Carpal tunnel syndrome

                                                               
                                                                    Carpal Tunnel Syndrome

Carpal tunnel syndrome can cause pain and other symptoms in the hand. It is caused by pressure on a nerve in the wrist. Treatment is usually effective. It is numbness, tingling, weakness, and other problems in your hand because of pressure on the median nerve in the wrist.

What is the carpal tunnel?

There are eight small bones called carpal bones in the wrist. A ligament (also called retinaculum) lies across the front of the wrist. Between this ligament and the carpal bones is a space called the carpal tunnel . The tendons that attach the forearm muscles to the fingers pass through the carpal tunnel. A main nerve to the hand (median nerve) also goes through this tunnel before dividing into smaller branches in the palm. The median nerve gives feeling to the thumb, index and middle fingers, and half of the ring finger. It also controls the movement of the small muscles at the base of the thumb.

What is carpal tunnel syndrome?

This syndrome is a set of symptoms thought to be caused by squashing (compression) of the median nerve in the carpal tunnel. In terms of age, carpal tunnel syndrome is more common in:

·         People in their late 50s, particularly women.

·         People in their late 70s, when men and women are equally affected.

Carpal tunnel syndrome is more common in people who are obese and it often runs in families. It is more common in women who are pregnant.

What are the symptoms of carpal tunnel syndrome?

·         Pins and needles. This is tingling or burning in part or all of the shaded area shown above. This is typically the first symptom to develop. The index and middle fingers are usually first to be affected.

·         Pain in the same fingers may then develop. The pain may travel up the forearm and even to the shoulder.

·         Numbness of the same finger(s), or in part of the palm, may develop if the condition becomes worse.

·         Dryness of the skin may develop in the same fingers.

·         Weakness of some muscles in the fingers and/or thumb occurs in severe cases. This may cause poor grip and eventually lead to muscle wasting at the base of the thumb.

Symptoms can vary from person to person from mild to severe. One or both hands may be affected. Symptoms tend to come and go at first, often after you use the hand. Typically, symptoms are worse at night and may wake you up.

The symptoms may be eased for a while by raising the hand up or hanging it down. Flicking the wrist may also give relief. Symptoms persist all the time if the condition becomes severe.

What causes carpal tunnel syndrome?

·         In most cases it is not clear why it occurs. It is thought that some minor changes occur in the tendons and/or other structures going through the carpal tunnel. This may cause an increase in pressure within the tunnel. The increase in pressure is thought to squash (compress) and restrict the blood supply to the median nerve. As a result, the function of the median nerve is affected causing the symptoms.

·         Your genes may play a part. There seems to be some inherited (genetic) factor. About 1 in 4 people with carpal tunnel syndrome have a close family member (father, mother, brother, sister) who also has or had the condition.

·         Bone or arthritic conditions of the wrist such as rheumatoid arthritis or wrist fractures may lead to carpal tunnel syndrome.

·         Various other conditions are associated with carpal tunnel syndrome. For example: pregnancy, obesity, an underactive thyroid, diabetes, the menopause, other rare diseases, and a side-effect of some medicines. Some of these conditions cause water retention (oedema) which may affect the wrist and cause carpal tunnel syndrome.

·         Rare causes include cysts, growths, and swellings coming from the tendons or blood vessels passing through the carpal tunnel.

Tests

Often the symptoms are so typical that no tests are needed to confirm the diagnosis.

If the diagnosis is not clear then a test to measure the speed of the nerve impulse through the carpal tunnel may be advised (nerve conduction test). A slow speed of impulse down the median nerve will usually confirm the diagnosis. Some people may also be referred for an ultrasound scan or a MRI scan to look at their wrist in more detail.

Treatment options for carpal tunnel syndrome

·         General measures

·         A wrist splint

·         A steroid injection

·         Surgery