Carpal tunnel syndrome (CTS) is a median entrapment neuropathy, that causes paresthesia, pain, numbness, and other symptoms

in the distribution of the median nerve due to its compression at the wrist in the carpal tunnel. The pathophysiology is not completely understood but can be considered compression of the median nerve traveling through the carpal tunnel.[1] It appears to be caused by a combination of genetic and environmental factors.[2] Some of the predisposing factors include: diabetes, obesity, pregnancy, hypothyroidism, and heavy manual work or work with vibrating tools but not lighter work even if repetitive.[2] The main symptom of CTS is intermittent numbness of the thumb, index, long and radial half of the ring finger.[3] The numbness often occurs at night, with the hypothesis that the wrists are held flexed during sleep. Recent literature suggests that sleep positioning, such as sleeping on one's side, might be an associated factor.[4] It can be relieved by wearing a wrist splint that prevents flexion.[5] Long-standing CTS leads to permanent nerve damage with constant numbness, atrophy of some of the muscles of the thenar eminence, and weakness of palmar abduction.[6] Pain in carpal tunnel syndrome is primarily numbness that is so intense that it wakes one from sleep. Pain in electrophysiologically verified CTS is associated with misinterpretation of nociception and depression.[7] Conservative treatments include use of night splints and corticosteroid injection. The only scientifically established disease modifying treatment is surgery to cut the transverse carpal ligament.[8]

Just a passing cramp? More likely you have carpal tunnel syndrome.a narrow. Most mild cases of carpal tunnel syndrome get better with treatment.You're working at your desk. The tingling. Suddenly. Symptoms often get worse if you do not stop or change an activity that is helping to cause the condition. rigid passageway of ligament and bones at the base of the hand houses the median nerve and tendons. or numbness in the hand and wrist. as well as impulses to some small muscles in the hand that allow the fingers and thumb to move. a painful progressive condition caused by compression of a key nerve in the wrist. thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed. trying to ignore the tingling or numbness you've had for months in your hand and wrist. What are the symptoms of carpal tunnel syndrome? . weakness. piercing pain shoots through the wrist and up your arm. and pain of carpal tunnel syndrome usually develop gradually. Sometimes. Usually there is no permanent damage to the median nerv What is carpal tunnel syndrome? Carpal tunnel syndrome occurs when the median nerve. The median nerve controls sensations to the palm side of the thumb and fingers (although not the little finger). radiating up the arm. In the early stages of carpal tunnel syndrome. a sharp. becomes pressed or squeezed at the wrist. numbness. 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. which runs from the forearm into the palm of the hand. The result may be pain. The carpal tunnel . Although painful sensations may indicate other conditions. you may sometimes lose some feeling in your hand.

Other contributing factors include trauma or injury to the wrist that cause swelling. Some people are unable to tell between hot and cold by touch. How is carpal tunnel syndrome diagnosed? . Who is at risk of developing carpal tunnel syndrome? Women are three times more likely than men to develop carpal tunnel syndrome. fluid retention during pregnancy or menopause. Other disorders such as bursitis and tendonitis have been associated with repeated motions performed in the course of normal work or other activities. with frequent burning. rheumatoid arthritis. A person with carpal tunnel syndrome may wake up feeling the need to "shake out" the hand or wrist. grasp small objects. perhaps because the carpal tunnel itself may be smaller in women than in men. 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. cleaning. finishing.manufacturing. rather than a problem with the nerve itself. 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. Most likely the disorder is due to a congenital predisposition . but is especially common in those performing assembly line work . Carpal tunnel syndrome usually occurs only in adults. As symptoms worsen. especially the thumb and the index and middle fingers. people might feel tingling during the day. or perform other manual tasks. work stress. and meat. even though little or no swelling is apparent.Symptoms usually start gradually. or the development of a cyst or tumor in the canal. sewing. In fact. Decreased grip strength may make it difficult to form a fist. mechanical problems in the wrist joint. In chronic and/or untreated cases. repeated use of vibrating hand tools. or itching numbness in the palm of the hand and the fingers. The symptoms often first appear in one or both hands during the night. such as sprain or fracture. In some cases no cause can be identified. The risk of developing carpal tunnel syndrome is not confined to people in a single industry or job. There is little clinical data to prove whether repetitive and forceful movements of the hand and wrist during work or leisure activities can cause carpal tunnel syndrome. overactivity of the pituitary gland. Some carpal tunnel sufferers say their fingers feel useless and swollen. the muscles at the base of the thumb may waste away. The dominant hand is usually affected first and produces the most severe pain. hypothyroidism.the carpal tunnel is simply smaller in some people than in others.. tingling. carpal tunnel syndrome is three times more common among assemblers than among data-entry personnel. poultry. since many people sleep with flexed wrists. or fish packing. Writer's cramp may also be brought on by repetitive activity.

