Carpal Tunnel Syndrome

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What Is Carpal Tunnel Syndrome?

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The Physiology Of Carpal Tunnel Syndrome

At the base of the palm is a tight canal or “tunnel” through which tendons and nerves must pass ontheir way from the forearm to the hand and fingers. The nerve that passes through this narrow tunnelto reach the hand is called the Median Nerve. This narrow passage between the forearm and hand iswhat is known as the "Carpal Tunnel".

The Carpal Tunnel is normally quite snug and thereis just barely enough room in it for the tendons andnerves that have to pass through it. If anythingtakes up extra room in the canal, things becometoo tight and the nerve in the canal becomesconstricted or "pinched"

This pinching of the nerve (a medical conditionreferred to officially as Nerve Entrapment) causesnumbness and tingling in the area of the hand thatthe nerve travels to. The condition that resultswhen the Median Nerve is being pinched in TheCarpal Tunnel is commonly referred to as CarpalTunnel Syndrome or "CTS".

In actuality, the condition and its accompanying symptoms can be brought on by either a decrease inthe size of the carpal tunnel OR an enlarging of the tissues inside the tunnel.

Carpal Tunnel Syndrome has received a lot of attention in recent years because of suggestions that itmay be linked with occupations that require repeated use of the hands, such as typing on a computer keyboard or doing assembly work. In reality, many people develop this condition regardless of thetype of work they do.

How Did I Get Carpal Tunnel Syndrome?

The most common cause of Carpal Tunnel Syndrome is inflammation of the tendons in the tunnelwhich can normally be attributed to repetitive use of the hand and/or wrist.

Repetitive Strain Injuries (RSIs) can happen to anyone whose work calls for long periods of steadyhand movement, from musicians & dental hygienists to meat cutters & cashiers. RSIs tend to comewith work that demands repeated grasping, turning and twisting; they are especially likely if the workrequires repeated twisting or involves repetitive vibration, as in hammering nails or operating a power tool. Stressful hand, arm and neck positions — whether from working at a desk, long-distance drivingor waiting on tables — only aggravate the potential for damage.

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A number of sports can bring on repetitive stress injuries: Rowing, golf, tennis, downhill skiing,archery, competitive shooting and rock climbing are just a sampling of activities that stress the handand wrist joints. Injuries and ailments that cause swelling or compression of soft tissue on nerves,such as sprains, leukemia, and rheumatoid arthritis, can lead to stress injuries.Diabetes, thyroid problems, and other systemic disorders are also associated with discomfort fromstressed nerves, as is the fluid accumulation that sometimes accompanies pregnancy. Someauthorities believe that a pyridoxine (vitamin B6) deficiency can also induce the symptoms.Fluid retention, a major contributor to CTS & RSI symptoms naturally occur with the usage of contraceptive pills. Post Menstrual Syndrome (PMS) also causes fluid retention as do many other medical conditions, all of which can result in Carpal Tunnel Syndrome symptoms.

What Are The Symptoms Of Carpal Tunnel Syndrome?

One of the first symptoms of CTS is gradual numbness in the areas supplied by the median nerve.This is quickly followed by pain where the nerve gives sensation in the hand. The hand may begin tofeel like it's "asleep," especially in the early morning hours after a night's rest.

Pain may spread up the arm to the shoulder and even to the side of the neck. If the conditionprogresses, the thenar muscles of the thumb can weaken and atrophy, causing the hand to beclumsy when picking up a glass or cup. If the pressure keeps building in the carpal tunnel, the thenar muscles may actually begin to shrink (atrophy).

Touching the pad of the thumb to the tips of the other fingers becomes difficult, making it hard to grasp itemssuch as a steering wheel, newspaper, or telephone.

Symptoms In Summary

•A tingling or numb feeling in the hand and/or fingers;

•Shooting pains in the wrist or forearm, andsometimes extending to the shoulder, neck andchest, or foot;

•Difficulty clenching the fist or grasping smallobjects;

For many unfortunate sufferers, CTS has a pattern of flaring up through the night thereby makingsleep difficult. CTS symptoms can also be expected to arise frequently while performing the activitythat is the cause of the condition in the first place.

The Diagnosis Of Carpal Tunnel Syndrome

Physicians normally identify the condition by first obtaining a history of the problem, followed by athorough physical examination. Your description of the symptoms and the physical examination arethe most important parts in the diagnosis of CTS. Commonly, patients will complain first of waking inthe middle of the night with pain and a feeling that the whole hand is asleep.

Careful investigation usually shows that the little finger is unaffected. This can be a key piece of information to make the diagnosis. If you awaken with your hand asleep, pinch your little finger to seeif it is numb also, and be sure to tell your doctor if it is or is not. Other complaints include numbness

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while using the hand for gripping activities, such as sweeping, hammering, or driving.

If your symptoms started after a traumatic wrist injury, X-rays may be needed to check for a fracturedbone.

If more information is needed to make the diagnosis, electrical studies of the nerves in the wrist maybe requested by your doctor. Several tests are available to see how well the median nerve isfunctioning, including the nerve conduction velocity (NCV) test. This test measures how fast nerveimpulses move through the nerve.

Treatments For Relieving Carpal Tunnel Syndrome

•Conservative Treatment

Activities that are causing your symptoms need to be changed or stopped if at all possible. Avoidrepetitive hand motions, heavy grasping, holding onto vibrating tools, and positioning or working withyour wrist bent down and out. If you smoke, talk to your doctor about ways to help you quit. Loseweight if you are overweight. Reduce your caffeine intake.

•Wrist Brace

A wrist brace will sometimes decrease the symptoms in the early stages of CTS. A brace keeps thewrist in a resting position (not bent back nor bent down too far). When the wrist is in this position, thecarpal tunnel is as big as it can be--so the nerve has as much room as possible inside the carpaltunnel. A brace can be especially helpful for easing the numbness and pain felt at night and can keepyour hand from curling under as you sleep. The wrist brace can also be worn during the day to calmsymptoms and rest the tissues in the carpal tunnel.

•Medication

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) may also help control the swelling and reducesymptoms of CTS. Common over-the-counter medications such as ibuprofen and aspirin aresometimes recommended. In some studies, high doses of Vitamin B-6 (a key ingredient in CTCream™) have been shown to help in decreasing CTS symptoms.

Another attractive option for many sufferers, especially those who prefer to not ingest medicationorally, is the application of an appropriate and effective topical anti-inflammatory.

CT Cream withA.C.P.

was specifically designed to reduce underlying inflammation and does so by taking advantageof proven effective ingredients including Arnica, Choline and Pyridoxine & Vitamin B

6.

•Physical Therapy

Your doctor may suggest that you work with a physical or occupational therapist. The main focus of treatment is to reduce or eliminate the cause of pressure in the carpal tunnel. Your therapist maycheck your workstation and the way you do your work tasks. Suggestions may be given about the useof healthy body alignment and wrist positions, helpful exercises, and tips on how to prevent futureproblems.

•Surgical Treatment

If all attempts to control your symptoms fail, surgery may be suggested to reduce the pressure on themedian nerve. Several different surgical procedureshave been designed to relieve pressure on themedian nerve. By releasing the pressure on thenerve, the blood supply to the nerve improves, andmost people get relief of their symptoms.

However, if the nerve pressure has been going on along time, the nerve may have thickened andscarred to the point that recovery after surgery ismuch slower.

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