Carpal Tunnel Syndrome
Occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist.
The median nerve controls sensations to the palm side of the thumb and fingers (although not the little finger), as well as impulses to some small muscles in the hand that allow the fingers and thumb to move.
* Nora's condition!! *
The carpal tunnel - a narrow, rigid passageway of ligament and bones at the base of the hand - houses the median nerve and tendons.
The result may be pain, weakness, or numbness in the hand and wrist, radiating up the arm.
( Nora has weakness and numbness in her hand! )
Symptoms
- Start gradually, with frequent burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers.
- Fingers feel useless and swollen, even though little or no swelling is apparent.
- The symptoms often first appear in one or both hands during the night, since many people sleep with flexed wrists. A person with carpal tunnel syndrome may wake up feeling the need to "shake out" the hand or wrist. ( Relate this to Nora's complaint! )
- As symptoms worsen, people might feel tingling during the day.
- Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In chronic and/or untreated cases, the muscles at the base of the thumb may waste away.
Causes
- Increase in the pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself.
- Congenital predisposition - the carpal tunnel is simply smaller in some people than in others.
- Trauma
- Injury to the wrist that cause swelling, such as sprain or fracture
- Over activity of the pituitary gland; hypothyroidism
- rheumatoid arthritis
- mechanical problems in the wrist joint
- work stress
repeated use of vibrating hand tools - fluid retention during pregnancy or menopause
- Development of a cyst or tumor in the canal.
Risk Factors
Women are three times more likely than men to develop carpal tunnel syndrome, perhaps because the carpal tunnel itself may be smaller in women than in men.
The dominant hand is usually affected first and produces the most severe pain.
Diabetics or other metabolic disorder patients make them more susceptible to compression
Common in those performing assembly line work - manufacturing, sewing, finishing, cleaning, and meat, poultry, or fish packing.
Diagnosis
A physical examination of the hands, arms, shoulders, and neck can help determine if the patient's complaints are related to daily activities or to an underlying disorder, and can rule out other painful conditions that mimic carpal tunnel syndrome.
The wrist is examined for tenderness, swelling, warmth, and discoloration.
Each finger should be tested for sensation, and the muscles at the base of the hand should be examined for strength and signs of atrophy.
Routine laboratory tests and X-rays can reveal diabetes, arthritis, and fractures.
Tinel test : the doctor taps on or presses on the median nerve in the patient's wrist. The test is positive when tingling in the fingers or a resultant shock-like sensation occurs.
Phalen, or wrist-flexion test : involves having the patient hold his or her forearms upright by pointing the fingers down and pressing the backs of the hands together.
Electrodiagnostic tests : electrodes are placed on the hand and wrist. Small electric shocks are applied and the speed with which nerves transmit impulses is measured. In electromyography, a fine needle is inserted into a muscle; electrical activity viewed on a screen can determine the severity of damage to the median nerve.
Ultrasound imaging : show impaired movement of the median nerve.
Magnetic resonance imaging (MRI) : show the anatomy of the wrist but to date has not been especially useful in diagnosing carpal tunnel syndrome.
Treatment
Initial treatment : involves resting the affected hand and wrist for at least 2 weeks avoiding activities that may worsen symptoms, and immobilizing the wrist in a splint to avoid further damage from twisting or bending. If there is inflammation, applying cool packs can help reduce swelling.
Non-surgical treatments
Drugs
Nonsteroidal anti-inflammatory drugs : aspirin, ibuprofen, and other nonprescription pain relievers, may ease symptoms that have been present for a short time or have been caused by strenuous activity.
Orally administered diuretics : decrease swelling.
Corticosteroids : prednisone or the drug lidocaine - can be injected directly into the wrist or taken by mouth (in the case of prednisone) to relieve pressure on the median nerve and provide immediate, temporary relief to persons with mild or intermittent symptoms
Exercise - Stretching and strengthening exercises.
Alternative therapies - Acupuncture and chiropractic care have benefited some patients but their effectiveness remains unproved. An exception is yoga, which has been shown to reduce pain and improve grip strength among patients with carpal tunnel syndrome.
Surgery
Carpal tunnel release
Generally recommended if symptoms last for 6 months
Surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve.
Done under local anesthesia and does not require an overnight hospital stay.
Open release surgery
Used to correct carpal tunnel syndrome
Making an incision up to 2 inches in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel.
Done under local anesthesia on an outpatient basis
Endoscopic surgery
Allow faster functional recovery and less postoperative discomfort than traditional open release surgery.
The surgeon makes two incisions (about ½" each) in the wrist and palm, inserts a camera attached to a tube, observes the tissue on a screen, and cuts the carpal ligament (the tissue that holds joints together).
Under local anesthesia
Effective and minimizes scarring and scar tenderness, if any.
*Recurrence of carpal tunnel syndrome following treatment is rare. *
Prevention
Perform stretching exercises, take frequent rest breaks, wear splints to keep wrists straight, and use correct posture and wrist position.
Wearing fingerless gloves can help keep hands warm and flexible.
Workstations, tools and tool handles, and tasks can be redesigned to enable the worker's wrist to maintain a natural position during work.
Jobs can be rotated among workers ( remember our rural week?! :D ) .
Reference :
http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm
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