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Carpal tunnel syndrome is a condition which many people have heard of, but very few people understand.
Carpal tunnel syndrome (CTS) occurs due to compression of the median nerve within the wrist, more specifically the carpal tunnel of the wrist. This is formed by the 8 carpal bones (Scaphoid, Lunate, Triquetral, Pisiform, Hamate,Trapezoid, Trapezium and Capitate) posteriorly and the flexor retinaculum anteriorly. This flexor retinaculum is an accessory ligament which attaches to the Scaphoid and Lunate on the medial side of the wrist and to the Pisiform and Hamate laterally. It forms a 'bridge' over the carpal bones with a 'tunnel' passing underneath. Through this tunnel passes four flexor tendons and the median nerve.
The median nerve emerges from the spinal cord as part of the brachial plexus, at the neck. It travels down the arm and through the carpal tunnel. At this point it branches off to supply the thumb and three fingers (all but the little finger).
As already mentioned, carpal tunnel syndrome is caused by compression of the median nerve within the carpal tunnel. The cause of the compression may vary and is not the same in every case. Compression may be caused by:
Swelling within the carpal tunnel
This is the most common cause of compression, although the causes of the swelling can also be varied. Repetitive wrist movements can cause overuse of the flexor tendons within the tunnel. These may become inflamed and swelling may occur. This is the case in carpal tunnel syndrome brought on by desk/computer work, or other repetitive activities.
Traumatic wrist injuries (such as following road traffic collisions or falls) may also result in swelling within this space.
Fluid retention within the carpal tunnel
Pregnancy is the most common cause of fluid retention within this space, resulting in the development of CTS. Hypothyroidism may be another cause. People with diabetes are also more likely to develop CTS.
Structural causes
Some individuals naturally have a smaller carpal tunnel, with a decreased space for the tendons and median nerve to pass through. This is more common in females.
Acromegaly, a growth hormone condition, can cause abnormal delayed growth of the bones around the hand and wrist, leading to a decrease in space.
Very rarely, the growth of a tumor such as a ganglion or a lipoma can decrease the carpal tunnel space.
Obesity may also contribute to the development of this condition.
Symptoms of carpal tunnel syndrome usually involve:
- A gradual onset and increase in symptoms
- Initially symptoms often occur only at night due to the tendency to sleep with a flexed wrist which further compresses the nerve.
- Numbness and tingling are usually the first symptoms, which are felt in the thumb, index and middle fingers, the thumb side of the ring finger and occasionally the palm.
- Weakness in the hand on gripping and on moving the thumb away from the hand.
- Pain may occur in the fingers, thumb, hand, wrist and even higher up the arm.
- Dry skin or skin colour changes in the hand.
- Long-term cases may result in wasting of the hand muscles, most notably the thenar eminence (muscular area below the thumb).
Treatment of carpal tunnel syndrome
CTS treatment should involve reducing the cause of the compression. In the majority of cases, this is swelling or fluid retention, possibly with accompanying inflammation in overuse of traumatic wrist injuries. In these cases:
- Rest from aggravating activities. A wrist splint can be worn to prevent wrist flexion as this further compresses the median nerve. This can also be worn at night if necessary.
- Applying cold therapy to the wrist. The use of a cold pack or ice bath immersion can be helpful in decreasing swelling and inflammation.
- Anti-inflammatory medication. The use of anti-inflammatory medication such as ibuprofen is useful in overuse and traumatic wrist injuries to decrease both pain and inflammation. Always speak to your Doctor first.
- Diuretics. Your Doctor may prescribe Diuretics (water tablets) for cases bought on by hypothyroidism to decrease water retention. These are no longer recommended during pregnancy.
- Steroids. Your Doctor may suggest the use of either corticosteroid tablets, or an injection.
- Ultrasound. Ultrasound therapy is used commonly in musculoskeletal injuries due to its ability to decrease swelling and inflammation. It has been shown to be effective in treating CTS.
- Surgery. In particularly severe cases, or if symptoms persist beyond 9-12 months, surgery can be performed to release the flexor retinaculum, creating more space within the wrist. Other surgical procedures may be performed in structural cases, for example to remove a tumor.
- Once symptoms start to improve a rehabilitation program to ensure full wrist range of motion and strength can commence.
For more information on treatment and a rehabilitation programme for carpal tunnel syndrome, please visit sportsinjuryclinic.net
Heidi Mills BSc GSR is a graduate sports rehabilitator who runs a sports injury clinic in Norwich, UK. She also works for information website http://www.sportsinjuryclinic.net.
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