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Carpal Tunnel

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What is Carpal Tunnel Syndrome?

There are many causes of pain in the hand, but carpal tunnel syndrome is the most common cause. See your doctor or nurse practitioner to be sure.

A common, painful, progressive condition, carpal tunnel is caused by compression of the median nerve in the wrist.

The carpal tunnel is a narrow passageway in the wrist that is made up of the carpal bones in the wrist and the ligament connecting them. The median nerve and tendons pass through this tightly spaced tunnel. Carpal tunnel syndrome occurs when these tendons or ligaments become enlarged, often from inflammation, and compress the median nerve as it passes through this tightly spaced area.

The median nerve provides sensation to the palm side of the thumb, index, middle fingers, as well as the inside half of the ring finger and muscle strength to the thumb. When this nerve becomes compressed, numbness, tingling and sometimes pain of the affected fingers and hand may occur and radiate into the forearm.


Symptoms

The first symptoms usually appear at night and can range from a burning, tingling numbness in the fingers, especially the thumb and the index and middle fingers. The symptoms can progresws to difficulty gripping or making a fist, or dropping things. If not treated, the symptoms may escalate into acute, persistent pain and it can become so crippling that people can no longer do their work or even perform simple tasks at home.

Causes of Carpal Tunnel

Repetitive use: Carpal tunnel is often found in workers whose tasks require repeating the same motion in the fingers and hand for long periods of time. With the growing numbers of people using computers, carpal tunnel syndrome is a common source of pain and disability. Recent studies have shown that carpal tunnel syndrome is on the rise while other workplace injuries have leveled off.

Many activities outside of work also may contribute to carpal tunnel: knitting or sewing; cooking and housework; playing cards; TV computer games and home computer work and games; athletic activities; and hobbies or projects like carpentry or using power tools for extended periods of time.

Diseases or conditions that predispose to the development of carpal tunnel syndrome include pregnancy, fluid retention, diabetes, obesity, or any metabolic condition such as thyroid disease.

Congenital defect: In some cases no direct cause of the syndrome can be identified in which case the disorder might be due to a congenital abnormality where the carpal tunnel is simply smaller than average.

Treatment of Carpal tunnel syndrome Five steps that will help:

  1. Rest : Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms. Assess the source of your problem:
      1. Computer users:
        1. Move only your fingers to type
        2. Keep a straight wrist at the keyboard
        3. Use a keyboard pad at the bottom to rest your wrist during breaks.
        4. Keep your monitor at a comfortable eye level so you're not bending your neck to look up or down.
        5. Sit comfortably with good posture, shoulders relaxed and elbows at your side.
        6. Use a lumbar support: place a lumbar support pillow or small throw pillow behind your lower back.
        7. Place your feet on a small foot rest so that your knees are at the same level as your hips.
      2. Small hand tool users:
        1. Use tools that are comfortable and easy to hold. A larger grip sometimes relieves the stress on the hands.
        2. Tools that require bending at the wrist will cause or aggravate carpal tunnel.
        3. Tools that vibrate will also cause or worsen the symptoms.

  2. Splint A special splint for carpal tunnel, worn at night, will keep the wrist straight during sleep and can provide significant relief of symptoms during the day. Day time use of the splint may also be necessary for a while to keep your wrist straight and avoid further damage from twisting or bending.

  3. Nonsteroidal anti-inflammatory drugs, (if not contraindated) such as aspirin, ibuprofen, and other nonprescription pain relievers, may ease pain.

  4. Cool (ice) packs x 20 min three to four times daily relieve pain, swelling, and inflammation.

  5. Exercises: Stretching and strengthening exercises can be helpful in people whose symptoms have abated.(4) Physical therapists can design and initiate an exercise program as well as target and correct poor work habits.


Surgical procedure If symptoms last for 6 months or more, doctors may recommend surgery to sever the band of tissue around the wrist and reduce pressure on the median nerve. However, only a small percentage of patients require surgery.

What is the prognosis?
Approximately 1 percent of individuals with carpal tunnel syndrome develop permanent injury. The majority recover completely and can avoid reinjury by changing the way they do repetitive movements, the frequency with which they do the movements, and the amount of time they rest between periods when they perform the movements.(4)

Severe and chronic carpal tunnel syndrome
When prolonged irritation occurs around the median nerve, it can become chronically constricted and compressed to the point that it begins to deteriorate. This results in a slowing of nerve impulses, which may cause diminished sensation in the fingers and a loss of strength and coordination at the base of the thumb. If left untreated, carpal tunnel can result in chronic pain and permanent deterioration of muscle tissue.
Educational Video Tutorials
Medline Plus   Scroll down to "Surgery and Treatment Procedures" and select "carpal tunnel".  Medline Plus is a service of the National Library of Medicine and the National Institute of Health.
National Organizations and References

(1)American Chronic Pain Association (ACPA), http://www.theacpa.org
Tel: 916-632-0922 800-533-3231
(2)National Chronic Pain Outreach Association (NCPOA) http://www.chronicpain.org
Tel: 540-862-9437
(3)National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) National Institutes of Health, DHHS http://www.niams.nih.gov; Tel: 301-496-8190 877-22-NIAMS (226-4267)
(4)Carpal Tunnel, from The National Institute of Neurological Disorders and Stroke, National Institutes of Health

Written by N Thompson, ARNP in collaboration with M Thompson, MD, Internal Medicine, Updated January 2008

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