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Encyclopedia > Carpal tunnel syndrome

Carpal tunnel syndrome
Classification and external resources
Transverse section across the wrist and digits. (The median nerve is the yellow dot near the center. The carpal tunnel is not labeled, but the circular structure surrounding the median nerve is visible.)
ICD-10 G56.0
ICD-9 354.0
OMIM 115430
DiseasesDB 2156
MedlinePlus 000433
eMedicine orthoped/455  pmr/21 emerg/83 radio/135
MeSH D002349
This article is about the medical condition. For the anatomical structure, see Carpal tunnel. For the Kid Koala album, see Carpal Tunnel Syndrome (album).

Carpal tunnel syndrome (CTS) or Median Neuropathy at the Wrist is a medical condition in which the median nerve is compressed at the wrist, leading to pain, paresthesias, and muscle weakness in the forearm and hand.[1] A form of compressive neuropathy, CTS is more common in women than it is in men and has a peak incidence around age 42, though it can occur at any age.[2] The lifetime risk for CTS is around 10% of the adult population.[3]. Image File history File links Gray422. ... The median nerve is a nerve that runs down the arm and forearm. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // G00-G99 - Diseases of the nervous system (G00-G09) Inflammatory diseases of the central nervous system (G00) Bacterial meningitis, not elsewhere classified (G01) Meningitis in bacterial diseases classified elsewhere (G02) Meningitis in other infectious and parasitic diseases classified elsewhere (G03) Meningitis due to other and unspecified causes (G04) Encephalitis, myelitis... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... This article is about the connective tissue. ... The 1st album released by recording artist Kid Koala. ... The median nerve is a nerve that runs down the arm and forearm. ... For the municipality in Germany, see Wrist, Germany. ... Paresthesia or paraesthesia (in British English) is a sensation of tingling, pricking, or numbness of a persons skin with no apparent long-term physical effect, more generally known as the feeling of pins and needles or of a limb being asleep (but not directly related to the phenomenon of... Muscle weakness (or lack of strength) is a direct term for the inability to exert force with ones muscles to the degree that would be expected given the individuals general physical fitness. ...


Most cases of CTS are idiopathic (without known cause). Repetitive activities are often blamed for the development of CTS along with several other possible causes. However, the correlation is often unclear.


It is a multi-faceted problem and can therefore be challenging to treat. Still, there are a multitude of possible treatments: treating any possible underlying disease or condition, immobilizing braces, physiotherapy, massage therapy, medication, prioritizing hand activities, ergonomics. Ultimately, carpal tunnel release surgery may be required in which outcomes are generally good.


The condition was first noted in medical literature in the early 20th century.

Contents

[edit] History

Although the condition was first noted in medical literature in the early 20th century, the first use of the term “carpal tunnel syndrome” was in 1938.[4] The pathology was identified by physician Dr. George S. Phalen of the Cleveland Clinic after working with a group of patients in the 1950s and 1960s.[4] CTS became widely known among the general public in the 1990s because of the rapid expansion of office jobs.[5] The Cleveland Clinic (formally known as the Cleveland Clinic Foundation) is a multispecialty academic medical center located in Cleveland, Ohio, United States. ...


[edit] Anatomy

Main article: Carpal tunnel

The median nerve passes through the carpal tunnel, a canal in the wrist that is surrounded by bone on three sides, and a transverse carpal ligament on the fourth. Nine tendons—the flexor tendons of the hand—pass through this canal.[3] 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 bending the wrist at 90 degrees will decrease the size of the canal. It's a painful, at times, condition which can improve over time with repeated daily self-managed physical therapy. This article is about the connective tissue. ... The median nerve is a nerve that runs down the arm and forearm. ... This article is about the connective tissue. ... For other uses, see Tendon (disambiguation). ...


[edit] Symptoms

Many people with carpal tunnel syndrome have gradually increasing symptoms over time. The first symptoms of CTS may appear when sleeping and typically include numbness and paresthesia (a burning and tingling sensation) in the fingers, especially the thumb, index, and middle fingers.[3] These symptoms appear at night because many people sleep with bent wrists which further compresses the carpal tunnel. If the median nerve is already under stress, the increased compression of the bent wrist results in numbness and tingling. Difficulty gripping and making a fist, dropping objects, and weakness are symptoms of progression. In early stages of CTS individuals often mistakenly blame the tingling and numbness on restricted blood circulation and they believe their hands are simply “falling asleep”. In chronic cases, there may be wasting of the thenar muscles (the body of muscles which are connected to the thumb). Paresthesia or paraesthesia (in British English) is a sensation of tingling, pricking, or numbness of a persons skin with no apparent long-term physical effect, more generally known as the feeling of pins and needles or of a limb being asleep (but not directly related to the phenomenon of...


