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Carpal Tunnel Syndrome

Carpal tunnel syndrome is a medical condition that occurs when the median nerve, which runs from the forearm into the hand becomes pressed or pinched at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers as well as impulses to some small muscles in the hand that allow the fingers and thumb to move. This very important nerve passes through a narrow, rigid passageway of ligament and bones at the base of the hand and shares this passageway or tunnel with nine tendons. Carpal tunnel syndrome happens when pressure builds up from swelling in this tunnel and puts pressure on the nerve, when the pressure from the swelling becomes great enough to disturb the way that the nerve works, this is commonly known as Carpal Tunnel Syndrome.

The most common symptoms of carpal tunnel syndrome are tingling, numbness, weakness, or pain of the fingers or, less commonly, the palm. Symptoms most often occur in the parts of the hand supplied by the median nerve, the thumb, index finger, middle finger and half of the ring finger. Symptoms usually start gradually, with frequent burning, tingling or itching numbness in the palm of the hand and the fingers. Some carpal tunnel sufferers say their fingers feel useless and swollen, even though little or no swelling is apparent. The symptoms often first appear in one or both hands during the night, since many people sleep with flexed wrists. A person with carpal tunnel syndrome may wake up feeling the need to "shake out" the hand or wrist and sometimes shaking the hand will temporarily relieve the symptoms. As symptoms worsen, people might feel tingling during the day. Decreased grip strength may make it difficult to form a fist, grasp small objects or perform other manual tasks; you may feel clumsy and may drop things that you try to grasp in the effected hand. In chronic and/or untreated cases, the muscles at the base of the thumb may waste away. Some people are unable to tell between hot and cold by touch.

The carpal tunnel is a small space or "tunnel" in the wrist formed by the wrist bones (carpal bones) and a ligament (transverse carpal ligament). Any reduction in the size of this space can cause symptoms. The most common cause of Carpal Tunnel Syndrome is overuse or repetitive work. Conditions such as hypothyroidism and rheumatoid arthritis can increase the amount of tissue in the carpal tunnel. The swelling that is common in pregnancy, with the use of birth control pills or at menopause can also crowd structures in the tunnel. Wrist injuries, bone spurs, or swelling of the tendon sheath can decrease the space available in the carpal tunnel. A common cause of tendon sheath swelling is forceful or repetitive movement of the fingers and hand, especially if the wrist is in an awkward position. Conditions such as diabetes, which increases nerve sensitivity, can make the median nerve more sensitive to pressure. Smoking and obesity can each increase the risk of developing symptoms.

Who Is At Risk?
Women are three times more likely than men to develop carpal tunnel syndrome, perhaps because the carpal tunnel itself may be smaller in women than in men. The dominant hand is usually affected first and produces the most severe pain. Carpal tunnel syndrome usually occurs only in adults. The risk of developing carpal tunnel syndrome is not confined to people in a single industry or job, but is especially common in those performing assembly line work, manufacturing, sewing, finishing, cleaning and meat, poultry or fish packing. Interestingly enough, carpal tunnel syndrome is three times more common among assemblers than among data-entry personnel. Heavy computer use does not necessarily increase a person's risk of developing carpal tunnel syndrome.

Carpal tunnel syndrome is diagnosed based on your medical history, a physical exam and sometimes further tests. In learning about your medical history, your health professional will want to know about health conditions you have, such as arthritis, hypothyroidism, diabetes or pregnancy. He or she will ask about any accidents or injuries of the wrist, arm, or neck you may have had recently. Your usual daily activities and any recent unusual activities are also an important part of your medical history. The physical examination will include evaluation of the feeling (sensation), strength and appearance of your neck, shoulders, arms, wrists and hands. Further testing may include: Blood tests, if any health conditions are thought to be contributing to your symptoms, Nerve testing to determine whether signals are passing normally down the median nerve and X-Rays to help evaluate the size and shape of the carpal tunnel or in some cases to evaluate your neck.

Non-surgical treatment usually relieves the pressure and pain in the wrist and hand. Many times Chiropractic adjustments are successful in relieving the pressure within the Carpal Tunnel if the Doctor is properly trained in such treatment procedures. Mild carpal tunnel syndrome is often treated first by changing the way you do things. If an activity seems to be aggravating your symptoms, you can try doing it less often, increasing the amount of rest time between repetitions or changing the position you are using for the activity.

