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 Carpal tunnel syndrome

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PostSubject: Carpal tunnel syndrome   Carpal tunnel syndrome EmptyThu Jan 20, 2011 9:41 am

Carpal tunnel syndrome
Filed under: Brain & Nervous System
Although it might seem that carpal tunnel syndrome is a condition born
from long hours spent working on a computer keyboard, carpal tunnel
syndrome actually has numerous causes.

Bound by bones and ligaments, the carpal tunnel is a narrow passageway —
about as big around as your thumb — located on the palm side of your
wrist. This tunnel protects a main nerve to your hand and nine tendons
that bend your fingers. Pressure placed on the nerve produces the
numbness, pain and, eventually, hand weakness that characterize carpal
tunnel syndrome.

Fortunately, for most people who develop carpal tunnel syndrome, proper
treatment usually can relieve the pain and numbness and restore normal
use of their wrists and hands.

©1998-2011 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.

Symptoms

Carpal tunnel syndrome typically starts gradually with a vague aching in
your wrist that can extend to your hand or forearm. Other common carpal
tunnel syndrome symptoms include:

* Tingling or numbness in your fingers or hand, especially your
thumb and index, middle or ring fingers, but not your little finger.
This sensation often occurs while holding a steering wheel, phone or
newspaper or upon awakening. Many people "shake out" their hands to try
to relieve their symptoms. As the disorder progresses, the numb feeling
may become constant.
* Pain radiating or extending from your wrist up your arm to your
shoulder or down into your palm or fingers, especially after forceful or
repetitive use. This usually occurs on the palm side of your forearm.
* A sense of weakness in your hands and a tendency to drop objects.

When to see a doctor
If you have persistent signs and symptoms that might be due to carpal
tunnel syndrome that interfere with your normal activities — including
sleep — see your doctor. If you leave the condition untreated, nerve and
muscle damage can occur.




Causes

The cause of carpal tunnel syndrome is pressure on the median nerve. The
median nerve is a mixed nerve, meaning it has a sensory function and
also provides nerve signals to move your muscles (motor function). The
median nerve provides sensation to your thumb, index finger, middle
finger and the middle-finger side of the ring finger.

Pressure on the nerve can stem from anything that reduces the space for it in the carpal tunnel. Possible causes include:

* Other health conditions. Some examples include rheumatoid
arthritis, certain hormonal disorders — such as diabetes, thyroid
disorders and menopause — fluid retention due to pregnancy, or deposits
of amyloid, an abnormal protein produced by cells in your bone marrow.
* Repetitive use or injury. Repetitive flexing and extending of the
tendons in the hands and wrists, particularly when done forcefully and
for prolonged periods without rest, also can increase pressure within
the carpal tunnel. Injury to your wrist can cause swelling that exerts
pressure on the median nerve.
* Physical characteristics. It may be that your carpal tunnel is more narrow than average.


Risk factors

Some research suggests that carpal tunnel syndrome can result from
overuse or strain in certain job tasks that require a combination of
repetitive, forceful, and awkward or stressed motions of your hands and
wrists. Examples of these include using power tools — such as chippers,
grinders, chain saws or jackhammers — and heavy assembly line work, such
as occurs in a meatpacking plant. Although repetitive computer use is
commonly assumed to cause carpal tunnel syndrome, the scientific
evidence for this association isn't definitive.

Although it's not clear which activities can cause carpal tunnel
syndrome, if your work or hobbies are hand-intensive — involving a
combination of awkward, repetitive wrist or finger motions, forceful
pinching or gripping, and working with vibrating tools — you may be at
higher risk of developing the condition.

Other risk factors include:

* Your sex. Women are three times as likely as men are to develop
carpal tunnel syndrome, according to the National Institute of
Neurological Disorders and Stroke.
* Heredity. You may be significantly more likely to develop carpal
tunnel syndrome if close relatives have had the condition. Inherited
physical characteristics, such as the shape of your wrist, may make you
more susceptible.
* Certain health conditions. Conditions including some thyroid
problems, diabetes, obesity and rheumatoid arthritis can increase your
risk. People with end-stage kidney disease also are more likely to
develop carpal tunnel syndrome. Women who are pregnant, taking oral
contraceptives or going through menopause also are at increased risk,
most likely due to hormonal changes. Fluid retention may be a cause of
carpal tunnel syndrome during pregnancy. Fortunately, carpal tunnel
syndrome related to pregnancy almost always improves after childbirth.

Tests and diagnosis

Your doctor will likely want to review your signs and symptoms to find
out where they're located. One diagnostic key is that the median nerve
doesn't provide sensation to the little finger, so symptoms in that
finger may indicate a different problem. Another clue is the timing of
the symptoms. Typical times when you might experience symptoms due to
carpal tunnel syndrome include while holding a phone or a newspaper,
gripping a steering wheel, or waking up during the night.

Your doctor will also want to test the feeling in your fingers and the
strength of the muscles in your hand, because these can be affected by
carpal tunnel syndrome. Pressure on the median nerve at the wrist,
produced by either bending the wrist, tapping on the nerve or simply
pressing on the nerve, can bring on the symptoms in many people.

