Carpal Tunnel Syndrome.....

Carpal Tunnel Syndrome (CTS) is associated by symptoms and signs, which are caused by compression of the median nerve travelling through thecarpal tunnel. Carpal Tunnel Syndrome affects the hands since it is an upper limb neuropathy that results in motor and sensory disturbance of the median nerve.

This condition affects individuals by causing pain, paresthesias, and sometimes weakness in the median nerve distribution. Those diagnosed with Carpal Tunnel Syndrome may experience pain, numbness and tingling sensations in the arm, which may extend to the shoulder and neck area; these feelings are more prevalent at night due to various sleeping positions. To aid in the prevention of Carpal Tunnel Syndrome, stretching exercises of the wrist, hand, and fingers have been used to combat against the pain and numbness caused by repetitive actions. Other than using recommended stretches and exercises, useful treatments for CTS include use of night splints, corticosteroid injections and ultimately surgery.

Most cases of Carpal Tunnel Syndrome have been found to be without a specific cause and certain individuals may be genetically predisposed to this condition.

History

The condition known as Carpal Tunnel Syndrome has had major appearances throughout the years but it was most commonly heard of in the years following World War II.Individuals who had suffered from this condition have been depicted in surgical literature for the mid 1800’s. In 1854, Sir James Paget was the first to report median nerve compression at the wrist in a distal radius fracture. Following the early 1900s there were various cases of median nerve compression underneath the transverse carpal ligament. Carpal Tunnel Syndrome was most commonly noted in medical literature in the early 20th century but the first use of the term was noted 1939. Physician Dr. George S. Phalen of the Cleveland Clinic identified the pathology after working with a group of patients in the 1950s and 1960s. Carpal Tunnel Syndrome, a disabling overuse injury to the hand is one of the most frequent work injuries reported by the medical profession 

natomy

Main article: Carpal tunnel

The carpal tunnel is an anatomical compartment located at the base of the wrist. Nine flexor tendons and the median nerve pass through the carpal tunnel that is surrounded on three sides by the carpal bones that form an arch. The nerve and the tendons provide function, feeling, and movement to some of the fingers. The finger and wrist flexor muscles including their tendons originate in the forearm at the medial epicondyle of the elbow joint and attach to the Metaphalangeal (MP), Proximal Interphalangeal (PIP), and Distal Interphalangeal bones of the fingers and thumb (BSI). The carpal tunnel is approximately as wide as the thumb and its boundary lies at the distal wrist skin crease and extends up the arm towards the elbow for approximately 3 cm.

The median nerve can be compressed by a decrease in the size of the canal, an increase in the size of the contents (such as the swelling of lubrication tissue around the flexor tendons), or both. Simply flexing the wrist to 90 degrees will decrease the size of the canal.

Compression of the median nerve as it runs deep to the transverse carpal ligament (TCL) causes atrophy of the thenar eminence, weakness of the flexor pollicis brevis, opponens pollicis, abductor pollicis brevis, as well as sensory loss in the distribution of the median nerve distal to the transverse carpal ligament. There is a superficial sensory branch of the median nerve, which branches proximal to the TCL and travels superficial to it. This branch is therefore spared, and it innervates the palm towards the thumb.

Symptoms

Carpal tunnel syndrome produces a series of symptoms from mild to extreme. These symptoms worsen over time and patients that have been diagnosed with CTS experience numbness, tingling, or burning sensations in the thumb and fingers, particularly the index and middle fingers, which are affected by the median nerve. Individuals also experience pain in the hands or wrists and some report to have lost gripping strength. Pain also develops in the arm and shoulder and swelling of the hand, which increases at night.

Numbness and paresthesias in the median nerve distribution are the neuropathic symptoms (NS) of carpal tunnel entrapment syndrome. Weakness and atrophy of the thenar muscles may occur if the condition remains untreated.

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.

Causes

Most cases of CTS are of unknown causes, or idiopathic. Carpal Tunnel Syndrome can be associated with any condition that causes pressure on the median nerve at the wrist. Some common conditions that can lead to CTS include obesity, hypothyroidism, arthritis, diabetes, and trauma.

Other causes of this condition include intrinsic factors that exert pressure within the tunnel, and extrinsic factors (pressure exerted from outside the tunnel), which include benign tumors such as lipomas, ganglion, and vascular malformation, and overuse factors. It is unclear whether there is a close relationship between work and CTS or if it’s due to underlying medical problems.