Recommended Carpal Tunnel Syndrome Products
Use of the Keyboard Wrist Rest Support Pads may be very beneficial. Cold therapy is often found to be very helpful, reducing swelling and inflammation and helping reduce pain. Cold Therapy products provide direct cold therapy to the wrist. You may also want to get a wrist brace that keeps your wrist straight. Products such as the Smart Glove with Thumb Support provides support, keeps the wrist straight and provides cold therapy, all in one product. Stretching and strengthening your hands and arms may also help. In some cases, pain relief creams may provide some assistance. Modern electromagnetic and magnetic therapies (similarly called biomagnetics, electrobiomagnetics, magnet therapy, magnetic energy therapy, magnetic field therapy, magnetic stimulation, and magnetotherapy) are the use of magnetic fields, magnets, and magnetic devices to treat various physical and emotional conditions. These therapies are based on the premise that electrical activity exists in the body at all times, particularly as the heart beats or during bone production. Products such as magnetic wrist supports provide direct magnetic therapy to the carpal tunnel area and may provide some relief as well. Alternative therapies such as acupuncture and chiropractic care have benefited some patients. Exercise products such as resistance training products may help stregnthen and improve strength. Surgery is an option for treating carpal tunnel syndrome, however, it is usually reserved for carpal tunnel syndrome that is disabling and that hasn't responded to weeks of treatment. Surgery involves cutting the ligament that forms the roof of the carpal tunnel, which makes more room in the tunnel and relieves pressure on the median nerve. The surgery (carpal tunnel release) is usually successful but in some cases does not completely relieve the numbness or pain.

Prevention The first line of defense against carpal tunnel syndrome is to take care of your basic health, maintain a healthy weight, don't smoke, and exercise to maintain your strength and flexibility. If you have chronic conditions such as arthritis or diabetes, follow your health professional's advice for keeping your condition under control. In addition, try to keep your wrists in a neutral position during repetitive or stressful hand activities, perhaps by using carpal tunnel wrist supports during the day and a carpal tunnel nightime brace for splinting at night. Also using an ice pack for your carpal tunnel syndrome can help reduce the pain and swelling.  (Your wrist is generally in a neutral position when you hold a glass of water.) If you begin to notice signs of carpal tunnel syndrome, stop or reduce any activity that stresses your fingers, hand, or wrist, or try changing the way you do that activity. At the workplace, workers can do on-the-job conditioning, perform stretching exercises, take frequent rest breaks, wear splints to keep wrists straight and use correct posture and wrist position. Wearing fingerless gloves can help keep hands warm and flexible. Workstations, tools and tool handles and tasks can be redesigned to enable the worker's wrist to maintain a natural position during work. Jobs can be rotated among workers. Employers can develop programs in ergonomics, the process of adapting workplace conditions and job demands to the capabilities of workers. The Future of Carpal Tunnel Syndrome The National Institute of Neurological Disorders and Stroke (NINDS) a part of the National Institutes of Health, is the federal government's leading supporter of biomedical research on neuropathy, including carpal tunnel syndrome. Scientists are studying the chronology of events that occur with carpal tunnel syndrome in order to better understand, treat and prevent this ailment. By determining distinct biomechanical factors related to pain, such as specific joint angles, motions, force and progression over time, researchers are finding new ways to limit or prevent carpal tunnel syndrome in the workplace. Percutaneous balloon carpal tunnel-plasty is an experimental technique that can ease carpal tunnel pain without cutting the carpal ligament. In this procedure, a ¼ inch cut is made at the base of the palm, the doctor then inserts a balloon through a catheter under the carpal ligament and inflates the balloon to stretch the ligament and free the nerve. Patients in one small study of percutaneous balloon carpal tunnel-plasty reported relief of symptoms with no postoperative complications; most of them were back to work within two weeks. This experimental technique is not yet widely available. Other research will discern differences between the relative new carpal compression test (in which the examiner applies moderate pressure with both thumbs directly on the carpal tunnel and underlying median nerve at the transverse carpal ligament) and the pressure provocative test (in which a cuff placed at the anterior of the carpal tunnel is inflated, followed by direct pressure on the median nerve) in predicting carpal tunnel syndrome. Scientists are also investigating the use of alternative therapies, such as acupuncture, to prevent and treat this disorder.

***The information, including opinions and recommendations, contained in the Web site is for general educational purposes only. Such information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. No one should act upon any information on this Web site without first seeking medical advice from a qualified medical physician with whom they have a confidential doctor/patient relationship.***

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