Carpal tunnel syndrome

Introduction
Carpal tunnel syndrome (CTS) is a relatively common condition thatcauses pain, numbness, and a burning, or tingling, sensation in your hand and fingers. Symptoms of CTS can range from mild to severe.

1) The carpal tunnel : – The carpal tunnel is a small tunnel that runs fromthe bottom of your wrist to your lower palm. Several tendons passthrough the carpal tunnel, which help to move your fingers. The mediannerve also passes through the tunnel and this controls sensation andmovement of your hand. The nerve and tendons are protected by a ridgeof bone and ligaments. In cases of CTS, the space inside the tunnelshrinks, placing pressure on the median nerve. Compression of the nerveresults in symptoms of pain and numbness.

2) How common is CTS: CTS is one of the most common conditions affecting the nerves of thehand. It is estimated that almost 5% of women and 3% of men have CTS.Most cases of CTS develop in people who are between 45-64 years of age.CTS is also common in pregnant women. This may be due to the fluidretention that often occurs during pregnancy placing additional pressureon the carpal tunnel.

3) Prognosis: – The likely prognosis of CTS seems to depend on theseverity of symptoms. People with mild to moderate symptoms usually respond well to non-surgical treatment,such as wrist splints and corticosteroids injections. However, more severe cases usually require surgery toreduce the pressure on the median nerve. Cases of CTS that occur during pregnancy usually resolve after thebirth. Left untreated, CTS may lead to permanent nerve damage.

4) Symptoms: The main symptoms of carpal tunnel syndrome (CTS) are tingling, numbness, or pain in the median nervewhich affects: The thumb, index finger, the middle finger, and half of the ring finger. The symptoms of CTS areoften worse at night and they may cause you to wake up.

5) Dexterity problems: – If you have CTS, you may find that your hand becomes weak and clumsy and that youfind it difficult to grip objects with your thumb. Similarly, you may have problems using the affected fingers tocarry out tasks that require high levels of manual dexterity, such as typing. Keeping your hand, or wrist, in oneposition, or carrying out repetitive tasks, can make the symptoms of CTS worse. However, moving your hand,or shaking your wrist, can often help to relieve the symptoms. In rare cases, you may also experience dry skin,swelling, or changes to the color of your skin in the affected hand.

6) Causes: The symptoms of carpal tunnel syndrome (CTS) are caused by compression of the median nerve. The mediannerve has two main functions:-it relays physical sensations, such as your sense of touch, from your hand to your brain, and it relays nervesignals from your brain to your hand, allowing you to move your hand and fingers. The compression of themedian nerve can disrupt these nerve signals, which means that both your sense of touch and your ability tomove your hand can be affected. Compression of the median nerve can occur when the tendons that runthrough the carpal tunnel become inflamed and swollen.

7) Risk factors for carpal tunnel syndrome: The exact reason why changes to the structure of the carpal tunnel occur in some people is unknown, but anumber of risk factors for CTS have been identified. These are outlined below:
Family history : -CTS seems to run in families. About 25% of people with the condition have a close relativewho also has CTS. Exactly how and why the condition is spread through families is not fully understood.
Health conditions : -Certain health conditions appear to increase the risk of a person developing CTS.These include: rheumatoid arthritis, diabetes, gout, lupus (a condition where the immune system attackshealthy tissue), under-active thyroid gland (hypothyroidism), obesity; particularly in young people, damage, or fracture, to the wrist, pregnancy, oedema (excess fluid in the body’s tissue), heart failure, and Lyme disease (abacterial infection that is caused by ticks).
Less commonly, CTS occurs when a person has an abnormal wrist structure, such as an unusually narrowcarpal tunnel, or as a result of cysts, growths, or swellings of the tendons, or blood vessels, that pass throughthe carpal tunnel.

8) Diagnosis: Carpal tunnel syndrome (CTS) can usually be diagnosed by your Neurologist who will examine your hand andwrist, and ask you about your symptoms
Physical tests : –
A common test that is used to help diagnose CTS involves tapping your wrist lightly to see if it produces a tingling feeling, or numbness, in your affected hand. Another test involves you flexing your wristfor 60 seconds to see if this produces pain, numbness, or tingling in your affected hand. A positive result for both tests would usually indicate that your median nerve is being compressed.
Nerve conduction study & Electromyography: –
A nerve conduction study is a test used to study howsignals are transmitted through your nerves. A slowing of the signals can suggest nerve compression, or damage. Small current is passed through the nerve by a computerised system and resultant waves arestudied. Electromyography uses needle electrodes to measure the electrical activity of your muscles. This testcan be used to see if any muscle damage has occurred.

9) Treatment: If it is thought that your CTS is due to an underlying health condition, such as rheumatoid arthritis, treating thathealth condition should also help to improve the symptoms of CTS.

Wrist splints : -Wearing a wrist splint at night should help to reduce thecompression on your median nerve, and help to improve your symptoms. However,it may take up to eight weeks for you to fully notice the benefits.Wrist splints are usually available from the larger pharmacies, or your Neurologistmay be able to recommend a suitable supplier. If you have CTS, you should try tominimize any activities that make your symptoms worse.

Corticosteroids : -If your symptoms of CTS do not improve after three months, or they get worse, you may require additional treatment with corticosteroids. It may be given locally in the carpaltunnel with injection or orally in tablet forms.
10) Surgery : –
Surgery is usually only recommended for severe cases of CTS, or if all other treatment optionshave failed. During surgery, the surgeon will cut some of the ligament that surrounds the carpal tunnel in order to reduce the pressure on the nerve.

11) Prevention: Carpal tunnel syndrome (CTS) can be difficult to prevent because it often occurs following a wrist injury, or abone condition, such as rheumatoid arthritis.If you have rheumatoid arthritis, receiving treatment for the condition will help. A specialist rheumatologist mayprescribe an anti-rheumatic medicine to slow down the disease and prevent joint damage.Even though there has not been any clinical evidence to suggest that working with computers causes CTS, itis important to adopt good working practices.For example, when using a computer for prolonged periods, you should ensure that your workstation is set upcorrectly and that you maintain a good posture. You should also take regular screen breaks.If you are overweight, adjusting your diet and losing a reasonable amount of weight will help to alleviate thesymptoms of CTS, and prevent the condition from occurring in future.

Note:
Compiled in year 2008.This article is for information only and should not be used for the diagnosisor treatment of medical conditions. We have used all reasonable care in compiling the information butmake no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis andtreatment of medical conditions.
Compiled by:-
Dr. Arun K. Dhanuka
MBBS, MD, DM (Neurology)1799/1, Maharaj Nagar, Near PAU Gate No. 3,Ludhiana (Punjab).Ph: 0161-4662345, 98550-30365, 98147-20265.