Unless numbness or paresthesia are among the predominant symptoms, it is unlikely the symptoms are primarily caused by carpal tunnel syndrome. In effect, pain of any type, location, or severity with the absence of significant numbness or paresthesia is not likely to fall under this diagnosis.


[edit] Causes

Most cases of CTS are idiopathic: without a known cause.[5] A common factor in developing carpal tunnel symptoms is increased hand use or activity. While repetitive activities are often blamed for the development of CTS, the correlation is often unclear. Physiology and family history may have a significant role in individual's susceptibility. Furthermore, stress, trauma and several other diseases are also possible causes of CTS. Idiopathic means arising spontaneously or from an obscure or unknown cause. ...


[edit] Work related

The international debate regarding the relationship between CTS and repetitive motion and work is ongoing. The Occupational Safety and Health Administration (OSHA) has adopted rules and regulations regarding cumulative trauma disorders. Occupational risk factors of repetitive tasks, force, posture, and vibration have been cited. However, the American Society for Surgery of the Hand (ASSH) has issued a statement that the current literature does not support a causal relationship between specific work activities and the development of diseases such as CTS. OSHA logo The United States Occupational Safety and Health Administration (OSHA) is an agency of the United States Department of Labor. ...


The relationship between work and CTS is controversial; in many locations workers injured at work are entitled to time off and compensation.[6] Many cases of carpal tunnel syndrome are provoked by repetitive grasping and manipulating activities, and the exposure can be cumulative. Symptoms are commonly exacerbated by forceful and repetitive use of the hand and wrists in industrial occupations.[7] Carpal tunnel syndrome results in billions of dollars of workers compensation claims every year.[citation needed] This article is about the type of currency, for the U.S. Dollar see United States dollar. ...


Studies done by the National Institute for Occupational Safety and Health (NIOSH), indicated that job tasks involving highly repetitive manual acts or necessitating wrist bending or other stressful wrist postures were connected with incidents of CTS or related problems. However, it appears that the 30+ studies reviewed were concerned with the occupations of assembly line workers, meat packers, food processors, and the like, not general office work. The National Institute for Occupational Safety and Health (NIOSH) is the United States federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. ...


In addition, a 2005 study found that people who have discomfort at the base of the neck or in the shoulder or work with their shoulder in elevation (indicators of poor working postures) are more likely to develop a repetitive overuse injury.[8] These factors can affect the biomechanics of the upper limb or tissue tolerance to repetitive tasks resulting in injury, or both. Postural and spinal assessment along with ergonomic assessments should be included in the overall determination of the condition. Addressing these factors has been found to improve the status of work related upper limb injuries.[9] Biomechanics is the research and analysis of the mechanics of living organisms or the application and derivation of engineering principles to and from biological systems. ...


Hypothyroidism, osteoarthritis and diabetes were most often associated with CTS-like symptoms, as were variables such as age, obesity and wrist dimension. In a 1998 study, only 35 of 297 subjects were aware of the underlying health condition which could account for their CTS-like symptoms.[10][11] Hence, these causes would be missed by doctors if they were relying on a patient's health history to rule out other causative factors. It is important that a doctor rule out other causes of CTS-like symptoms. If a patient does not have CTS, corrective surgery is destined to fail. This article or section does not cite its references or sources. ... Osteoarthritis (OA, also known as degenerative arthritis, degenerative joint disease), is a condition in which low-grade inflammation results in pain in the joints, caused by abnormal wearing of the cartilage that covers and acts as a cushion inside joints and destruction or decrease of synovial fluid that lubricates those... This article is about the disease that features high blood sugar. ...


[edit] Stress related

Studies have also related carpal tunnel and other upper extremity complaints with psychological and social factors. A large amount of psychological distress showed doubled risk of the report of pain, while job demands, poor support from colleagues, and work dissatisfaction also showed an increase in the report of pain, even after short term exposure.[12] A minority viewpoint holds that stress is the main cause, rather than a contributing factor, of a large fraction of pain symptoms usually attributed to carpal tunnel syndrome.


[edit] Trauma related

  • Fractures of one of the arm bones, particularly a Colles' fracture.
  • Dislocation of one of the carpal bones of the wrist.
  • Strong blunt trauma to the wrist or lower forearm, incurred for example by using arm extremity to cushion a fall or protecting oneself from falling heavy objects.
  • Hematoma forming inside the wrist, because of internal hemorrhaging.
  • Deformities from abnormal healing of old bone fractures.