The test is positive when tingling in the fingers or a resultant shock-like sensation occurs. test involves having the patient hold his or her forearms upright by pointing the fingers down and pressing the backs of the hands together. Doctors may also ask patients to try to make a movement that brings on symptoms. Orally administered diuretics ("water pills") can decrease swelling. applying cool packs can help reduce swelling. In a nerve conduction study. and neck can help determine if the patient's complaints are related to daily activities or to an underlying disorder. swelling. Ultrasound imaging can show impaired movement of the median nerve. If there is inflammation. such as tingling or increasing numbness. such as aspirin. warmth. Physicians can use specific tests to try to produce the symptoms of carpal tunnel syndrome. and immobilizing the wrist in a splint to avoid further damage from twisting or bending. the doctor taps on or presses on the median nerve in the patient's wrist. electrodes are placed on the hand and wrist. Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks. arthritis. shoulders. and can rule out other painful conditions that mimic carpal tunnel syndrome.Early diagnosis and treatment are important to avoid permanent damage to the median nerve. In the Tinel test. Small electric shocks are applied and the speed with which nerves transmit impulses is measured. Underlying causes such as diabetes or arthritis should be treated first. How is carpal tunnel syndrome treated? Treatments for carpal tunnel syndrome should begin as early as possible. a fine needle is inserted into a muscle. under a doctor's direction. avoiding activities that may worsen symptoms. electrical activity viewed on a screen can determine the severity of damage to the median nerve. Nonsteroidal anti-inflammatory drugs. Non-surgical treatments Drugs . and the muscles at the base of the hand should be examined for strength and signs of atrophy. The Phalen. (Caution: persons with diabetes and those who may be predisposed to diabetes should note that prolonged use of corticosteroids can . various drugs can ease the pain and swelling associated with carpal tunnel syndrome. and discoloration. may ease symptoms that have been present for a short time or have been caused by strenuous activity. The wrist is examined for tenderness. and other nonprescription pain relievers. or wrist-flexion.In special circumstances. Each finger should be tested for sensation. temporary relief to persons with mild or intermittent symptoms. is felt in the fingers within 1 minute. and fractures. Corticosteroids (such as prednisone) or the drug lidocaine can be injected directly into the wrist or taken by mouth (in the case of prednisone) to relieve pressure on the median nerve and provide immediate. arms. A physical examination of the hands. Magnetic resonance imaging (MRI) can show the anatomy of the wrist but to date has not been especially useful in diagnosing carpal tunnel syndrome. In electromyography. The presence of carpal tunnel syndrome is suggested if one or more symptoms. ibuprofen. Often it is necessary to confirm the diagnosis by use of electrodiagnostic tests. Routine laboratory tests and X-rays can reveal diabetes.

