Carpal Tunnel Syndrome


What causes carpal tunnel syndrome?

Certain medical conditions such as wrist injury and excessive repetitive movements of the arms, wrists or hands can cause carpal tunnel syndrome. Pregnancy can also cause carpal tunnel syndrome.

The carpal tunnel is the passageway in the hand made up of the arching carpal bones (eight bones in the wrist) and the ligament connecting the pillars of the arch. The median nerve and the tendons that connect the fingers to the muscles of the forearm pass through the tightly spaced tunnel. Carpal tunnel syndrome occurs when the median nerve, which relays sensation from the palm of the hand and fingers, becomes pinched, usually by swelling of the tendons or fluid collection. This leads to numbness and sometimes pain of the fingers and hand, and sometimes the forearm.

What are the symptoms of carpal tunnel syndrome?

Usually, people with carpal tunnel syndrome initially notice that their fingers "fall asleep" and become numb at night. They often wake up with numbness and tingling in their hands. A person may notice weakness of thumb movements and wasting away of thumb muscles. Burning pain is frequently associated with the feeling of numbness, and it generally runs up the centre of the person's forearm, sometimes as far as the shoulder. As carpal tunnel syndrome becomes more severe, symptoms are noticed during the day.

What happens in severe cases of carpal tunnel syndrome?

When chronic irritation occurs around the median nerve, it becomes compressed and is continually pushed against the ligament above it. When the median nerve in the hand is continually compressed, it can reach a point where it begins to deteriorate. This results in a slowed transmission of nerve impulses, which may cause a loss of feeling in the fingers and a loss of muscle function at the base of the thumb. If the condition is not treated, it could result in a deterioration of muscle tissue.

Do certain medical conditions make people more likely to develop carpal tunnel syndrome?

People with diabetes or metabolic conditions may be more likely to develop carpal tunnel syndrome. These conditions affect the nerves directly, making them more vulnerable to compression. Carpal tunnel syndrome is also common in pregnancy due to fluid build-up.

What tests can help diagnose carpal tunnel syndrome?

Often, an electromyogram, which includes nerve conduction studies, is done to document the extent of nerve damage in carpal tunnel syndrome. An electromyogram is a test that measures the electrical activity in your nerves and muscles. Nerve conduction studies measure the ability of specific nerves to transmit electrical impulses or messages.

The nerve conduction studies, however, may not become positive until there is significant nerve damage (degeneration). In addition, the severity of a person's symptoms is often not correlated with the findings of a nerve conduction study.

Therapy

Different types of physical therapy, or mobilisation, can be used to treat people with spinal alignment problems. With acute musculoskeletal pain, these techniques have been shown to speed recovery.

In patients with musculoskeletal disorders such as fibromyalgia, medication to increase the body's level of serotonin and noradrenaline (neurotransmitters that modulate sleep, pain and immune system function) are prescribed in low doses.

  • Physical Therapy. A physical therapist can address pain, walking, mobility, bracing and equipment needs that help you stay independent. Practicing low-impact exercises may help maintain your cardiovascular fitness, muscle strength and range of motion for as long as possible.

    A physical therapist can also help you adjust to a brace, walker or wheelchair and may suggest devices such as ramps that make it easier for you to get around.

    Regular exercise can also help improve your sense of well-being. Appropriate stretching can help prevent pain and help your muscles function at their best.

  • Occupational Therapy. An occupational therapist can help you find ways to remain independent. Adaptive equipment can help you perform daily activities such as dressing, grooming, eating and bathing.

    An occupational therapist can also help you modify your home to allow accessibility if you have trouble walking safely.

    Occupational therapists also have a good understanding of how assistive technology and computers can be used, even if your hands are weak.

An occupational therapist can also help you modify your home to allow accessibility if you have trouble walking safely.


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