Tuesday, May 10, 2011

Carpal Tunnel Syndrome

What is carpal tunnel syndrome?  Carpal tunnel syndrome (CTS) refers to the pain, numbness, and sometimes, but less commonly weakness which is caused by the compression of the median nerve as it travels through the wrist. Carpal tunnel syndrome is one of the most common causes of hand numbness seen.
What are the symptoms?  The classic symptoms include numbness and tingling limited to the median nerve innervated fingers (or fingers that contain nerves that are supplied stimulation through the median nerve), but there is wide variability. The pain and numbness may be localized to the wrist or involve the entire hand. It is also not uncommon for the symptoms to radiate into the forearm, and as well, less frequently to radiate above the elbow to the shoulder. So, the hand symptoms described could be carpal tunnel or radiating pain from the neck.
These symptoms are often provoked by activities that involve extending the wrist, such as raising the arm while driving, reading, writing, typing, or holding a phone.
It is good to know that CTS often presents bilaterally (in both hands), up to 65% of the time.
Carpal tunnel may follow an alternating pattern with periods of remission and exacerbation. In some cases, there is progression from intermittent to persistent that may even advance to motor loss (strength).  In the most severe cases, motor loss involves difficulty holding onto objects, turning keys or doorknobs, or buttoning clothes. One may even see atrophy.
How is it diagnosed?  The diagnosis is a clinical one determined by a physician based on some testing and symptoms. The most important clue is nighttime pain or numbness. Standard symptoms include: dull, aching discomfort of the hand, forearm, or upper arm; numbness in the hand, weakness or clumsiness of the hand, any symptom in median distribution.
Some provoking factors include symptoms occurring in the sleep and repetitive actions of the hand. A test called an EMG which is a series of electrodiagnostic studies are needed to make the diagnosis. The EMG results in combination with the physical exam and the clinical history all lead to the diagnosis.
Who is at risk?  Risk factors for CTS: obesity, female gender, pregnancy, diabetes, rheumatoid arthritis, diabetes, hypothyroidism, connective tissue disease( ex: lupus), pre-existing CTS, genetic predisposition, use of HIV meds, or workplace factors such as cold temperatures, vibrating tools, or repetitive hand use. As an interesting note, most studies do not support the association between computer usage and developing carpal tunnel.
What is the treatment?  Treatment includes splinting, stretches, physical therapy, yoga, injections into the carpal tunnel and finally surgery. For sure there are many treatment options, the success of which usually depends on the severity of the compression. Ask your doctor to discuss the risk and benefits of each. Not all carpal tunnel needs necessarily end in surgery! As well, there are potentially other causes of it other than just overuse.


Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
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1 comment:

  1. Carpal tunnel syndrome is a condition of nerve entrapment. It is caused when the tunnel surrounding the tissues inside the bones of your wrist narrows, inflaming the tissues and your median nerve. A mass may occupy the canal compressing the nerve. The median nerve gives feeling to your thumb, and index, middle and ring fingers. When tissues in the carpal tunnel, such as ligaments and tendons, get swollen or inflamed, they press against the median nerve. That pressure results in the symptoms of carpal tunnel syndrome. People engaged in repetitive motions throughout their day may suffer from carpal tunnel syndrome. Just get an Endoscopic of Carpal Tunnel Syndrome. It will be clear to you.