Carpal Tunnel Syndrome by Nancy Glick

CTS is a condition on which the small narrow passage that allows passage of the nerves and blood vessels at the base of the hand through the wrist area.  This carpal tunnel is made up of bone, tendons, tissue, and nerves that run from the arm traveling through the carpal tunnel to their distal end points of the hand, palm, fingers, and wrist.  Carpal Tunnel Syndrome occurs when this passage is affected by narrowing, swelling, or enlargement of the tendons in the carpal tunnel, which can result in the cause of severe pain, tingling, itching, burning sensations and numb sensations from the phalanges and may run up the forearm to the elbow when the nerves in the tunnel are compressed. Compression of the peripheral nerves is often referred to as entrapment neuropathy.

Symptoms of CTS are mostly caused by pressure on the median nerve that runs through the carpal tunnel that relays signals from the thumb, index finger, middle finger, and half of the ring finger. Under continued advancement of CTS can affected individuals experience loss of strength in the fingers, thumb, and palm, resulting in loss of grip, making it difficult to hold or open objects.  Eventually could lead to atrophy, aka muscle wasting. Muscle wasting occurs most frequently in muscles situated under the thumb at the attachment to the palm. Most affected also report a loss of temperature response in the fingers and hands, leaving them unable to distinguish between hot and cold water running over the sides.

Populations affected by Carpal Tunnel syndrome may not be commonly perceived. Most individuals think of secretaries or data entry works when they think of the CTS. However, it has been found that typing actually may decrease the progression of the Carpal Tunnel Syndrome. CTS rather effects populations working in other repetitive occupations such as assembly line workers, or any occupation that performs the same repetitive motion for long periods of time such as playing an instrument or working with tools (especially tools that involve vibration). Even sleeping in awkward positions with the wrist flexed may be a source of CTS. Obesity can exasperate the condition, as well as, fluid retention during pregnancy or menopause, sprain or fracture to the wrist, development of a tumor or cyst in the tunnel, hypothyroidism, rheumatoid arthritis, and diabetes. Sometimes there is no identifiable cause for the onset of CTS. Carpal Tunnel Syndrom is said to affect 3% or 2% of men in recorded cases but is said to transpire in three times more adult women than men. CTS does not often plague children or adolescence.

The onset of the Carpal Tunnel Syndrome is usually a gradual progression most often first appearing at night in one or both hands. Stiffness may also be felt in the morning within the hands and fingers. The sooner treatment is started; the more likely long-term damage to the nerve can be prevented. However, any underlying problem that can be identified as the cause, such as diabetes or arthritis must be addressed before proceeding with treatments of CTS.

The process of diagnosing Carpal Tunnel Syndrome by a full exam of neck, shoulders, arms, and hands, to rule out any other disorders and determine the effected’s pain level. Wrists will be checked for warmth, swelling, discoloration, atrophy, strength, and tenderness. Also, each finger is examined individually. X-rays may be used to determine if any fractures, arthritis, nerve diseases or diabetes have affected that area. A process called the Tinel test will test positive if there is a tingling sensation in the affected fingers when the median nerve is tapped. For wrist flexion, Phalen’s maneuver, in which pressing the backs of hands and fingers together with the wrists flexed will also present a positive response if the tingling or numbness is felt in the fingers within 1-2 minutes. Confirmation of CTS may also be checked trough electrodiagnostic tests, which determine the electrical activity of nerves and muscles to send signals. This can determine how much damage has progressed on the median nerve. Any irregularities of the size of the medial nerve can be determined by ultrasound imaging.

Western medicine approaches to treating CTS involve the use of splints worn on the wrist. However, it was found that wearing the splints during activity can exasperate the condition, and it is best to be used to prevent flexion of the wrists during sleep. Both uses of nonsteroidal anti-inflammatory drugs and corticosteroid injections are used to reduce swelling to relieve pain. The icing on the wrists is also used to relieve pain in intervals of 10 to 15 minutes, once or twice per hour.  Patients are encouraged to take frequent breaks from repetitive activities to alleviate symptoms. For prolonged cases, open release surgery or endoscopic surgery may apply incisions to the Capital tunnel to allow more room, and relieve pressure on the median nerve. Operation most often results in lowered grip function, infections, verve damage, stiffness and painful scarring. With surgery modified work activity is mandatory, and there is no assurance that a change in jobs may not be necessary, or that CTS will not reoccur.

Alternatively, use of yoga for stretching and massage therapy is being used to treat Carpal Tunnel syndrome. Massage helps to alleviate pain by breaking down adhesions and scar tissue in muscles from the arm and wrist that may have formed from overuse of the muscle fibers. Stretching of the tendons and ligaments of the wrist relieves the pressure of the tendons and ligaments of facilitating recovery and diminish friction on the inflamed areas; giving a nonsurgical solution to the problems of CTS.

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