A fractured bone in a living person is typically treated by restoring the fractured pieces of bone to their natural positions (if necessary), and maintaining those positions while the bone heals. ... This article is about the skeletal organs. ... A Colles fracture is a fracture of the distal radius, most commonly caused by people falling forward onto a hard surface and breaking their fall with extended, outstretched hands - falling with wrists flexed would lead to a Smiths fracture. ... In materials science, a dislocation is a crystallographic defect, or irregularity, within a crystal structure. ... In human anatomy, the carpal bones are the bones of the human wrist. ... Hematoma on thigh, 6 days after a fall down stairs, 150ml of blood drained a few days later A hematoma, or haematoma, is a collection of blood, generally the result of hemorrhage, or, more specifically, internal bleeding. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... For the Todd Rundgren album, see Healing (Todd Rundgren). ...

[edit] Non-traumatic

This article needs additional citations for verification.
Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (April 2007)

Non-traumatic causes generally happen over a period of time, and are not triggered by one certain event. Many of these factors are manifestations of physiologic aging. Examples include: Image File history File links Question_book-3. ...

  • which is inflammation of the thin mucinous membrane around the tendons. Part of the process of inflammation is swelling, and this compresses the nerve. Swelling of this membrane is the final common pathway for most cases of carpal tunnel, whether caused idiopathically, through exposure, or medically.
  • With pregnancy and hypothyroidism, fluid is retained in tissues, which swells the tenosynovium.
  • Acromegaly, a disorder of growth hormones, compresses the nerve by the abnormal growth of bones around the hand and wrist.
  • Tumors (usually benign), such as a ganglion or a lipoma, can protrude into the carpal tunnel, reducing the amount of space. This is exceedingly rare (less than 1%).
  • Double crush syndrome, where there is compression or irritation of nerve branches contributing to the median nerve in the neck or anywhere above the wrist. This then increases the sensitivity of the nerve to compression in the wrist. This, while a possible factor, is also a rare contributor in most cases.
  • Common activities that have been identified as contributing to repetitive stress induced carpal tunnel syndrome include:
    • Use of power tools
    • Typing on a computer keyboard or typewriter
    • Construction work such as handling many bricks, stone and/or lumber
    • A group of hobbyists known as speed-cubists who solve Rubik's Cubes as fast as possible for competitions are known to have been prone to carpal tunnel syndrome from turning the sides of their cubes in such a fast manner, which according to a bonus feature on the DVD of The Pursuit of Happyness, causes the problems cubist's thumb and Rubik's Wrist
    • Excessive play of percussion instruments

Often people suffering from carpal tunnel syndrome can have multiple contributing factors which are aggravated by vigorous hand activities and repetitive stress trauma to the hand. An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... This article is about human pregnancy in biological females. ... This article or section does not cite its references or sources. ... Acromegaly (from Greek akros high and megas large - extremities enlargement) is a hormonal disorder that results when the pituitary gland produces excess growth hormone (hGH). ... Growth hormone (GH) or somatotropin (STH) is a protein hormone which stimulates growth and cell reproduction in humans and other animals. ... For malignant tumors specifically, see cancer. ... This is a dorsal root ganglion (DRG) from a chicken embryo (around stage of day 7) after incubation overnight in NGF growth medium stained with anti-neurofilament antibody. ... A lipoma is a common, benign tumor composed of fatty tissue. ... Idiopathic means arising spontaneously or from an obscure or unknown cause. ... Mechanical desktop typewriters, such as this Underwood Five, were long time standards of government agencies, newsrooms, and sales offices. ... Variations of Rubiks Cubes (from left to right: Rubiks Revenge, Rubiks Cube, Professors Cube, & Pocket Cube (also known as Mini-Cube)). Rubiks Cube is a mechanical puzzle invented in 1974[1] by Hungarian sculptor and professor of architecture Ernő Rubik. ... For the famous phrase from which the title derives, see Life, liberty and the pursuit of happiness. ...


Proper attention to ergonomic considerations can reduce or eliminate these kinds of exposures. Ergonomics (from Greek ergon work and nomoi natural laws) is the study of designing objects to be better adapted to the shape of the human body and/or to correct the users posture. ...


While carpal tunnel syndrome is often called a "repetitive strain injury" (RSI) or "cumulative trauma disorder" (CTD), these labels are discouraged by physicians, particularly hand specialists. Carpal tunnel is a specific condition with specific symptoms that responds fairly reliably. Most of the time, carpal tunnel is not caused by a "strain" or "trauma" of any type. RSI and CTD are relatively non-specific terms with non-specific symptoms that respond variably to treatment.[citation needed] A repetitive strain injury (RSI), also called cumulative trauma disorder (CTD), occupational overuse syndrome, or work related upper limb disorder (WRULD), is any of a loose group of conditions resulting from overuse of a tool, eg. ... Repetitive strain injury (RSI), also called repetitive stress injury, is a loose group of conditions from overuse of the computer, guitar, knife or similar motion or tool. ...


