The carpal tunnel is a narrow passageway which is surrounded by bones, ligaments and tendons — about as big around as your thumb — located on the palm side of your wrist. This tunnel protects a main nerve ( called the median nerve )to your hand and nine tendons that bend your fingers.
When the median nerve is compressed at the wrist, it leads to pain, paresthesias ( numbness ), and muscle weakness in the forearm and hand. A form of compressive neuropathy ( nerve damage ), Carpal Tunnel Syndrome ( CTS ) is more common in women than it is in men. It has a peak incidence on the 40's, though it can occur at any age. The lifetime risk for CTS is around 10% of the adult population.
There is evidence of people experiencing signs and symptoms of carpal tunnel syndrome occurs in medical records dating back to the beginning of the 20th century, but the first time the term “carpal tunnel syndrome” was used was in 1938. The pathology was identified by physician Dr. George S. Phalen of the Cleveland Clinic after working with a group of patients in the 1950s and 1960s. CTS became widely known among the general public in the 1990s because of the rapid expansion of office jobs
Signs and Symptoms
CTS has gradually increasing symptoms over time. The first symptoms of CTS may appear when sleeping and typically include numbness ( "falling asleep" ) and paresthesia (a burning and tingling sensation) in the fingers, especially the thumb, index, and middle fingers.
These symptoms appear at night due to wrist bending, which further compresses the carpal tunnel. When CTS advances, it is not uncommon to see difficulty gripping and making a fist, dropping objects, and weakness.
Numbness or paresthesias need to be predominant symptoms of the problem, otherwise it is unlikely that carpal tunnel syndrome is responsible for them. In effect, pain of any type, location, or severity with the absence of significant numbness or paresthesia is not likely to fall under this diagnosis.
When you go and see a doctor he might perform Tinel's test for carpal tunnel: He might tap the wrist area. If you feel a tingling that shoots down into your right hand and fingers, you could have carpal tunnel syndrome. Phalen test is performed by flexing the wrist gently as far as possible, then holding this position and awaiting symptoms. A positive test is one that results in numbness in the median nerve distribution when holding the wrist in acute flexion position within 60 seconds. The quicker the numbness starts, the more advanced the condition.
Causes
As the median nerve is a mixed nerve it has a sensory function and also provides nerve signals to move your muscles -motor function-. The median nerve provides sensation to your thumb, index finger, middle finger and the middle-finger side of the ring finger.
Pressure on the nerve can stem from anything that reduces the space for it in the carpal tunnel. Causes might include:
1. Miscelaneous health conditions: Some examples include rheumatoid arthritis, certain hormonal disorders — such as diabetes, thyroid disorders,menopause, fluid retention due to pregnancy, etc.
2. Repetitive flexing and extending of the tendons in the hands and wrists, particularly when done forcefully and for prolonged periods without rest, also can increase pressure within the carpal tunnel.
3. Physical characteristics. It may be that your carpal tunnel is more narrow than average. Other less common causes include a generalized nerve problem or pressure on the median nerve at more than one location.
4. Stress related. Studies have also related carpal tunnel and other upper extremity complaints with psychological and social factors. A large amount of psychological distress showed doubled risk of the report of pain, while job demands, poor support from colleagues, and work dissatisfaction also showed an increase in the report of pain, even after short term exposure.
5. Trauma. such as fractures, dislocations and hematomas around the area.
Treatment
A. Regular
SOme common sense would say that patients with CTS can ease their discomfort by taking more frequent breaks to rest their hands and applying cold packs to reduce occasional swelling. Some times these techniques offer relief, but if they don't then your physician should consider these other options:
I. Nonsurgical therapy
-Wrist splinting. Splints and braces are easy to obtain on pharmacies, but can be specifically fitted to you on an orthopedic shop. They involve wearing a splint that holds the patient's wrist still while they sleep. It can help relieve nighttime symptoms of tingling and numbness. Splinting is more likely be effective if symptoms are mild and shorter than 1-2 ears duration.
-Nonsteroidal anti-inflammatory drugs. NSAIDs may help relieve pain from carpal tunnel syndrome if you have an associated inflammatory condition.
-Corticosteroid Injections. They decrease inflammation, thus relieving pressure on the median nerve.
When the median nerve is compressed at the wrist, it leads to pain, paresthesias ( numbness ), and muscle weakness in the forearm and hand. A form of compressive neuropathy ( nerve damage ), Carpal Tunnel Syndrome ( CTS ) is more common in women than it is in men. It has a peak incidence on the 40's, though it can occur at any age. The lifetime risk for CTS is around 10% of the adult population.
There is evidence of people experiencing signs and symptoms of carpal tunnel syndrome occurs in medical records dating back to the beginning of the 20th century, but the first time the term “carpal tunnel syndrome” was used was in 1938. The pathology was identified by physician Dr. George S. Phalen of the Cleveland Clinic after working with a group of patients in the 1950s and 1960s. CTS became widely known among the general public in the 1990s because of the rapid expansion of office jobs
Signs and Symptoms
CTS has gradually increasing symptoms over time. The first symptoms of CTS may appear when sleeping and typically include numbness ( "falling asleep" ) and paresthesia (a burning and tingling sensation) in the fingers, especially the thumb, index, and middle fingers.
