Carpal Tunnel Syndrone
You're working at your desk, trying to ignore the tingling or numbness you've had for months in your hand and wrist. Suddenly, a sharp, piercing pain shoots through the wrist and up your arm. More likely you have carpal tunnel syndrome, a painful progressive condition caused by compression of a key nerve in the wrist. What is carpal tunnel syndrome? Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers (although not the little finger), as well as impulses to some small muscles in the hand that allow the fingers and thumb to move. The carpal tunnel - a narrow, rigid passageway of ligament and bones at the base of the hand houses the median nerve and tendons. The Lunate is one of the eight bones of the wrist and resembles the crescent moon. The Median nerve travels through the “tunnel” of the lunate as it passes into the hand. Sometimes, a misalignment of the Lunate or a thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed. The result may be pain, weakness, or numbness in the hand and wrist, radiating up the arm. Although painful sensations may indicate other conditions, carpal tunnel syndrome is the most common and widely known of the entrapment neuropathies in which the body's peripheral nerves are compressed or traumatized. What are the symptoms of carpal tunnel syndrome? Symptoms usually start gradually, with frequent burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers. Some carpal tunnel sufferers say their fingers feel useless and swollen, even though little or no swelling is apparent. The symptoms often first appear in one or both hands during the night, since many people sleep with flexed wrists. A person with carpal tunnel syndrome may wake up feeling the need to "shake out" the hand or wrist. As symptoms worsen, people might feel tingling during the day. Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In chronic and/or untreated cases, the muscles at the base of the thumb may waste away. Some people are unable to tell between hot and cold by touch.
What are the causes of carpal tunnel syndrome? Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. The most common cause is over use disorder from repeated activity such as using a mouse on a computer of constantly using vibrating power tools. Other possible causes are due to a congenital predisposition - the carpal tunnel (lunate) is simply smaller in some people than in others. Other contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture possibly in a car accident; over activity of the pituitary gland; hypothyroidism; rheumatoid arthritis, fluid retention during pregnancy or menopause; or the development of a cyst or tumor in the canal. Some cases seem to have no specific cause. Who is at risk of developing carpal tunnel syndrome? Women are three times more likely than men to develop carpal tunnel syndrome, perhaps because the carpal tunnel itself may be smaller in women than in men. The dominant hand is usually affected first and produces the most severe pain. Persons with diabetes or other metabolic disorders that directly affect the body's nerves and make them more susceptible to compression are also at high risk. Carpal tunnel syndrome usually occurs in adults. The risk of developing carpal tunnel syndrome is not confined to people in a single industry or job, but is especially common in those performing assembly line work – extensive computer work, manufacturing, sewing, finishing, cleaning, and meat, poultry, or fish packing. During 1998, an estimated three of every 10,000 workers lost time from work because of carpal tunnel syndrome. Half of these workers missed more than 10 days of work. The average lifetime cost of carpal tunnel syndrome, including medical bills and lost time from work, is estimated to be about $30,000 for each injured worker. How is carpal tunnel syndrome diagnosed? Early diagnosis and treatment are important to avoid permanent damage to the median nerve. A physical examination of the hands, arms, shoulders, and neck can help determine if the patient's complaints are related to daily activities or to an underlying disorder, and can rule out other painful conditions that mimic carpal tunnel syndrome. The wrist is examined for structural integrity and misalignment, tenderness, swelling, warmth, and discoloration. Each finger should be tested for sensation, and the muscles at the base of the hand should be examined for strength and signs of atrophy.
Physicians can use specific tests to try to produce the symptoms of carpal tunnel syndrome. In the Tinel test, the doctor taps on or presses on the median nerve in the patient's wrist. The test is positive when tingling in the fingers or a resultant shock-like sensation occurs. The Phalen, or wrist-flexion, test involves having the patient hold his or her forearms upright by pointing the fingers down and pressing the backs of the hands together. The presence of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing numbness, is felt in the fingers within 1 minute. Doctors may also ask patients to try to make a movement that brings on symptoms. Often it is necessary to confirm the diagnosis by use of electrodiagnostic tests. In a nerve conduction study, electrodes are placed on the hand and wrist. Small electric shocks are applied and the speed with How can carpal tunnel syndrome be prevented? 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. The use of cryotherapy or ice after work vcan be helpful in controlling inflammation. Workstations ergonomics, tools and tool handles, and tasks can be redesigned to enable the worker's wrist to maintain a natural position during work. Employers can develop programs in ergonomics, the process of adapting workplace conditions and job demands to the capabilities of workers. Exhaust Conservative Treatment Before Considering Surgery Before you resort to surgery, make sure you actually have carpal tunnel syndrome. The source of your problem may be far simpler than your Medical Doctor thinks. Your hands, wrist pain and numbness may have nothing whatsoever to do with a problem with your wrist. Conservative chiropractic management is the most efficient medical method in taking care of this condition. . Recent studies have demonstrated favorable outcome with conservative management to include Chiropractic Manipulation of the carpal bones and joints of the wrist and upper extremities, ultrasound treatments, Acoustic Compression therapy (ACT) using the WellWave and FDA Approved Cold Laser Therapy.