[edit] Diagnosis

Clinical assessment by history taking and physical examination can frequently diagnose CTS.

  • Phalen's maneuver is performed by flexing the wrist gently as far as possible, then holding this position and awaiting symptoms.[13] A positive test is one that results in numbness in the median nerve distribution when holding the wrist in acute flexion position within 60 seconds. The quicker the numbness starts, the more advanced the condition.
  • Tinel's sign, a classic, though less specific test, is a way to detect irritated nerves. Tinel's is performed by lightly tapping (percussing) the area over the nerve to elicit a sensation of tingling or "pins and needles" in the nerve distribution.
  • Durkan test, carpal compression test, or applying firm pressure of the palm over the nerve for up to 30 seconds to elicit symptoms has also been proposed.[14][15]

Other conditions may also be misdiagnosed as carpal tunnel syndrome. Thus, if, based on history and physical examination, a CTS diagnosis is suspected but not clear, patients will likely be tested electrodiagnostically with nerve conduction studies and electromyography; MRI or ultrasound imaging are also used.[16][17][18] Phalens maneuver is a test for carpal tunnel syndrome. ... Tinels sign is a way to detect irritated nerves. ... A nerve conduction study (NCS) is a test commonly used to evaluate the function, especially the ability of electrical conduction, of the motor and sensory nerves of the human body. ... Electromyography (EMG) is a technique for evaluating and recording physiologic properties of muscles at rest and while contracting. ... MRI redirects here. ... Sonography redirects here. ...


[edit] Prevention

The most effective way to prevent carpal tunnel syndrome is to take frequent breaks from repetitive movement such as computer keyboard usage. Free software programs such as Workrave and Xwrits are available to remind users to take breaks and stretch their wrists. Keyboard redirects here. ... Workrave is a software application intended to prevent computer users from developing or aggravating occupational diseases such as carpal tunnel syndrome and repetitive strain injuries. ... xwrits is a Linux software application which reminds computer users to take wrist breaks. ...


[edit] Treatment

There has been much discussion as to the most effective treatment for CTS.[19] CTS is a multi-faceted problem and can be challenging to treat from a clinician's perspective. Nevertheless, starting therapy early, when carpal tunnel is in a mild stage, is associated with improved long-term results.[citation needed] In summary, one has the choice of controlling the symptoms with any of the non-surgical options listed, or correcting the condition with surgery.[20] Treatments can be generally divided into six basic categories: 1. You must rest your hand for weeks 2. The doctor may include some drugs to relieve the pain 3. Doctor may give you a cast to help ease pain 4. If the hand does not cure, you may need surgery


[edit] Reversible causes

Some causes of CTS are secondary to other conditions — metabolic disorders such as hypothyroidism, for example. Treatment of the primary disorder often resolves CTS symptoms. This article or section does not cite its references or sources. ...


[edit] Immobilizing braces

A splint can keep the wrist straight.
A splint can keep the wrist straight.

The importance of wrist braces and splints in the carpal tunnel syndrome therapy is known, but many people are unwilling to use braces. In 1993, The American Academy of Neurology recommend a non-invasive treatment for the CTS at the beginning (except for sensitive or motor deficit or grave report at EMG/ENG): a therapy using splints was indicated for light and moderate pathology.[21] Current recommendations generally don't suggest immobilizing braces, but instead activity modification and non-steroidal anti-inflammatory drugs as initial therapy, followed by more aggressive options or specialist referral if symptoms do not improve.[22] [23][24] Image File history File links Download high resolution version (1660x1000, 307 KB) File links The following pages link to this file: Carpal tunnel syndrome ... Image File history File links Download high resolution version (1660x1000, 307 KB) File links The following pages link to this file: Carpal tunnel syndrome ... An orthopaedic brace (also orthosis or orthotic) is a device used to: immobilize a joint or body segment, restrict movement in a given direction, assist movement, reduce weight-bearing forces, or correct the shape of the body. ... A splint is a medical device for the immobilisation of limbs or of the spine. ... Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs, are drugs with analgesic, antipyretic and anti-inflammatory effects - they reduce pain, fever and inflammation. ...