These symptoms appear at night due to wrist bending, which further compresses the carpal tunnel. When CTS advances, it is not uncommon to see difficulty gripping and making a fist, dropping objects, and weakness.
Numbness or paresthesias need to be predominant symptoms of the problem, otherwise it is unlikely that carpal tunnel syndrome is responsible for them. In effect, pain of any type, location, or severity with the absence of significant numbness or paresthesia is not likely to fall under this diagnosis.
When you go and see a doctor he might perform Tinel's test for carpal tunnel: He might tap the wrist area. If you feel a tingling that shoots down into your right hand and fingers, you could have carpal tunnel syndrome. Phalen test is performed by flexing the wrist gently as far as possible, then holding this position and awaiting symptoms. A positive test is one that results in numbness in the median nerve distribution when holding the wrist in acute flexion position within 60 seconds. The quicker the numbness starts, the more advanced the condition.
Causes
As the median nerve is a mixed nerve it has a sensory function and also provides nerve signals to move your muscles -motor function-. The median nerve provides sensation to your thumb, index finger, middle finger and the middle-finger side of the ring finger.
Pressure on the nerve can stem from anything that reduces the space for it in the carpal tunnel. Causes might include:
1. Miscelaneous health conditions: Some examples include rheumatoid arthritis, certain hormonal disorders — such as diabetes, thyroid disorders,menopause, fluid retention due to pregnancy, etc.
2. Repetitive flexing and extending of the tendons in the hands and wrists, particularly when done forcefully and for prolonged periods without rest, also can increase pressure within the carpal tunnel.
3. Physical characteristics. It may be that your carpal tunnel is more narrow than average. Other less common causes include a generalized nerve problem or pressure on the median nerve at more than one location.
4. Stress related. Studies have also related carpal tunnel and other upper extremity complaints with psychological and social factors. A large amount of psychological distress showed doubled risk of the report of pain, while job demands, poor support from colleagues, and work dissatisfaction also showed an increase in the report of pain, even after short term exposure.
5. Trauma. such as fractures, dislocations and hematomas around the area.
Treatment
A. Regular
SOme common sense would say that patients with CTS can ease their discomfort by taking more frequent breaks to rest their hands and applying cold packs to reduce occasional swelling. Some times these techniques offer relief, but if they don't then your physician should consider these other options:
I. Nonsurgical therapy
-Wrist splinting. Splints and braces are easy to obtain on pharmacies, but can be specifically fitted to you on an orthopedic shop. They involve wearing a splint that holds the patient's wrist still while they sleep. It can help relieve nighttime symptoms of tingling and numbness. Splinting is more likely be effective if symptoms are mild and shorter than 1-2 ears duration.-Nonsteroidal anti-inflammatory drugs. NSAIDs may help relieve pain from carpal tunnel syndrome if you have an associated inflammatory condition.
-Corticosteroid Injections. They decrease inflammation, thus relieving pressure on the median nerve.
II.SurgicalUseful when the pain or numbness of carpal tunnel syndrome persists or doesn't resolve with non-surgical options.
Surgery usually consists on cutting the ligament pressing on the median nerve. It can be done using endoscopy, a telescope-like device that allows to see inside your carpal tunnel and perform the surgery with minimal incisions in your hand or wrist. The other option is doing an open surgery. It involves making an incision in the palm of your hand over the carpal tunnel and releasing the nerve.
Usually, surgery improves symptoms considerably, but patients may be left with residual numbness, pain, stiffness or weakness. About 70 percent are completely or very satisfied with the outcome of their surgery. After the surgery the patient might need to have limited use of your hand and wrist. It may take, however, from several weeks to as long as a few months before having unrestricted use of hand and wrist.
If carpal tunnel syndrome results from an inflammatory arthritis, such as rheumatoid arthritis, then treating the underlying condition is a must on the treatment and will potentially reduce the symptoms of CTS.
B. Alternative Medicine
The key component for alternative medicine is the Vitamin B6 100mg 3 times a day ( not recommended for more than 3 months at a time ). The diet needs to be whole, and adding beans, legumes, brewer's yeast, soy, wheat germ, etc can help ensuring that your food dose of Vitamin B6 is reached. You can accompany B6 with B2 and B12 too.
Eliminate: Sodium ( salt ) from your diet, tobacco ( decreases circulation )and saturated fats.
Begin an exercise program through physical therapy. It needs to include: hand shaking ( 20 seconds ), rotate wrists both clockwise and counterclockwise to their range of motion.
Other supplements include: Bromelain ( 500mg 3 times a day ), Boswellia 1500mg 3 times a day, Calcium/Magnesium on a 2:1 ration 2 times a day.
Homeopathy wise, you can use Arnica Montana 30C 4 pillules 3-4 times a day, Hypericum 30C 4 pillules 3-4 times a day and/or Rhus Toxicodendron 30C 4 pillules 3-4 times a day.
Finally, don't forget about acupuncture and acupressure that can be as effective as a steroid shot for carpal tunnel. 2 points that are commonly used are P6 and P7, located close to the wrist.
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