Carpal Tunnel Syndrome

Carpal tunnel syndrome occurs when the median nerve is compressed, resulting in pain, numbness, tingling, weakness, or a burning sensation in your hand and fingers (except for the little finger, which remains unaffected). The median nerve runs from your forearm into your hand through a tunnel in your wrist. Wrist bones comprise the sides and bottom of the tunnel, while the transverse ligament forms the top of the tunnel. There are also tendons in the tunnel that connect muscle to bone, but the median nerve is the culprit in carpal tunnel syndrome. Compression of the median nerve, whether it is from swelling or narrowing of the tunnel, is the cause of symptoms. In some cases, enlargement of the median nerve can cause carpal tunnel syndrome, but more often it is compression of the nerve.

Symptoms associated with carpal tunnel syndrome typically begin gradually with a sensation of itching, tingling, or burning in the palm of the hand or index finger, middle fingers, or thumb. One or both hands may be affected. Often, a feeling of fullness or swelling is present even when no swelling is truly evident. Clumsiness and problems with tasks requiring manual dexterity are frequent complaints.

Pain may radiate from the hand up to the elbow. It is common for carpal tunnel symptoms to be worse at night and when the hand is warm. The muscles at the base of the thumb can atrophy.

Diagnosing and Treating Carpal Tunnel Syndrome

According to the Arthritis Foundation, several physical tests help diagnose carpal tunnel syndrome. One of the physical tests is called Tinel's sign; it involves tapping the front of your wrist to check for pain and tingling. Another test, known as Phalen's sign, involves bending the wrist downward, holding, and releasing to check for pain and tingling. Nerve conduction studies can also provide more information. To rule out other conditions, blood tests and x-rays may be ordered.

Essential

The cause of carpal tunnel syndrome is not always known. Wrist injury, swelling associated with different types of arthritis, repetitive motion, certain occupations, diabetes, thyroid disease, inflammatory arthritis such as rheumatoid arthritis, and hormonal changes have all been linked to carpal tunnel syndrome. However, sometimes it can develop for no obvious reason.

Treatment of carpal tunnel syndrome focuses on relieving pain and restoring normal sensations. NSAIDs (nonsteroidal anti-inflammatory drugs) and corticosteroid injections are often used to control inflammation. Protective splints can help the condition from worsening in many cases. If work or certain activities aggravate symptoms, modifying those activities or using adaptive equipment can help by decreasing pain, stiffness, and swelling. Surgery is a common but last-resort solution. The procedure, called a carpal tunnel release, relieves pressure on the median nerve.

Prevalence of Carpal Tunnel Syndrome

Women are more commonly affected by carpal tunnel syndrome than men; according to the National Institutes of Health, women are three times more likely than men to develop carpal tunnel syndrome. Though it can develop at any age, onset is most common after age fifty. Carpal tunnel syndrome is rare in children.

In 2002, the Bureau of Labor Statistics reported that carpal tunnel syndrome accounted for the highest number of missed workdays (twenty-seven), more than missed days due to back injury or broken bones. It has been estimated that about 3 percent of women and 2 percent of men will at some time develop carpal tunnel syndrome.

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