit the nerve gliding and this is what leads to scarring and injury after the scarring, the nerve adheres to the surrounding tissue and this brings about a locked position and this is what results in reduced movement.

The normal pressure at the carpal tunnel is defined at between 2-10 millimeters and the flexion of the wrist increases the pressure 8 times while the extension is rated at 10 times. Repetitive extension and flexion of the wrist will increase the pressure in the tunnel via synovial tissue which provides lining to the tendons found in the carpal tunnel.

Associated Conditions

There are a number of factors which are known to lead to carpal tunnel syndrome including the size of the carpal tunnel which is hereditary, systematic and local diseases, and some habits. The non-traumatic causes will usually occur over a long period and will mostly be triggered by a particular event. Most of the involved factors will be manifestations of physiologic aging.

Prevention of Carpal Tunnel Syndrome

There are suggested healthy behaviors like avoiding repetitive stress, modifying work via ergonomic equipment, taking breaks, keyboard alternatives such as voice recognition and dictation. This can also be combined with treatment such as the taking of anti-inflammatory foods like turmeric, B vitamins, and omega-3 fatty acids.

Isometric exercises and stretches have been found to be helpful and will aid in the preventive measures for people who are at a risk of developing carpal tunnel syndrome. The tension at the wrist can be alleviated through stretching during breaks and before starting any activities that involve wrist movements. The exercise can be through a firm press on a flat surface while the fingers are stretched. It can also be through the tight clinching of the fist and fanning the fingers out when releasing. The exercises and the stretches should not cause any pain.

Diagnosis

There is no known consensus reference standard in the diagnosis of carpal tunnel syndrome. A proper diagnosis will be achieved through a combination of electrophysiological test, clinical finding and the symptoms described by the patient. There are experts who will make a diagnosis using physical examinations and history with a combination of electrodiagnostic testing. The advancement in technology has resulted in the use of ultrasonography.

Signs of carpal tunnel syndrome include the median nerve numbness distribution, nocturnal symptoms, weakness of the thenar muscle, and abnormal sensory testing. Pain will also be a presenting symptom but is less common when compared to sensory disturbances. Carpal tunnel syndrome is in some cases applied as a label to people who are experiencing swelling, burning, and numbness in the radial side of the wrist and/or hand.

Treatment of carpal tunnel syndrome

There are generally accepted treatments such as physiotherapy, the use of injected or oral steroids, splinting and in some cases, surgery may be indicated for the transverse carpal ligament release. There is little or no evidence of the effectiveness of lasers, B6, exercise therapy, yoga or ultrasound. Corticosteroid injections may be recommended in the temporal relief of the symptoms of carpal tunnel syndrome as the patient plans on strategies that rhyme with their lifestyle.

Anyone with symptoms such as pain, weakness, and numbness among other symptoms of carpal tunnel syndrome should see a physician for a diagnosis and a treatment plan that will relieve the symptoms and allow them to go back to their normal activities.

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