Carpal Tunnel Syndrome
Carpal tunnel syndrome, a common disorder of the wrist, was first described during the 19th century.
Widespread recognition and treatment for this condition began in the 1950s.
The carpal tunnel is an area in the hand located at the junction of the wrist. A band of dense fibrous
tissue stretches over the palm to stabilize the structures that pass to the hand. The back wall of the carpal
tunnel is bound by the carpal bones of the base of the hand. The transverse carpal ligament on the palm
surface and the carpal bones on the dorsal surface comprise the boundaries of the carpal tunnel. Passing
through the carpal tunnel are the various tendons to the fingers, the median nerve, and branches
of nutrient arteries that supply these structures.
The symptoms of carpal tunnel syndrome are caused by compression of the median nerve by these rigid structures.
The median nerve becomes flattened just after it passes across the crease of the wrist.
The syndrome is seen more often in women than in men and occurs more frequently between the
ages of 40 and 70. While symptoms involve both hands, the dominant hand is usually most severely
The cause of carpal tunnel syndrome has not been specifically identified, but certain associations are
recognized with a number of conditions and disorders. The use of vibratory hand tools and the performance
of repetitive motion tasks, such as knitting, contribute to carpal tunnel symptoms.
Pregnancy is commonly associated and appears to be related to increased fluid retention. Women taking oral
contraceptives may also experience symptoms. Within three months after termination of pregnancy or oral
contraceptive use, many of these cases clear.
Carpal tunnel syndrome can co-exist with other disorders, including diabetes, hypothyroidism, acromegaly,
amyloidosis, scleroderma, measles immunization, rheumatoid arthritis, systemic lupus erythematosus, various
drug ingestions (hormones having a weakly androgenic activity, postmenopausal estrogen use, and others),
hypertension, hysterectomy, oophorectomy or tubal ligation.
Symptoms and Diagnosis:
How do you know if you have carpal tunnel syndrome? First, the symptoms are specific. There is tingling
and numbness from the wrist to the hand. The index finger is commonly involved, but there also may be tingling
and numbness of the entire hand. There may be some weakness of the muscles of the hand and inability to
operate the thumb appropriately.
When the symptoms occur at night, shaking or rubbing the hands or holding them down, off the bed may relieve
symptoms. Tinel's sign is a test for the syndrome. It involves tapping gently over the palm surface of the wrist at the
crease. Increased pain may confirm carpal tunnel syndrome.
Another diagnostic test is Phalen's sign. In this test, the wrist is bent forward on itself and held tightly in position for 60
seconds. Increased pain may confirm diagnosis.
Fullness or swelling at the wrist and some emptiness or atrophy (shrinkage) of the large fleshy muscle at the base
of the thumb may also be seen. An aching discomfort may extend up the arm. Occasionally, bursts of pain erupt
when the hand, wrist, or forearm are used.
Treatment and Management:
Treatment for carpal tunnel syndrome should begin as soon as symptoms appear. If symptoms are left
untreated for two to three years, there may be a permanent loss of sensation or muscle ability in the hand or wrist.
If symptoms appear, cease gardening, ironing, sewing, crocheting, and the use of vibratory equipment.
Relief of symptoms often follows discontinuation of these activities.
Immobilize the wrist while you sleep with a splint on the back surface of the hand and forearm. This simple
treatment can be achieved by a surgical device or rigged from any rigid support strapped to the hand and forearm
by tape or with an ace bandage.
Fluid retention causing carpal tunnel syndrome is seen in many patients, particularly pregnant women. For
these cases, diuretic teas may help improve symptoms. Diuretic teas include buchu, burdock, corn silk tea, and
watermelon seed tea. One cup taken daily is the recommended dosage. Eight to ten glasses of water should be
consumed daily as drinking water is a natural diuretic.
Some biochemical studies suggest a deficiency of vitamin B-6 in cases of carpal tunnel syndrome. For these
cases, eat foods high in vitamin B-6, including whole grain cereals, legumes, bananas, and oatmeal.
Rest, weight reduction, and the correction of any systemic disease should be an initial part of treatment. This
includes correction of anemia, thyroid conditions, diabetes, etc. All drugs suspected of being a cause should be stopped
at once, including possible oral contraceptives and female and male hormones.
The injection of corticosteroids into the carpal space or the systemic use of corticosteroids provides temporary
relief from a few days to months. The injection of medication may aggravate compression or injure the nerve.
For serious cases, surgical section of the carpal ligament is an option. This method may bring relief immediately
after surgery in 70 to 80 percent of cases. The prognosis is best for patients with least severe symptoms for the shortest
duration, stressing the importance of beginning treatment early.
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