Carpal Tunnel Syndrome
Three nerves (median, ulnar and radial) supply sensation and promote movement of the hand. The median nerve, arising from multiple nerves of the spinal cord, travels along the middle arm and forearm through the wrist and into the hand. This nerve passes though the wrist in a tunnel known as the carpal tunnel. Numerous tendons that control finger movement form the base and walls of the carpal tunnel. A broad fibrous band, the transverse carpal ligament, forms the tunnel roof. With thickening of this ligament, the median nerve can be compressed in this tunnel, causing pain and numbness in the hand.
Risk factors for carpal tunnel syndrome include repetitive movements of the wrist in certain jobs, such as assembly line work or typing. Retained fluid or soft tissue swelling can cause median nerve entrapment in pregnancy, diabetes, rheumatoid arthritis, degenerative arthritis, lupus, and trauma. Endocrinologic causes of carpal tunnel syndrome include acromegaly and hypothyroidism. Other disorders that may cause similar pain are cervical spine disease, brachial plexus injuries and other peripheral nerve problems.
Patients often complain of tingling or "pins and needles" in their fingers and hand, most significantly in the thumb, index and middle fingers. Sensory loss and a burning sensation are also commonly reported. Pain may radiate up into the arm. Patients frequently notice difficulty with fine motor movements as well. Eventually, there is wasting of the muscles in the hands. Many times symptoms are worse at night.
Conservative treatment involves an extension wrist splint and the use of non-steroidal anti-inflammatory pain relievers. Some patients will experience improvement with such medical management. Steroid injections may also be helpful. Surgical treatment can also produce significant improvement.
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