The carpal tunnel syndrome (CTS) is a collection of characteristic symptoms and signs that occurs following entrapment of the median nerve within the carpal tunnel.

The carpal tunnel is a narrow passage way bounded by carpal bones (wrist bones) and ligaments at the level of wrist through which nerves and tendons pass. One of the nerves passing through the carpal tunnel is the median nerve (running from forearm into the hand), supplying brain commands to the thumb, index and middle fingers, and half of the ring finger.

Carpal tunnel syndrome is caused by increased pressure in the carpal tunnel resulting in compression of the median nerve. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed. Possible causes include:

• Increasing age

• Female sex

• Square-shaped wrist

• Genetics

• Family susceptibility (e.g., square wrist, stature).

• Inherited medical conditions are associated with CTS (e.g., diabetes, hypothyroidism).

• Wrist fractures and dislocations

• Crush injuries

• Inflammation around tendons

• Diseases like Rheumatoid Arthritis

• Tumors

• Fluid retention in the wrist joint

• Certain occupational activities

• Pregnancy

• Female to male ratio is 3-10:1.

• Peak age of development of CTS is between 45-60 years.

• Numbness, burning, or tingling in one or more of the fingers .
• Loss of grip strenght, sometimes associated with dropping things.
• Pain (at the nerve distribution site).
• Tight or swollen feeling in the hands.
• Temperature changes (e.g., hands being cold/hot all the time).
• Complaints of changes in sweating, sensitivity to temperature changes (esp. cold) and skin discoloration of the affected hand (these symptoms are due to autonomic nerve entrapment).

The symptoms often first appear gradually in one or both hands during the night, since many people sleep with their wrists flexed.Patients may also experience the symptoms on performing everyday tasks. A person with carpal tunnel syndrome may wake up feeling the need to “shake out” the hand or wrist. As symptoms worsen, they may also feel a tingling sensation throughout the day.

Carpal tunnel syndrome does not usually cause significant disfigurement.However a muscle group in the hand called the thenar muscles (supplied by median nerve) located just below the thumb may begin to waste away, giving a flattened appearance to the palm when compared to the other hand.

Some possible methods of treating CTS include:

CONSERVATIVE TREATMENT:

• Treating the underlying cause.
• Resting the affected hand and wrist for at least 2 weeks.
• Avoiding activities that may worsen symptoms.
• Immobilization of the wrist with a splint.
• Applying cold packs (helps reduce swelling).

MEDICAL TREATMENT:

Drugs usually are directed against pain, so various analgesics may serve the purpose

• Non steroidal anti-inflammatory drugs, such as aspirin, ibuprofen

• Diuretics can decrease swelling.

• Steroids may be injected directly into the wrist or taken by mouth to relieve pressure on the median nerve

SURGICAL INTERVENTION:

Patients whose condition do not improve following conservative treatment and patients who experience severe CTS symptoms may need surgery.

• No conclusive evidence exists for its prevention of carpal tunnel syndrome. However regular exercise, rest, reducing repetitive hand movements, and the use of properly designed tools and equipment may help reduce the risk.

• Caffeine, alcohol, and nicotine are associated with development of CTS so these should be avoided.

• Permanent impairment and disability

• Chronic wrist and hand pain

Find out how Carpal Tunnel Syndrome can be more effectively treated.

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