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  • Jihan El Sokkary

Carpal Tunnel Syndrome: Causes, Symptoms and Treatment


Carpal Tunnel Syndrome is caused by pressure on one of the major nerves to the hand — the median nerve — is squeezed or compressed as it travels through the wrist, which causes pain that radiate up the affected arm. With further progression, hand weakness, decreased fine motor coordination, clumsiness, and thenar atrophy can occur.


Patients can be diagnosed quickly and respond well to treatment but the best means of integrating clinical, functional, and anatomical information for selecting treatment choices have not yet been identified.

Anatomy


The carpal tunnel forms a gateway into the wrist near the crease. It is a narrow canal or tube in the wrist which allows the median nerve and tendons to connect the hand and forearm. The parts of this tunnel include:

  • Carpal bones: These bones make up the bottom and sides of the tunnel. They are formed in a semi-circle.

  • Ligament: The top of the tunnel, the ligament is a strong tissue that holds the tunnel together.

Inside the tunnel are the median nerve and tendons.

  • Median nerve: This nerve provides feeling to most of the fingers in the hand (expect the little finger). It also adds strength to the base of the thumb and index finger.

  • Tendons: Rope-like structures, tendons connect muscles in the forearm to the bones in the hand. They allow the fingers and thumb to bend

Causes

Carpal tunnel syndrome is an inflamed condition within the median nerve that tunnels its way through the openings that surround the carpals of the hand and pass beneath the dense fibrous tissue. Due to the inflammation, these fingers are the ones affected most from the condition. Internal swelling exerts an outward pressure that prohibits full range of motion for the wrist and the affected fingers, which interferes with daily activities. Anything that causes swelling, thickening or irritation of the synovial membranes around the tendons in the carpal tunnel can result in pressure on the median nerve.

Some common causes and associated conditions are:

  • Repetitive and forceful grasping with the hands

  • Repetitive bending of the wrist

  • Pregnancy

  • Use of vibrating/heavy machines, like drills or lawn mowers.

Carpal tunnel syndrome is aggravated by prolonged flexion (bending forward) of the wrist and relieved by extension (backward bending) of the wrist. The primary and most common cause of carpal tunnel syndrome is repetitive over use, but contributing factors can be rheumatoid arthritis, and pregnancy.



Symptoms

Numbness and tingling in the hands, especially when these symptoms occur at night and after use of the hands:

Common daytime symptoms can include:

  • Tingling in the fingers.

  • Numbness in the fingertips and sometimes palms.

  • Difficulty using the hand for small tasks, like:

  • Handling small objects.

- Grasping a steering wheel to drive.

- Holding a mug.

- Writing.

- Using a computer keyboard/ mouse.

As carpal tunnel syndrome worsens, symptoms become more constant. These symptoms can include:

  • Weakness in the hand.

  • Inability to perform tasks that require delicate motions (such as buttoning a shirt).

  • Dropping objects.

In the most severe condition, the muscles at the base of the thumb visibly shrink in size (atrophy).

Quick Test:

Apply Pressure for 1 min

Carpal Compression Test


Phalen's Test



Results: Pain, numbness and tingling in the hands. (+)




Treatment:

  • Physical therapy - can be useful for treating carpal tunnel syndrome. Your therapist will reduce inflammation in the wrist, reducing the compression on the median nerve, and reducing your symptoms. They might also look further up your arm to your shoulder, neck or upper back in case this is having an influence on the area.

  • Ergonomics Proper - Seating is crucial to good ergonomics. The height of your seat and the position of your backrest should be adjustable. If your keyboard is positioned properly your wrists should be able to rest comfortably on the table in front of it. Some keyboards are very thick or deep and they require you to bend your hands uncomfortably upward to reach the keys. If so, it will help to place a raised wrist rest on the table in front of the keyboard. A keyboard that requires you to bend your wrists is a common cause of CTS among computer users.

  • Minimize Certain Activities - Avoiding or changing those activities that can cause all of the symptoms can help to alleviate some of the pain and pressure. Make sure to take a frequent break from any repetitive tasks to minimize the chance of injury the tendons and nerves within the wrist.

  • Bracing or splinting - Wearing a brace or splint will keep you from bending your wrist while you sleep and work. Keeping your wrist in a straight or neutral position reduces pressure on the nerve in the carpal tunnel.

  • Nerve gliding exercises - Some patients may benefit from exercises that help the median nerve move more freely within the confines of the carpal tunnel.

  • Surgical Procedure - The surgical procedure performed for carpal tunnel syndrome is called a "carpal tunnel release." There are two different surgical techniques for doing this, but the goal of both is to relieve pressure on your median nerve by cutting the ligament that forms the roof of the tunnel. This increases the size of the tunnel and decreases pressure on the median nerve.


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References:

Brunnstrom's Clinical Kinesiology by P. Houglum & D. Bertoti 2012

American Academy of Orthopedic Surgeons - CTS



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