Carpal Tunnel

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Carpal Tunnel Syndrome or Carpel Tunnel Syndrome
 
Many of these facts have been adapted from Wikipedia
 
Carpal tunnel syndrome

Sometimes wrongly spelt as Carpel tunnel Syndrome (CTS), or median neuropathy at the wrist, is a medical condition in which the median nerve is compressed at the wrist, leading to paraesthesia, numbness and muscle weakness in the hand. The median nerve is one of three nerves that supply the hand.  The median nerve controls sensations to the palm side of the thumb and fingers (but not the little finger). The diagnosis of CTS is often misapplied to patients who have activity-related arm pain.
 

Pain during the night and that wakes you up is a very distinguishing feature of CTS this can be effectively with night-time wrist splinting in most patients.

Anatomy of Carpal Tunnel Syndrome or Carpel Tunnel Syndrome

The bones of the wrist form a semi-circle shape and have a tough ligament called the transverse carpal ligament forming the forth side and therefore a tunnel for all the structures that supply the hand to pass through. 

The median nerve passes through the carpal tunnel, a canal in the wrist that is surrounded by bone on three sides, and a transverse carpal ligament on the fourth. The flexor tendons of the hand also pass through this canal.

The median nerve can be either compressed by a decrease in the size of the canal, or by an increase in the size of the contents, or both. If you bend the wrist to 90 degrees the size of the canal will decrease and this may bring on or increase the symptoms felt by those with CTS.

 
Symptoms of Carpal Tunnel Syndrome or Carpel Tunnel Syndrome 

Many people that have carpal tunnel syndrome have gradually increasing symptoms over time. The first symptoms of CTS may appear when sleeping and typically include numbness and parenthesis (a burning and tingling sensation) in the thumb, index, and middle fingers, although some patients may experience symptoms in the palm as well.

These symptoms appear at night because people tend to bend their wrists when they sleep, which further compresses the carpal tunnel. 

Decreased grip strength may make it difficult to form a fist, grasp small objects and even drop things.  It is unclear if carpal tunnel syndrome creates problems holding things, but because it decreases sweating it can decrease the friction between an object and the skin.

At the beginning it is common to blame the tingling and numbness on restricted blood circulation. After a while the muscles of the thumb (the thenar muscles) may become wasted making it difficult to bring the thumb out away from the hand.

Because numbness and altered sensation are the two main symptoms of CTS if you have a painful wrist or hand without numbness and/or tingling or pins and needles, you are unlikely to have CTS.
 
Causes of Carpal Tunnel Syndrome or Carpel Tunnel Syndrome 

Because the carpal tunnel is a very small space for lots of structures to fit through, any swelling or thickening of the structures will result in the median nerve being compressed. 

CTS usually only occurs in adults and effects 3 times more women than men (probably because the carpal tunnel is smaller in women).  The dominant hand is most at risk and is likely to be more painful.

The most important risk factors for carpal tunnel syndrome are structural and biological rather than environmental or activity-related. The strongest risk factor is genetic predisposition; some people are just born with a smaller carpal tunnel.

 
Work related Carpal Tunnel Syndrome or Carpel Tunnel Syndrome 

The international debate regarding the relationship between CTS and repetitive motion in work is ongoing.
 

Trauma related Carpal Tunnel Syndrome or Carpel Tunnel Syndrome 

· If you fall onto your hand and fracture of one of the arm bones, particularly a Colles’ fracture.  Or if you dislocate of one of the carpal bones of the wrist.
· Deformities from abnormal healing of old bone fractures.
 
Carpal tunnel syndrome associated with other diseases

· Rheumatoid arthritis and other diseases that cause inflammation of the flexor tendons can create median nerve compression at the carpal tunnel.
· With both pregnancy and hypothyroidism you can get fluid retained in tissues, which can cause swelling in the carpal tunnel and therefore compression of the median nerve.
· Acromegaly, a disorder of growth hormones, compresses the nerve by the abnormal growth of bones around the hand and wrist.
· Tumours (usually benign), such as a ganglion or a lipoma, can protrude into the carpal tunnel, reducing the amount of space. This is exceedingly rare (less than 1%).
· Diabetes.
· A cyst in the carpal tunnel.
· Medications such as the oral contraceptive.
· Obesity also increases the risk of CTS with individuals who are classified as obese (BMI > 29) 2.5 times more likely than slender individuals (BMI < 20) to be diagnosed with CTS.
· Double crush syndrome is a speculative and debated theory which postulates that when there is compression or irritation of nerve branches contributing to the median nerve in the neck or anywhere above the wrist, this then increases the sensitivity of the nerve to compression in the wrist. There is little evidence, however, that this syndrome really exists.

 
Diagnosis of Carpal Tunnel Syndrome or Carpel Tunnel Syndrome

If you go to your doctor he may perform the Phalen’s maneuver and ask for a full history of your symptoms and the pattern of your symptoms.

· Phalen’s maneuver is done by bending the wrist gently as far as possible and holding this position and awaiting symptoms. If you feel numbness on the part of the hand that the median nerve supplies you are likely to have CTS.  The quicker the numbness is felt the more severe the CTS. 

Updated: 15th September 2009