If you are experiencing frequent burning, tingling or itching numbness in the palm of your hand and fingers, you may be one of the 8 million Americans suffering from carpal tunnel syndrome. With more than 260,000 carpal tunnel release operations performed annually, carpal tunnel syndrome remains a grave concern for the aging population.
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| Figure 1 (Median Nerve in Yellow) |
Beginning
as part of the brachial plexus, the median nerve travels
down the
inside of the forearm into the wrist and hand and ends at the thumb, index and
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| Figure 2 |
The wrist
is the second major part of carpal tunnel anatomy (Figure 2),
The several small carpal bones form the carpal tunnel, which
houses the median nerve, tendons and blood vessels.
So what is
carpal tunnel syndrome? The condition occurs from pressure placed on the median
nerve at the wrist. In other words, carpal tunnel syndrome arises when space in
the carpal tunnel becomes limited, causing an atypical pressure on the median
nerve and surrounding tendons. This atypical pressure causes the nerve to
become irritated.
As mentioned earlier, typical symptoms of carpal tunnel syndrome include burning, tingling or itching numbness in the palm of the hand and fingers. In addition, people suffering from carpal tunnel syndrome may find it difficult to grasp small objects or form a fist due to decreased grip strength. Because many people sleep with flexed wrists, symptoms are often first noticed at night.
There are
several causes of carpal tunnel syndrome. First, carpal tunnel syndrome may be
due to a congenital disposition.
Some
individuals have a smaller-than-normal carpal tunnel. This is likely the reason
that women are three times more likely than men to develop carpal tunnel
syndrome. In addition, carpal tunnel syndrome has also been linked to sprain
and fractures; hypothyroidism; mechanical problems in the wrist joint;
rheumatoid arthritis; and over activity of the pituitary gland.
Some
evidence suggests that repetitive motion causes carpal tunnel syndrome.
According to a study done by the National Institute for Occupational Safety and
Health, job tasks involving highly repetitive manual acts or necessitating
wrist bending or other stressful wrist postures were
connected with incidents of carpal tunnel syndrome. Moreover, the National
Center for Health Statistics approximated 260,000 carpal tunnel release
operations performed each year, with 47 percent of the cases considered to be
work related.
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| Figure 3 |
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| Figure 4 |
To
diagnose carpal tunnel syndrome, doctors use a variety of tests including the
Tinel Test and Phalen Test. Using the Tinel Test (Figure 3), the doctor will
tap on or press the median nerve in the patient’s wrist. If the test is
positive, a patient will report a shock or tingling in the fingers. During a
Phalen Test (Figure 4), patients hold their forearms upright by pointing their
fingers down and pressing the backs of their hands together. If numbness or
tingling arises, the test is considered positive.
Doctors may also use nerve conduction studies. By measuring the nerve’s response to electric shock, doctors are able to determine if the nerve is responding normally. Electromyography may also be used to diagnose carpal tunnel syndrome. Here, a needle is inserted into the muscle which transmits electrical activity on a screen.
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| Figure 6 |
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| Figure 5 |
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| Figure 7 |
Treatments for carpal tunnel syndrome can be conservative or surgical. Conservative treatments include medication; (Figure 5-6) exercise including stretching and strengthening; physiotherapy; and immobilization. If conservative treatment fails and pain persists, doctors will perform a carpal tunnel release (Figure 7). This surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve.
