Carpal tunnel syndrome (CTS) or Median Neuropathy at the Wrist is a medical condition in which the median nerve is compressed at the wrist, leading to pain, paresthesias, and muscle weakness in the forearm and hand. A form of compressive neuropathy, CTS is more common in women than it is in men and, though it can occur at any age, has a peak incidence around age 42. The lifetime risk for CTS is around 10% of the adult population.
Most cases of CTS are idiopathic (without known cause). Repetitive activities are often blamed for the development of CTS along with several other possible causes. However, the correlation is often unclear.
It is a multi‐faceted problem and can therefore be challenging to treat. Still, there are a multitude of possible treatments: treating any possible underlying disease or condition, immobilizing braces, physiotherapy, massage therapy, medication, prioritizing hand activities, ergonomics, et cetera. Ultimately, carpal tunnel release surgery may be required in which outcomes are generally good.
The condition was first noted in medical literature in the early 1900s.
Causes:
The cause of carpal tunnel syndrome is pressure on the median nerve. The median nerve is a mixed nerve, meaning it has a sensory function and also provides nerve signals to move your muscles (motor function). The median nerve provides sensation to your thumb, index finger, middle finger and the middle-finger side of the ring finger.
Pressure on the nerve can stem from anything that reduces the space for it in the carpal tunnel. Causes might include anything from bone spurs to the most common cause, which is swelling or thickening of the lining and lubricating layer (synovium) of the tendons in your carpal tunnel.
The exact cause of the swelling usually isn't known, but a variety of conditions and factors can play a role:
* Other health conditions. Some examples include rheumatoid arthritis, certain hormonal disorders — such as diabetes, thyroid disorders and menopause — fluid retention due to pregnancy, or deposits of amyloid, an abnormal protein produced by cells in your bone marrow.
* Repetitive use or injury. Repetitive flexing and extending of the tendons in the hands and wrists, particularly when done forcefully and for prolonged periods without rest, also can increase pressure within the carpal tunnel. Injury to your wrist can cause swelling that exerts pressure on the median nerve.
* Physical characteristics. It may be that your carpal tunnel is more narrow than average. Other less common causes include a generalized nerve problem or pressure on the median nerve at more than one location.
Pressure on the nerve can stem from anything that reduces the space for it in the carpal tunnel. Causes might include anything from bone spurs to the most common cause, which is swelling or thickening of the lining and lubricating layer (synovium) of the tendons in your carpal tunnel.
The exact cause of the swelling usually isn't known, but a variety of conditions and factors can play a role:
* Other health conditions. Some examples include rheumatoid arthritis, certain hormonal disorders — such as diabetes, thyroid disorders and menopause — fluid retention due to pregnancy, or deposits of amyloid, an abnormal protein produced by cells in your bone marrow.
* Repetitive use or injury. Repetitive flexing and extending of the tendons in the hands and wrists, particularly when done forcefully and for prolonged periods without rest, also can increase pressure within the carpal tunnel. Injury to your wrist can cause swelling that exerts pressure on the median nerve.
* Physical characteristics. It may be that your carpal tunnel is more narrow than average. Other less common causes include a generalized nerve problem or pressure on the median nerve at more than one location.
Symptoms:
Carpal tunnel syndrome typically starts gradually with a vague aching in your wrist that can extend to your hand or forearm. Other common carpal tunnel syndrome symptoms include:
* Tingling or numbness in your fingers or hand, especially your thumb, index, middle or ring fingers, but not your little finger. This sensation often occurs while driving a vehicle or holding a phone or a newspaper or upon awakening. Many people "shake out" their hands to relieve their symptoms.
* Pain radiating or extending from your wrist up your arm to your shoulder or down into your palm or fingers, especially after forceful or repetitive use. This usually occurs on palm side of your forearm.
* A sense of weakness in your hands and a tendency to drop objects.
* A constant loss of feeling in some fingers. This can occur if the condition is advanced.
Diagnosis:
* Tingling or numbness in your fingers or hand, especially your thumb, index, middle or ring fingers, but not your little finger. This sensation often occurs while driving a vehicle or holding a phone or a newspaper or upon awakening. Many people "shake out" their hands to relieve their symptoms.
* Pain radiating or extending from your wrist up your arm to your shoulder or down into your palm or fingers, especially after forceful or repetitive use. This usually occurs on palm side of your forearm.
* A sense of weakness in your hands and a tendency to drop objects.
* A constant loss of feeling in some fingers. This can occur if the condition is advanced.
Diagnosis:
If you have signs and symptoms of carpal tunnel syndrome, your doctor may recommend the following diagnostic tests:
* Electromyogram- Electromyography measures the tiny electrical discharges produced in muscles. A thin-needle electrode is inserted into the muscles your doctor wants to study. An instrument records the electrical activity in your muscle at rest and as you contract the muscle. This test can help determine if muscle damage has occurred.
* Nerve conduction study- In a variation of electromyography, two electrodes are taped to your skin. A small shock is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel.
Treatment:
* Electromyogram- Electromyography measures the tiny electrical discharges produced in muscles. A thin-needle electrode is inserted into the muscles your doctor wants to study. An instrument records the electrical activity in your muscle at rest and as you contract the muscle. This test can help determine if muscle damage has occurred.
* Nerve conduction study- In a variation of electromyography, two electrodes are taped to your skin. A small shock is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel.
Treatment:
Most people with carpal tunnel syndrome experience effective treatment with nonsurgical methods, including:
* Wrist splinting- A splint that holds your wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness. Splinting is more likely to help you if you've had only mild to moderate symptoms for less than a year.
* Nonsteroidal anti-inflammatory drugs- NSAIDs may help relieve pain from carpal tunnel syndrome if you have an associated inflammatory condition. If no inflammatory condition is involved, NSAIDs are unlikely to help relieve your symptoms.
* Corticosteroids- Your doctor may inject your carpal tunnel with a corticosteroid, such as cortisone, to relieve your pain. Corticosteroids decrease inflammation, thus relieving pressure on the median nerve. Oral corticosteroids aren't as effective as corticosteroid injections for treating carpal tunnel syndrome.
* Wrist splinting- A splint that holds your wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness. Splinting is more likely to help you if you've had only mild to moderate symptoms for less than a year.
* Nonsteroidal anti-inflammatory drugs- NSAIDs may help relieve pain from carpal tunnel syndrome if you have an associated inflammatory condition. If no inflammatory condition is involved, NSAIDs are unlikely to help relieve your symptoms.
* Corticosteroids- Your doctor may inject your carpal tunnel with a corticosteroid, such as cortisone, to relieve your pain. Corticosteroids decrease inflammation, thus relieving pressure on the median nerve. Oral corticosteroids aren't as effective as corticosteroid injections for treating carpal tunnel syndrome.
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