Injuries or pathology related to muscles, bones, nerves, tendons ligaments and other structural tissue comes in the category of musculoskeletal disorders.
One such condition is carpal tunnel syndrome. Here an unbalanced pressure causes and compresses the median nerve at a very specific location in the wrist called a carpal tunnel. Carpals are the eight bones that form the distal end of the wrist joint. Between two rows of carpals, the median nerve gets pinched producing carpal tunnel syndrome. The condition presents with numbness, thinning, and weakness of the hand.
The main cause is impingement of the median nerve which may happen due to:
- Repetitive hand movements like those involved in typing or excessive persistent vibrations like that of factory equipment can act as causative agents. Movement involving repetitive flexing of the wrist is also responsible for the condition.
- Pregnancy or weight and fluid accumulation due to pregnancy.
- Hormonal disorders like acromegaly and hypothyroidism and diabetes mellitus.
- Rheumatoid arthritis.
- A post wrist fracture or dislocation.
- Obesity or being overweight can also reduce the space between carpal tunnels.
- Some people anatomically have smaller carpal tunnels making them more prone
- Being a women makes you more at risk of carpal tunnel syndrome due to anatomically smaller carpal tunnel
- A condition affecting nerves directly or due to other underlying conditions like diabetes and the thyroid problems
- Certain medications like anastrozole (Arimidex) that is being used to manage breast cancer
- Fluid retention that may occur due to pregnancy, menopause, kidney issues, lymphadenopathy and more
- Obesity-related disorders like hypothyroidism are also associated with carpal tunnel syndrome
- Cold weather
- Tingling and numbness radiating both upwards to arm and downwards to hand. Three and a half fingers from thumb (index and middle) are affected. The symptom usually wakes you at night or while you perform a long term continuous activity like typing or driving. There may be a loss of sensation in the stated fingers and radial side of the forearm.
- Thinning of the area in your palm below the thumb.
- Weakness is felt in hand muscles that may present as clumsiness and dropping things.
- Hand Exam for motor and sensory inputs. A sensation on the radial forearm and paper test for the weakness of hand muscles
- History, symptoms and verbal questions
- X-Ray to diagnose an underlying cause
- Electromyography for evaluating the activity of muscles to confirm nerve damage
- Nerve conduction velocity through the median nerve
- Physiotherapeutic Management
- Rest, Ice, Compress and Elevate
- Pain relieving modalities like TENS
- Ultrasound for healing
- Strengthening of thenar muscles
- Splinting to avoid excessive wrist flexion
- Functional splints
- Stability splints
- Take frequent/hourly breaks and perform wrist/arm stretches
- Avoid triggering movements
- Medication Management
- Anti epileptics like Gabapentin and oxcarbazepine
- Surgical Management
- Endoscopic minimally invasive surgery by relieving the cause of pressure from the median nerve
- Open surgery
Prevention and lifestyle:
- Use correct ergonomic postures for specific tasks like keeping your wrist neutral while typing
- Use ergonomic precaution gear for factory jobs that involve vibration
- Lose extra weight that you have
- Breaks and stretches will take you a long way
- Avoid cold weather, wear gloves to keep extremities warmer
I hope the above bit must have substantially added to your knowledge base about carpal tunnel syndrome. You already know it, awareness is the preliminary precaution.