Carpal Tunnel Syndrome

Carpal Tunnel SyndromeThe carpal tunnel syndrome is compression of the median nerve which passes through the carpal tunnel in the wrist. This is a very common syndrome mostly complained by women aged 30 to 50. The incidence of carpal tunnel syndrome is 1-3 cases per 1000 subjects per year; prevalence is approximately 50 cases per 1000 subjects in the general population. Incidence may rise as high as 150 cases per 1000 subjects per year, with prevalence rates greater than 500 cases per 1000 subjects in certain high-risk groups.

Until the advent of electro physiologic testing in the 1940s, carpal tunnel syndrome (CTS) commonly was thought to be the result of compression of the brachial plexus by cervical ribs and other structures in the anterior neck region. It is now known that the median nerve is damaged within the rigid confines of the carpal tunnel, initially undergoing demyelization followed by axonal degeneration. Sensory fibers often are affected first, followed by motor fibers.

Symptoms include pain of the hand and wrist, with tingling and numbness, classically located on the palm side of the thumb, middle finger and half of the ring finger, where the median nerve gives innervations. But it also possibly involves the entire hand. Typically, the patient wakes at night with burning or aching pain and with numbness and tingling sensation, then the patient would shake the hand the and to obtain relief and restore sensation. In the later progress, the thumb will become weak.

Carpal tunnel syndrome is not fatal, but it can lead to complete, irreversible median nerve damage, with consequent severe loss of hand function, if left untreated.

Note that carpal tunnel syndrome (CTS) is associated with many different factors. In particular, the more the hand and wrist are used, the greater the symptoms. This observation does not necessarily mean that using the hand and wrist causes the syndrome or that more median nerve damage ensues. Association should not be assumed to signify causation.

No good clinical test exists to support the diagnosis of CTS. Diagnosis is based on the doctor’s clinical evaluation, while objective diagnosis can be done with nerve conduction testing.

Treatment

The main reason of nerve compression is due to inflammation inside the carpal tunnel. Inflammation can be cause by overworking the wrist so the first thing to do is resting the wrist. Your doctor might give you a splint and anti inflammatory medicine. More persistent symptoms will be a consideration for steroid injection. The injection actually works as an anti inflammatory. Patients whose condition does not improve following conservative treatment and patients who initially are in the severe carpal tunnel syndrome (CTS) category (as defined by electro physiologic testing) should be considered for surgery. Surgical release of the transverse ligament provides high initial success rates (greater than 90%), with low rates of complication; however, it has been suggested that the long-term success rate may be much lower than previously thought (approximately 60% at 5 y). Success rates also are considerably lower for individuals with normal electro physiologic studies. Steroid injection into the carpal tunnel has been shown to be of long-term benefit and may be worthwhile prior to surgical management or in cases in which surgery is relatively contraindicated (eg, because of pregnancy).

Prevention

At the workplace, workers can do on-the-job conditioning, perform stretching exercises, take frequent rest breaks, wear splints to keep wrists straight, and use correct posture and wrist position. Wearing fingerless gloves can help keep hands warm and flexible. Workstations, tools and tool handles, and tasks can be redesigned to enable the worker’s wrist to maintain a natural position during work. Jobs can be rotated among workers. Employers can develop programs in ergonomics, the process of adapting workplace conditions and job demands to the capabilities of workers. However, research has not conclusively shown that these workplace changes prevent the occurrence of carpal tunnel syndrome.

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