Carpal Tunnel Syndrome
Carpal Tunnel Syndrome is an extremely common disorder affecting the hand, present in approximately 1 in 100 people. It is a condition characterized by numbness and tingling in the fingers. Pain can extend to the elbow, shoulder or neck and can occur any time, either in the day or night. People oftentimes complain of awakening from their sleep and oftentimes shake their hands to try to restore sensibility. Symptoms often occur during the day when one talks on the telephone, holds a book or newspaper. Many people awaken in the morning with their hands numb and tingling and it will take some time before the symptoms diminish.
What Is Carpal Tunnel Syndrome?
To understand carpal tunnel syndrome, one needs to learn about the basic structures occurring at the wrist and hand level. The basic supporting structures are the bones of the wrist, which include the forearm bones, the wrist bones, medically known as the carpal bones, and the bones of the hand. The flexor tendons are the structures that extend from the muscles to the fingers like the strings of a marionette. They allow us to perform the multiple activities during the day. There are three main nerves to the hand to control the muscles and tendons known as motor nerves and it gives us the ability to feel, which the sensory nerves are. The nerve involved with carpal tunnel is known as the median nerve which generally gives sensation of the thumb, index, long and ring fingers. There is also a small branch of the nerve that goes the muscles base of the thumb.
The median nerve involved with carpal tunnel syndrome runs with the tendons in the area appropriately called the carpal tunnel. The bones of the wrist cover this tunnel on three sides and on the palm side, there is a thick ligament called the transverse carpal ligament that forms the roof of the tunnel. It is within this tunnel that pressure builds up that can cause the classic symptoms of numbness and tingling.
Causes of Carpal Tunnel Syndrome
Idiopathic: Many cases of carpal tunnel have no known cause and are thought to be anatomic abnormalities that make an individual at risk.
Overuse: There is some information to suggest that overuse of the fingers or wrist or certain positions, for extended periods of time, can contribute to pressure on the nerve.
Injuries: An injury to the wrist involving bleeding, such as with a fracture, can cause increased pressure within the tunnel leading to symptoms either early or late in the course after a fracture or dislocation.
Medical Conditions: Pregnancy, diabetes and thyroid problems are all known causes of carpal tunnel syndrome.
Understanding Carpal Tunnel Syndrome
In many cases the long-term consequences of numbness and tingling can be prevented through simple modifications. Altering the way one does certain activities, whether be at work, home or at recreation, can significantly improve and sometimes eliminate the symptoms of numbness and tingling.
Oftentimes wearing a proper splint, time or over the counter medications can significantly help.
Prescription medication known as anti-inflammatories can oftentimes help relieve the swelling. An injection of Cortisone can be helpful either temporarily or permanently to improve and eliminate the symptoms associated with this condition. Sometimes, physical therapy can be helpful.
Scientific studies have not today shown any predictable benefit from vitamins, though there have been anecdotal reports that vitamin B6 is helpful, though studies are not conclusive.
How to Diagnose Carpal Tunnel Syndrome
An early, thorough approach is very beneficial to diagnose, treat and prevent ongoing symptoms of carpal tunnel syndrome; one is history. It is very important to obtain a thorough history of other medical conditions, injuries and the characteristics of the condition. It is helpful to write down certain information that you can pass on to the doctor at the time of the examination.
A thorough examination of the area is very helpful to either rule in or rule out the diagnosis. Most patients do not have textbook-like symptoms and it is important for you and me to look at the characteristics and the physical examination findings.
Three commonly used maneuvers are a Tinel’s test, tap over the nerve, the second is the Phalen’s maneuver, which is performed by flexing the wrist and seeing if this causes characteristic numbness, and the third is termed a forearm compression test where wrist pressure is placed over the nerve to determine the distribution of tingling.