Carpal Tunnel Syndrome
Carpal tunnel syndrome is the most common nerve entrapment syndrome. It results from compression of the median nerve in the wrist, where it passes through the carpal tunnel.
The median nerve controls motions in the forearm, wrist, and hand, such as turning the wrist toward the body, flexing the index and middle fingers, and many thumb movements. It also supplies sensation to the index, middle, and ring fingers. Compression of this nerve causes loss of movement and sensation in the wrist, hand, and fingers. Carpal tunnel syndrome usually occurs in women between ages 30 and 60 and may pose a serious occupational health problem. It may also occur in people who move their wrists continuously, such as butchers, computer operators, and concert pianists. Any strenuous use of the handssustained grasping, twisting, or flexing - aggravates the condition.
Doing the same hand movements over and over can lead to carpal tunnel syndrome. It's most common in people whose jobs require pinching or gripping with the wrist held bent. People at risk include people who use computers, carpenters, grocery checkers, assembly-line workers, meat packers, musicians and mechanics. Hobbies such as gardening, needlework, golfing and canoeing can sometimes bring on the symptoms.
Carpal tunnel syndrome is linked to other things too. It may be caused by an injury to the wrist, such as a fracture. Or it may be caused by a disease such as diabetes, rheumatoid arthritis or thyroid disease. Carpal tunnel syndrome is also common during the last few months of pregnancy.
Signs and Symptoms
The primary symptoms of carpal tunnel syndrome are pain and numbness in the thumb, index, and middle fingers that often worsen at night and may radiate to the upper arm. Symptoms usually occur near the palm of the hand. Other symptoms include muscle weakness in the hand and wrist, tingling, and impaired reflexes.
Electromyography detects a median nerve motor conduction delay of more than 5 milliseconds.
Digital electrical stimulation discloses median nerve compression by measuring the length and intensity of stimulation from the fingers to the median nerve in the wrist.
A compression test supports the diagnosis. A blood pressure cuff inflated above systolic pressure on the forearm for 1 to 2 minutes provokes pain and paresthesia along the distribution of the median nerve.
Treatment is initially conservative: splinting the wrist for 1 to 2 weeks, possible occupational changes, and correction of any underlying disorder. Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) taken orally and corticosteroids given by injection are the most commonly prescribed agents. NSAIDs, such as indomethacin, mefenamic acid, phenylbutazone, or piroxicam, typically accompany corticosteroid and splinting therapy. They help control pain and reduce inflammation. Corticosteroid injections reduce inflammation almost immediately but only temporarily. If the doctor suspects a vitamin B6 deficiency, he may prescribe pyridoxine.
When conservative treatment fails, the only alternative is surgical decompression of the nerve by sectioning the entire transverse carpal tunnel ligament. Neurolysis (freeing the nerve fibers) may also be necessary.
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