Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a compression neuropathy of median nerve. It is constriction of median nerve as it passes beneath the flexor retinaculum.

Carpus is a word derived from the Greek word "karpos" which means "wrist.

CTS, or median neuropathy at the wrist is a nerve disorder in the wrist that causes pain, hand weakness, loss of feeling often in the thumb and the first three fingers. It involves compression, stretching, irritation, of median nerve at the wrist joint

Any tension in this canal can compress the median nerve. It is more common in women than in men and occurs typically later in life (40-60 yrs).Sometimes it is seen in young individuals secondary to trauma.

The numbness usually occurs at night because we tend to sleep with our wrists flexed and is relieved by wearing a wrist splint that prevents flexion.

Long-standing CTS leads to permanent nerve damage with constant numbness, atrophy of some of the muscles of the thenar eminence, and weakness of palmar abduction

Palliative treatments for CTS include use of night splints and corticosteroid injection. The only scientifically established disease modifying treatment is surgery to cut the transverse carpal ligament

Compression of the median nerve as it runs deep to the transverse carpal ligament (TCL) causes atrophy of the thenar eminence, weakness of the flexor pollicis brevis, opponens pollicis, abductor pollicis brevis, as well as sensory loss in the distribution of the median nerve distal to the transverse carpal ligament

Symptoms For Carpal Tunnel Syndrome

·         Numbness or tingling in the thumb and next two or three fingers of one or both hands

·         Numbness or tingling of the palm of the hand

·         Pain extending to the elbow

·         Pain in wrist or hand in one or both hands

·         Problems with fine finger movements (coordination) in one or both hands

·         Wasting away of the muscle under the thumb (in advanced or long-term cases)

·         Weak grip or difficulty carrying bags (a common complaint)

·         Weakness in one or both hands

Cause Of Carpal Tunnel Syndrome
The median nerve provides feeling and movement to the "thumb side" of the hand (the palm, thumb, index finger, middle finger, and thumb side of the ring finger).

The area in your wrist where the nerve enters the hand is called the carpal tunnel. This tunnel is normally narrow, so any swelling can pinch the nerve and cause pain, numbness, tingling or weakness. This is called carpal tunnel syndrome.

Carpal tunnel syndrome is common in people who perform repetitive motions of the hand and wrist. Typing on a computer keyboard is probably the most common cause of carpal tunnel. Other causes include:

·         Sewing

·         Driving

·         Assembly line work

·         Painting

·         Writing

·         Use of tools (especially hand tools or tools that vibrate)

·         Sports such as racquetball or handball

·         Playing some musical instruments

A number of medical problems are associated with carpal tunnel syndrome, including:

·         Bone fractures and arthritis of the wrist

·         Acromegaly

·         Diabetes

·         Alcoholism

·         With pregnancy and hypothyroidism, fluid is retained in tissues, which swells the tenosynovium.

·         During pregnancy women experience CTS due to hormonal changes and water retention which is common during pregnancy.

·         Previous injuries including fractures of the wrist. Kidney failure and dialysis

·         Menopause, premenstrual syndrome (PMS)

·         Infections

·         Obesity

·         Rheumatoid arthritis, systemic lupus erythematosus (SLE), and scleroderma

Investigation Of Carpal Tunnel Syndrome

Physical Examination:
Phalen's Test ” Bending the wrist forward all the way for 60 seconds will usually result in numbness, tingling, or       weakness.

“ Tinel's sign ” Tapping over the median nerve at the wrist may cause pain to shoot from the wrist to the hand.

“ Carpal Compression Test ”  The examiner holds the supinated wrist in both the hands and applies a direct even pressure over the median nerve in the carpal tunnel for upto 30 seconds.Production of patient's symptoms is considered a positive test.

 Tests may include:

·         Electromyography

·         Nerve conduction velocity

·         Wrist x-rays should be done to rule out other problems (such as wrist arthritis)

                  Treatment For Carpal Tunnel Syndrome
  • A splint to prevent hyperflexion or hyperextension of the wrist, mainly at night
  • Ultrasound therapy.
  • TENS for pain relief.
  • Massage  - Massaging is produced in a particular pattern to attenuate the tendons, as well as to drain fluid from the inflammed carpal tunnel. This combined effect reduces the pressure inside the carpal tunnel and therefore reduces pain caused by median nerve compression.
  • stretching and strengthening exercises can be used to help prevent a reoccurrence of symptoms.
  • If symptoms do not improve following rest and anti-inflammatories, other options include Corticosteroids or lidocaine injections.
  • If all of this treatment fails and symptoms persist over a 6 month period, surgery may be required.
Stretching Exercises:
Stretching the muscles surrounding the wrist can help to ensure the tendons which pass through the carpal tunnel are in good condition. Tendon injuries can sometimes cause carpal tunnel syndrome.
Prevention strategies for carpal tunnel syndrome
  • Keep hand in neutral position.
  • Avoid activities that require Repetitive hand and wrist functions such as hammering.
  • Avoid prolonged grasping,such as holding newspaper,steering wheel,pen,shopping bag etc.
  • Avoid pinching activities like needle work and writing.

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