Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

Carpal Tunnel syndrome is a common and troublesome condition that interferes with the use of the hand. It is caused when too much pressure is put on the median nerve that runs through your wrist.

The median nerve is found in a tunnel within the hand, whose floors and walls are formed by a collection of small bones, the roof of the tunnel is a tightly sprung sheet of dense fibrous material called fascia.

Running through this tunnel are the tendons – the ropes and pulleys that bend your fingers and thumb – as well as the median nerve, which is a large electrical cable transmitting signals to and from the brain to the fingers.

In the majority of cases, we don’t know what causes this. Fluid retention is sometimes to blame, which is why it sometimes flares up during pregnancy, and it is more common in diabetics or in people with an under active Thyroid gland.

THE SYMPTOMS

Women are far more likely to have carpal tunnel syndrome than men. It can affect people of all ages. If you have this condition you will experience pain, aching and tingling or numbness. The symptoms are usually worse in the thumb, index and middle fingers. The symptoms are usually worse at night, when they may disturb your sleep, or in the morning when you wake. Hanging your hand out of bed or shaking it around will often relieve the pain and tingling.

During the day time the problem may not occur, but some people find that it can be brought on by physical activities at work or home such as writing, typing, housework and DIY. If the nerve is badly squeezed, the problems may continue throughout the day. The hand may feel weak, or the fingers numb or both. There is then a tendency for objects to slip out of your grasp and you may find that activities, which require fine finger movements like writing or sewing, become more difficult.

THE EXAMINATION

The wrist may be swollen due to arthritis or tendon swelling and this may explain why carpal tunnel syndrome has developed. If the problem is severe the thumb, index and middle fingers may be insensitive (numb) to either gentle touch or to a pinprick. You may be tapped over the median nerve on the palm side of the wrist. A sharp tingling pain in the fingers confirms the diagnosis. Holding the wrist in a flexed position with pressure applied to the carpal tunnel can cause tingling in the fingers.

If the diagnosis isn’t clear from clinical examination and if surgery is being considered, you may be sent to see another doctor to perform a nerve conduction test. Small electrodes are placed on the skin just above the wrist to stimulate the median nerve. In someone with carpal tunnel syndrome there is a delay before the impulse arrives in the thumb muscles. This delay can be measured and will tell the doctor whether the nerve is badly or only slightly compressed.

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