Carpal Tunnel Syndrome

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Carpal Tunnel Syndrome Carpal tunnel syndrome is
a common disorder that causes pain, numbness,
tingling, and weakness in the hand and wrist. It
occurs when there is a high amount of pressure
within the wrist on a nerve called the median
nerve. This median nerve provides sensation to
the thumb, index, and middle fingers, and half of
the ring finger. The little finger (the pinky)
is typically not affected. This median nerve also
provides strength to few muscles at the base of
the thumb and index finger. Carpal tunnel -
Carpal tunnel is a narrow passage in the wrist.
The bottom and sides of the tunnel are formed by
small semi-circular bones called carpal bones. A
tissue called ligament forms in the top of the
tunnel. The median nerve and tendons pass
through this space. These tendons connect muscles
in the forearm to bones in the hand. These help
the finger and thumb to bend and
straighten. Who is at risk? Women are three
times more possible to have carpal tunnel
syndrome than men. Carpal tunnel syndrome is
mostly diagnosed between the ages of 30 and 60.
Jobs that involve repetitive finger use, mainly
those associated with high force, extreme wrist
motions may develop this disorder. Many factors
contribute to the development of carpal tunnel
syndromes such as high salt intake, sedentary
lifestyle and, obesity. People who work in
professions like Manufacturing, Assembly line
work, Keyboarding occupations, and Construction
work are at greater risk. Causes The carpal
tunnel is a narrow passage in the wrist it is
surrounded by bones and ligaments. Tendons run
through the carpal tunnel and help the fingers
and the median nerve move, which is responsible
for both sensation and movement in the hand,
thumb,
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• index finger, middle finger, and ring finger.
  Any condition that causes swelling of the
  membranes of the carpal tunnel can lead to the
  carpel tunnel syndrome. When the tissues of the
  carpal tunnel become swollen, it will cause the
  median nerve to be compressed, which is known as
  nerve entrapment.
• Conditions related to carpal tunnel syndrome are
• Diabetes
• Thyroid dysfunction
• Fluid retention from pregnancy or menopause
• High blood pressure
• Autoimmune disorders such as rheumatoid arthritis
• Fractures or trauma to the wrist
• Wrist fracture or dislocation
• Wrist Deformity
• Tumor in the carpel tunnel
• Older age
• Placing of your wrists while using your keyboard
  or mouse
• Continuous exposure to vibrations from using
  hand-tools or power-tools
• playing the piano or typing
• Symptoms
• Symptoms begin slowly, early symptoms occur along
  the nerve path because of compression of the
  median nerve. Your hand may asleep often and drop
  objects.

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Diagnosis

• Your doctor will check your medical history and
  examine you. Later tests are performed, that
  include-
• Tinels sign- In this test, the doctor will tap
  over the median nerve at the wrist to check if it
  produces a tingling sensation in the fingers.
• Wrist flexion test- in this test, the patient
  rests his elbow on a table and allows the wrist
  to fall forward freely. People with carpal
  tunnel syndrome will experience numbness and
  tingling in the fingers within 60 seconds. The
  severity of the carpal tunnel syndrome is
  diagnosed based on how quickly symptoms appear.
• X-rays X-rays of the wrist is done if there is
  limited wrist motion, or to exclude if any other
  causes such as arthritis or fracture.
• Electromyography (EMG) This test is conducted to
  know the health of the muscles and the nerve
  cells that control them. A thin needle electrode
  is inserted into specific muscles to evaluate the
  electrical activity when muscles contract and
  rest this is to find out if there is any muscle
  damage.
• Nerve conduction study. In this test, two
  electrodes are taped to the skin and a small
  shock is passed through the median nerve to
  check if electrical impulses are slowed in the
  carpal tunnel. This method is done to check your
  condition and to rule out other conditions.

Treatments for CTS given are

• If the Carpal tunnel syndrome is diagnosed at an
  early stage then non-surgical treatments are
  given first such as
• Avoid continuous movement of your hand
• Wrist splints that hold your hand in a neutral
  position
• Medication for mild pain and to reduce
  inflammation
• Treatment of any underlying conditions you may
  have, such as diabetes or arthritis
• Steroid injections into your carpal tunnel area
  to reduce inflammation
• Physiotherapy
• If swelling occurs, use a cold pack to reduce
• Surgery treatment - if non-surgical treatment
  doesnt help, surgery may be recommended for
  serious cases. This is done in one day by giving
  local anesthesia. The surgery is known as carpal
  tunnel release. This surgery has two techniques
  and your doctor will suggest the ideal one for
  your condition.
• Open release surgery - An incision is made in
  your wrist and palm and the surgeon locates the
  flexor retinaculum (a strong band of tissue
  within the carpal tunnel that wraps the median
  nerve and the tendons that move the fingers). The
  flexor retinaculum

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• is cut and released, with that, the pressure on
  the median nerve is released then the skin is
  stitched back together.
• Endoscopic surgery- in this technique the doctor
  uses a narrow telescope called an arthroscope.
  This is used to see the structures of the carpal
  tunnel from inside. In this procedure two small
  incisions are made one in the wrist and one in
  the palm and then the arthroscope is passed
  through one incision and the surgical instruments
  through the other. The surgeon will be able to
  see the structures of the carpal tunnel on the
  monitor while using the surgical instruments to
  release the flexor retinaculum. The incisions are
  closed either with stitches or small paper tapes
  (steristrips).
• Recovery - Endoscopic carpal tunnel release
  usually has a quicker recovery time it has less
  postoperative pain and causes less scarring than
  open release surgery.
• However, this endoscopic type of surgery is not
  suitable for all people.
• Postoperative recovery- usually the recovery
  from the surgery happens very quick and have
  very fewer complications. 95 of people who
  undergo carpal tunnel release surgery get relief
  from the symptoms.
• It is very important to follow the post-operative
  recovery guidelines. You will be recommended to
  use a splint. This helps you to restrict hand
  movement and promote healing. Gentle hand
  exercises may also be recommended.
• If your condition is long term (chronic) then the
  symptoms may take a longer time to disappear.
• Prevention
• Carpal tunnel syndrome is caused by multiple
  factors, you can try to prevent carpal tunnel
  syndrome by making lifestyle changes that help
  decrease some of your risk factors
• Try to maintain your levels of diabetes, high
  blood pressure, and arthritis that may lessen
  your risk of developing carpal tunnel syndrome.
• Paying cautious attention to hand posture and
  avoiding activities that overstretch your wrist
  are also significant approaches for reducing
  symptoms.
• Physical therapy exercises may be co-operative as
  well.
• Position your wrist straight while sleeping.

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• Avoid curling your wrists repeatedly.
• Take frequent breaks while working.
• Perform exercises and warm-ups before and after
  activities.