Carpal Tunnel Syndrome is a commonly -and sometimes loosely - used term and disability ailment. However, the causes of this nervous syndrome and how it can affect wrist and hand function is not commonly known.
Carpal Tunnel Syndrome is termed a neuromuscular disorder because in classic cases the median nerve is compressed at the wrist, causing pain and a loss of sensory and motor function in the hand. The median is one of the three main nerves that innervate the hand. It passes through the wrist into the hand through the carpal tunnel, a passage way below the flexor retinaculum ligament and between the four lower bones of the hand.
Causes
Carpal tunnel syndrome results from lesions to or inflammation (swelling) of the tendons or synovial tissue sheaths that surround the carpal tunnel. This can occur from injury, fluid retention, infection and activities that require repetitive wrist movements: mechanical work, sports, gardening, painting, and typing. Predisposing causes include pregnancy, rheumatoid arthritis and other disorders.
The median nerve is the most sensitive structure in the carpal tunnel and is therefore most affected. As the passageway in the carpal tunnel becomes constricted, the median nerve is compressed or pinched and unable to function correctly in the hand.
Symptoms of Carpal Tunnel Syndrome
Symptoms include numbness tingling, and burning sensations in the palm and in the fingers that the median nerve supplies: thumb, index, middle and lower half of the ring finger. Pain and paresthesia (a tingling and prickling sensation) usually worsen at night and often interrupt sleep. The pain is prominent at the wrist but may radiate to the forearm and in some cases the shoulder. In severe cases individuals with carpal tunnel syndrome are unable to oppose the thumb (touch the thumb to the opposite finger of the same hand) and have difficulty with fine movements of the thumb.
Both pain and tingling are temporarily relieved by loosely shaking the hand. In some patients symptoms may persist for years without permanent damage to the median nerve. In others, sensory loss (numbness) may occur on the tips of the fingers and weakness can develop in the thumb muscles along with with atrophy or shrinking of the outer part of the thumb muscle. If the cause of the median nerve compression is not alleviated a progressive loss of coordination and strength in the thumb as well as loss of sensation in parts of the fingers, can result in serious disability in hand function and dexterity.
Diagnosis
Diagnosis is based on clinical symptoms and signs and nerve function can be tested with electromyography. If rest and splinting do not alleviate symptoms, surgical treatment called carpal tunnel release in which a partial or complete sectioning of the flexor retinaculum ligament is carried out, may be necessary to decompress the median nerve and restore full function to the hand. This procedure is commonly done by an orthopaedic surgeon.
See your doctor as soon as possible if you feel that you may suffer from carpal tunnel syndrome. Prevention and early treatment are important to maintain nerve health.
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