If you have signs and symptoms of carpal tunnel syndrome, your doctor may recommend the following diagnostic tests:

* Electromyogram. Electromyography measures the tiny electrical
discharges produced in muscles. A thin-needle electrode is inserted into
the muscles your doctor wants to study. An instrument records the
electrical activity in your muscle at rest and as you contract the
muscle. This test can help determine if muscle damage has occurred.
* Nerve conduction study. In a variation of electromyography, two
electrodes are taped to your skin. A small shock is passed through the
median nerve to see if electrical impulses are slowed in the carpal
tunnel.

These tests are also useful in checking for other conditions that might
mimic carpal tunnel syndrome, such as a pinched nerve in your neck.
Imaging tests, such as MRI or X-ray, generally aren't used to diagnose
carpal tunnel syndrome.

Your doctor may recommend that you see a rheumatologist, neurologist,
hand surgeon or neurosurgeon if your signs or symptoms indicate other
medical disorders or a need for specialized treatment.


Treatments and drugs

Some people with mild symptoms of carpal tunnel syndrome can ease their
discomfort by taking more-frequent breaks to rest their hands and
applying cold packs to reduce occasional swelling. If these techniques
don't offer relief, carpal tunnel syndrome treatment options include
wrist splinting, medications and surgery.

Nonsurgical therapy
Most people with carpal tunnel syndrome experience effective treatment with nonsurgical methods, including:

* Wrist splinting. A splint that holds your wrist still while you
sleep can help relieve nighttime symptoms of tingling and numbness.
Splinting and other conservative treatments are more likely to help you
if you've had only mild to moderate symptoms for less than 10 months.
* Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs may help
relieve pain from carpal tunnel syndrome if you have an associated
inflammatory condition.
* Corticosteroids. Your doctor may inject your carpal tunnel with a
corticosteroid, such as cortisone, to relieve your pain. Corticosteroids
decrease inflammation, which relieves pressure on the median nerve.
Oral corticosteroids aren't as effective as corticosteroid injections
for treating carpal tunnel syndrome.

If carpal tunnel syndrome results from an inflammatory arthritis, such
as rheumatoid arthritis, then treating the underlying condition
generally also reduces the carpal tunnel syndrome symptoms.

Surgery
Generally, nonsurgical treatments may be more effective if you have only
mild nerve impairment. When the pain or numbness of carpal tunnel
syndrome persists more than six months, surgery may be the best option.

Your surgeon may use one of a few accepted techniques. But in all
accepted surgical procedures, your doctor cuts the ligament pressing on
your nerve. At times, surgery can be done using an endoscope, a
telescope-like device with a tiny camera attached to it that allows your
doctor to see inside your carpal tunnel and perform the surgery through
small incisions in your hand or wrist. In other cases, surgery involves
making a larger incision in the palm of your hand over the carpal
tunnel and releasing the nerve.

Surgery usually results in marked improvement, but you may experience
some residual numbness, pain, stiffness or weakness. Surveys of people
who have undergone carpal tunnel release indicate that about 70 percent
are completely or very satisfied with the outcome of their surgery. Some
variables that are associated with lower levels of satisfaction include
drinking more than two alcoholic drinks a day, smoking, lower mental
and physical health status before surgery, and exposure to repetitive,
forceful activity.

Soreness or weakness may take from several weeks to as long as a few
months to resolve. If surgery appears to be the best alternative for
relieving your symptoms or preventing further muscle degeneration, be
sure to talk with your surgeon about the procedure that will work best
for you and with your plans to return to your previous activity levels,
both at work and at home.


nLifestyle and home remedies

Quick breaks, stretching, aspirin or other over-the-counter NSAIDs —
such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others) —
may relieve your symptoms temporarily.

You might also want to try wearing a wrist splint at night and avoid
sleeping on your hands to help ease the pain or numbness in your wrists
and hands. The splint should be snug but not tight. If pain, numbness or
weakness recurs and persists, see your doctor.


Alternative medicine

Yoga and other relaxation techniques may help with chronic pain that
occurs with some muscle and joint conditions. Yoga postures designed for
strengthening, stretching and balancing each joint in the upper body,
as well as the upper body itself, may help reduce the pain and improve
the grip strength of people with carpal tunnel syndrome.

Although some people use acupuncture or chiropractic therapy to treat
carpal tunnel syndrome, these techniques haven't been proved in clinical
trials. Supplements of vitamin B-6 may be helpful for relieving the
symptoms of carpal tunnel syndrome. Ultrasound treatments also may be
used, but have had variable results in studies. Electrical stimulation,
magnet therapy and laser treatments haven't provided the same benefits
in controlled trials.

You may have to experiment to find a treatment that works for you.
Still, always check with your doctor before trying any complementary or
alternative treatment.


Coping and support

If you experience chronic pain or can't use your hands as before, you
may become depressed or experience low self-esteem. In addition, if your
hand symptoms are caused or worsened by your current profession or
leisure activities, you may face the tough decision of switching careers
or giving up hobbies. You may also feel that you aren't actively
contributing to your family if you can't drive a car or perform ordinary
household tasks.

Support groups for people with carpal tunnel syndrome can help you find
out more information about your condition plus offer advice and solace
from those who've lived with carpal tunnel syndrome. Stress management
and relaxation techniques also may help you deal with the psychological
and emotional issues that may accompany carpal tunnel syndrome.


Prevention

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