Carpal tunnel syndrome
Carpal tunnel syndrome is a painful condition of the hand in which there is pressure on the median nerve. The median nerve in located in the wrist and provides feeling and movement to the thumb side of the hand (the palm, thumb, index finger, middle finger, and thumb side of the ring finger). Carpal tunnel syndrome can lead to numbness, tingling, weakness, or muscle damage in the hand and fingers.
Causes
The area in the wrist where the median nerve enters the hand is called the carpal tunnel. This tunnel is normally narrow, so any swelling of this part can pinch the nerve and cause pain, numbness, tingling or weakness. This is called carpal tunnel syndrome. Some people who develop this problem are considered to have been born with a carpal tunnel that is small. However, carpal tunnel syndrome can also be caused by making the same hand and wrist motion over and over. Using hand tools that vibrate may lead to carpal tunnel syndrome.
There are no good studies that prove carpal tunnel is caused by typing on a computer, using a mouse, or repeating movements while working, playing an instrument, or playing sports.
Occurrence
Carpal tunnel syndrome occurs most often in people 30 to 60 years old, and is more common in women than men. Other factors that may lead to carpal tunnel syndrome include:
Alcohol abuse
Bone fractures and arthritis of the wrist
Cyst or tumor that grows in the wrist
Infections
Obesity
If your body keeps extra fluids during pregnancy or menopause
Rheumatoid arthritis
Symptoms
Clumsiness of the hand when gripping objects
Numbness or tingling in the thumb and next two or three fingers of one or both hands
Numbness or tingling of the palm of the hand
Pain extending to the elbow
Pain in the wrist or hand in one or both hands
Problems with fine finger movements (coordination) in one or both hands
Wasting away of the muscle under the thumb (in advanced or long-term cases)
Weak grip or difficulty carrying bags (a common complaint)
Weakness in one or both hands
Diagnosis
Carpal Tunnel Syndrome can be diagnosed by a physical examination, the doctor may find:
Numbness in the palm, thumb, index finger, middle finger, and thumb side of the ring finger
Weak hand grip
Tapping over the median nerve at the wrist may cause pain to shoot from the wrist to the hand (this is called Tinels sign)
Bending the wrist forward all the way for 60 seconds will usually result in numbness, tingling, or weakness (this is called Phalens test)
Other tests for diagnosis may include:
Electromyography
Nerve conduction velocity
Wrist x-rays should be done to rule out other problems (such as wrist arthritis)
Treatment
You may try wearing a splint at night for several weeks. If this does not help, you may need to try wearing the splint during the day. Avoid sleeping on your wrists. Hot and cold compresses may also be recommended. There are many changes you can make in the workplace/office to reduce the stress on your wrist:
Special devices include keyboards, different types of computer mouse, cushioned mouse pads, and keyboard drawers.
Make sure the keyboard is low enough so that your wrists arent bent upward while typing. Your health care provider may suggest an occupational therapist.
You may also need to make changes in your work duties or recreational activities. Some of the jobs associated with carpal tunnel syndrome include those that involve typing and vibrating tools. Carpal tunnel syndrome has also been linked to professional musicians.
If it doesnt resolve by the above measures, it will need to be assessed by a doctor and then be treated by the use of medicines or surgery.
Medication:
Medications used in the treatment of carpal tunnel syndrome include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. Corticosteroid injections, given into the carpal tunnel area, may relieve symptoms for a period of time.
Surgery:
Carpal tunnel release is a surgical procedure that cuts into the ligament that is pressing on the nerve. Surgery is successful most of the time, but it depends on how long the nerve compression has been occurring and its severity.
Prognosis
Symptoms often improve with treatment, but more than 50% of cases eventually require surgery. Surgery is often successful, but full healing can take months.
Possible Complications
If the condition is treated properly, there are usually no complications. If untreated, the nerve can be damaged, causing permanent weakness, numbness, and tingling.
Prevention
Avoid or reduce the number of repetitive wrist movements whenever possible. Use tools and equipment that are properly designed to reduce the risk of wrist injury.
Ergonomic aids, such as split keyboards, keyboard trays, typing pads, and wrist braces, may be used to improve wrist posture during typing. Take frequent breaks when typing and always stop if there is tingling or pain. (Reprint)
Source: AsiaMed Connect
