|
Sign and Symptoms of Carpal Tunnel Syndrome
In recent years, carpal tunnel syndrome has become a commonly occurring orthopaedic problem within the American public. This problem stems from compression on the median nerve, a major nerve in the wrist, which assists the hand with motion and sensation. The median nerve supplies the thumb with motor enervation (movement) and supplies the thumb, index, and middle fingers with sensation (feeling to the palmar side of the fingers). It is through entrapment (compression of the median nerve) that the symptoms of carpal tunnel syndrome occur. Compression results from over development of swollen, inflamed tissue in the area where the median nerve crosses the wrist. The inflamed tissue generally results from overuse and repeated stress to the wrist joint and tendons. This condition is seen most often in those who work with their hands. Bricklayers, carpenters, tile-setters, computer keyboard operators, and heavy laborers are at greatest risk for developing carpal tunnel syndrome. This condition is three times more common in females versus males and typically presents in the female between the ages of 30 and 50.
Common symptoms include tingling and numbness in the fingers (mainly the thumb, index, and middle finger) and occasional "electric shock" pains that may move up the arm (from the wrist), or travel into the hand. Symptoms are usually worse at the end of the day, nighttime, or after periods of activity. Patients frequently complain of waking up at night with their "hands asleep". Carpal tunnel syndrome is usually bilateral, but often presents first in the hand most dominantly used. Evaluation includes history and physical examination. Phalen's test is performed to diagnose this condition. In this test, the patient holds their wrist in full, unforced, palmar flexion. The development if any sensory disturbance (numbness, tingling, or burning pain) within 60 seconds is diagnostic for carpal tunnel syndrome. Any evidence for weakness to the thumb, or diminished feeling in the fingertips, should make the examiner suspicious. Nerve conduction studies can be done to confirm the diagnosis of nerve entrapment (nerve dysfunction) and represents the most sensitive test for diagnosing this problem. Routine bone x-rays will be performed to exclude the possibility of associated bone fracture, tumor, or arthritis. Treatment includes the use of anti-inflammatories (i.e. ibuprofen) to reduce swelling at the site of impingement, thus reducing symptoms. Rest, elevation, and splinting (in neutral) to immobilize the wrist will also be recommended. The use of injectable steroids into the wrist can provide dramatic but only temporary relief of symptoms. Surgical management will be necessary for those patients with neurologic findings (weakness or numbness) or abnormal nerve conduction testing. Operative intervention to release the median nerve from the surrounding tissue causing the problem is performed by a hand surgeon or orthopaedic surgeon in most cases. More recently, endoscopic median nerve release has been performed through a thin fiberoptic tube, eliminating the need for the larger, conventional incision.
Hope this article will provide you information about carpal tunnel syndrome.
|