Occasionally the wrist loses strength because the carpal ligament is cut. The following are types of carpal tunnel release surgery: Open release surgery. Corticosterioids should not be taken without a doctor's prescription. who is trained in evaluating people with physical impairments and helping them build skills to improve their health and well-being. surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve.Stretching and strengthening exercises can be helpful in people whose symptoms have abated. Exercise . Alternative therapies . How can carpal tunnel syndrome be prevented? . inserts a camera attached to a tube. Although symptoms may be relieved immediately after surgery. observes the tissue on a screen. Some patients may have infection. Some patients may need to adjust job duties or even change jobs after recovery from surgery. These exercises may be supervised by a physical therapist. It generally allows individuals to resume some normal activities in a short period of time. or an occupational therapist. Many patients require surgery on both hands. Patients should undergo physical therapy after surgery to restore wrist strength. is effective and minimizes scarring and scar tenderness. nerve damage. This two-portal endoscopic surgery. Surgery Carpal tunnel release is one of the most common surgical procedures in the United States. consists of making an incision up to 2 inches in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel. Endoscopic surgery may allow faster functional recovery and less postoperative discomfort than traditional open release surgery. who is trained to use exercises to treat physical impairments. full recovery from carpal tunnel surgery can take months. Surgery is done under local anesthesia and does not require an overnight hospital stay. stiffness. if any. which has been shown to reduce pain and improve grip strength among patients with carpal tunnel syndrome. The surgeon makes two incisions (about ½ inch each) in the wrist and palm. Recurrence of carpal tunnel syndrome following treatment is rare. some studies show that vitamin B6 (pyridoxine) supplements may ease the symptoms of carpal tunnel syndrome. generally performed under local anesthesia. unless there are unusual medical considerations. the traditional procedure used to correct carpal tunnel syndrome. and cuts the carpal ligament (the tissue that holds joints together).make it difficult to regulate insulin levels. The majority of patients recover completely. and pain at the scar. The procedure is generally done under local anesthesia on an outpatient basis.) Additionally. Generally recommended if symptoms last for 6 months. An exception is yoga.Acupuncture and chiropractic care have benefited some patients but their effectiveness remains unproved. Single portal endoscopic surgery for carpal tunnel syndrome is also available and can result in less post-operative pain and a minimal scar.

Researchers also are examining biomechanical stresses that contribute to the nerve damage responsible for symptoms of carpal tunnel syndrome in order to better understand. a part of the National Institutes of Health. treat. However. wear splints to keep wrists straight. tools and tool handles. the National Institute of Arthritis and Musculoskeletal and Skin Disorders (NIAMS). Scientists funded through NIH's National Center for Complementary and Alternative Medicine are investigating the effects of acupuncture on pain. a randomized clinical trial designed to evaluate the effectiveness of osteopathic manipulative treatment in conjunction with standard medical care is underway. and tasks can be redesigned to enable the worker's wrist to maintain a natural position during work.At the workplace. By quantifying the distinct biomechanical pressures from fluid and anatomical structures. In addition. and use correct posture and wrist position. and changes in the brain associated with carpal tunnel syndrome. the process of adapting workplace conditions and job demands to the capabilities of workers. Employers can develop programs in ergonomics. Another NIH component. Wearing fingerless gloves can help keep hands warm and flexible. loss of median nerve function. Workstations. . is the federal government's leading supporter of biomedical research on neuropathy. supports research on tissue damage associated with repetitive motion disorders. Jobs can be rotated among workers. Scientists supported by the NINDS are studying the factors that lead to long-lasting neuropathies. and functional loss. perform stretching exercises. workers can do on-the-job conditioning. researchers are finding ways to limit or prevent carpal tunnel syndrome in the workplace and decrease other costly and disabling occupational illnesses. and prevent this ailment. including carpal tunnel syndrome. and how the affected nerves are related to symptoms of pain. Evaluations of these therapies and other therapies will help to tailor patient treatment programs. numbness. take frequent rest breaks. What research is being done? The National Institute of Neurological Disorders and Stroke (NINDS). including carpal tunnel syndrome. research has not conclusively shown that these workplace changes prevent the occurrence of carpal tunnel syndrome.

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