Carpal Tunnel Syndrome-Pressure Set At Large

Carpal tunnel syndrome is a group of symptoms all caused by the pressure effects on the nerves of the forearm. This has a counterpart in the lower limb, at the ankle, called the tarsal tunnel syndrome. But the hand one is the most common and median nerve is the most common nerve involved.

Mechanism of action

At the front of the wrist is a tight cave of bones, called the carpal tunnel, formed by the small bones of the hand (carpals) at the back and a tight band of fibrous tissue called the flexor retinaculum. The entire nerves and blood vessels of the palms have to pass through this cave to enter and this is the root cause of all the problems.

CTS presents as a tingling and loss of feeling in the hand. It can also inhibit the ability to pinch the thumb to the fingers. Under such conditions the circulation of blood gets hampered and as a result the nerves get starved for nutrition and goes numb. When the pressure is relieved, the feeling comes back and pain dissipates. This disabling syndrome occurs more often in women than men, by a ratio of 3 to 1, usually between the ages of 30 and 50 years.

CTS and Diabetes

It is a know fact that diabetes predisposes a patient to thyroid problems. Women specially face a lot of complications as a result of thyroidism because of the reduction in the estrogen and progesterone. This causes a weakening of bones. The condition has also been found to be common in people who are obese. Obesity is more or less considered to be one of the risk factors for diabetes. As a result the tunnel may get narrowed down due to fat accumulation and this exerts pressure on the median nerve. Prolonged pressure could result in the development of the syndrome.

Symptoms

The first symptoms usually appear at night. Symptoms range from

1. Burning
2. Tingling numbness in the fingers, especially the thumb and the index and middle fingers.
3. Difficulty gripping or making a fist.
4. Pain consisting of a "pins and needles" feeling at night.
5. Feeling of incoordination
6. Inability to hold things for a long time
7. Dropping things.

Causes

Anything that can exert pressure on the nerves in the tunnel can trigger off the conditions but some of the reasons that make people susceptible to CTS are:

1. Work-related cumulative trauma of the wrist.
2. Diabetes
3. Pregnancy
4. Obesity.
5. Different types of arthritis can cause inflammation of the tenosynovium directly.
6. A fracture of the wrist bones may result in abnormal irritation on the flexor tendons.
7. Repetitive use of the hands can result in carpal tunnel syndrome.
8. Smaller Carpal Tunnel since birth
9. Misusing your hands, wrist and forearms or overuse.
10. People who tend to do forceful repetitive types of work, such as grocery store checkers, assembly line workers, meat packers, typist, accountants, writers, etc.
11. Acromegaly
12. Rheumatoid arthritis
13. Gout
14. Tuberculosis
15. Renal failure and hemodialysis
16. Hypothyroidism
17. Amyloidosis

Diagnosis

• Evaluation begins with the doctor giving a thorough physical examination.
• Cross-examination of symptoms by the patient and the doctor is made.
• Major physical findings indicate that pressure is increased in the carpal tunnel.
• To make a thorough diagnosis several tests are ordered. The diagnosis of CTS is made from the ED presumptively.
• Magnetic resonance imaging (MRI) is reasonably accurate in diagnosing CTS.
• Ultrasonography shows promise but is still experimental.
• Electromyographic (EMG) and nerve conduction studies (NCV). This test measures how fast nerve impulses are conducted through the nerve.

Complications

Complications of CTS include:

• Chronic hand pain
• Chronic hand weakness and numbness
• Chronic disability

Treatment

In the early stages of carpal tunnel syndrome, a simple non-operative treatment like fitting a brace will sometimes decrease the symptoms, especially the numbness and pain occurring at night. Anti-inflammatory drugs can also help control the swelling of the tenosynovium and reduce the symptoms. These medications are easily available and include the common over the counter medications such as ibuprofen and aspirin. Exercise has also been considered to be a major factor in controlling CTS. Regular exercise ensure proper blood supply to the nerves. In severe cases, where there is excessive pressure on the nerves surgical treatment may be required.

Prevention

A few suggestions given below could help prevent the condition:

• When doing your work, it is very important to keep the wrist position as close to neutral as possible. Because the carpal tunnel gets maximum space in the neutral position.
• Do not flex or extend the wrist for longer periods as this exerts pressure on the nerves.
• It is important that you understand that even if you are just sitting at a computer all day, you are an athlete from the elbow down.
• You must warm up the muscles before exercising them or they will become inflamed and you will decrease the amount of space in the tunnel.
• Take proper nutrition.
• If you are diabetic manage it properly and maintain proper control so as to avoid complications like thyroidism.

CTS as such is not dangerous, the biggest hurdle that it brings along with is that it limits the movements of your hands and make working difficult. A better way out would be by following the suggestions that have been given above and taking proper care of your hands and wrists. Also be sure not to put them to excess of strain.