Many health professionals suggest that, for best results, one should wear braces at night and, if possible, during the activity primarily causing stress on the wrists.[25][26]


[edit] Physiotherapy

Physiotherapy offers several ways to treat and control carpal tunnel syndrome. This procedure should be directed specifically towards the pattern of pain / symptoms and dysfunction assessed by the therapist. As such, it may include a range of modalities ranging from soft tissue massage, conservative stretches and exercises and techniques to directly mobilize the nerve tissue. It can also include the aforementioned immobilizing braces.


Clinically, sometimes a patient will present with a hand that is very inflamed and swollen with severe symptoms of pain, tingling and numbness and almost a fear of use because of the pain. In these cases a physiotherapist may focus on techniques to reduce the pain and inflammation, and exercises to encourage improved circulation. A comprehensive review of effectiveness of hand therapies in carpal tunnel management demonstrates that there is some valid scientific evidence for a range of therapeutic modalities.[27] For instance, Body Awareness Therapy such as the Feldenkrais method has positive effects in relation to fibromyalgia and chronic pain.[28] Structured exercise programs using these therapies to reduce wrist pain have been developed. The Feldenkrais Method is an educational system intended to give a greater functional awareness of the self. ... Fibromyalgia (FM) is stated to be a disorder classified by the presence of chronic widespread pain and tactile allodynia. ...


[edit] Localized steroid injections

Steroid injections can be quite effective for temporary relief from symptoms of CTS for a short time frame while a patient develops a longterm strategy that fits with his/her lifestyle.[29] In certain patients an injection may also be of diagnostic value. This treatment is not appropriate for extended periods, however. In general, medical professionals only prescribe to localized steroid injections until other treatment options can be identified. For most patients, permanent relief requires surgery.[30]


[edit] Prioritizing hand activities and ergonomics

Any forceful and repetitive use of the hands and wrists can cause upper extremity pain. More frequent rest can be useful if it can be orchestrated into one's schedule. It has been shown that taking multiple mini breaks during the stressful activity is more effective than taking occasional long breaks.[citation needed] There are computer applications that aid users in taking breaks. All of these applications have recommended defaults, following the most effective average break configuration, which is a 30 sec. pause every 3 to 5 minutes (the more severe the pain, the more often one should take this break). Before investing in these types of programs, it's best to consult with a doctor and research whether computer use is causing or contributing to the symptoms, as well as getting a formal diagnosis.


More pro-active ways to reducing the stress on the wrists which will alleviate wrist pain and strain involve adopting a more ergonomic work and life environment. Switching from a QWERTY computer keyboard layout to a more optimised ergonomic layout such as Dvorak or Colemak was commonly cited as beneficial in early CTS studies, however some meta-analyses of these studies claim that the evidence that they present is limited.[31][32] Some users do, however, report a significant improvement on switching to more ergonomic layouts.[33] For the song by Linkin Park, see QWERTY (song). ... The Dvorak Simplified Keyboard layout. ... Colemak is an alternative computer keyboard layout to QWERTY and Dvorak, designed by Shai Coleman. ... A meta-analysis is a statistical practice of combining the results of a number of studies. ...


It is also important that one's body be aligned properly with the keyboard. This is most easily accomplished by bending ones elbows to a 90 degree angle and making sure the keyboard is at the same height as the elbows. Also it is important not to put physical stress on the wrists by hanging the wrist on the edge of a desk, or exposing the wrists to strong vibrations (e.g. manual lawn mowing). Position the computer monitor directly in front of your seat, so the neck is not twisted to either side when viewing the screen.[citation needed]


Exercises that relax and strengthen the muscles of the upper back can reduce the risk of a double crush of the median nerve.


Massage is one of the most overlooked methods for treatment of the symptoms of CTS. The use of myofascial release and active stretch release can erase the pain, numbness, tingling and burning in minutes. Then following up with the stretches and exercises afore mentioned will lengthen the relief attained by these release techniques. Myofascial release refers to the manual massage technique for stretching the fascia and releasing bonds between fascia and integument, muscles, and bones, with the goal of eliminating pain, increasing range of motion and balancing the body. ...


[edit] Medication

Using an over-the-counter anti-inflammatory such as aspirin, ibuprofen or naproxen can be effective as well for controlling symptoms. Recently the natural anti-inflammatory and antioxidant Bioastin has been shown to lessen and sometimes even eliminate the symptoms of carpal tunnel altogether however clinical studies are limited (http://www.cyanotech.com/bioastin/bioastin_clinical.html) and results last only with continued use. Pain relievers like paracetamol will only mask the pain, and only an anti-inflammatory will affect inflammation. Non-steroidal inflammatory medications theoretically can treat the root swelling and thus the source of the problem. Oral steroids (prednisone) do the same, but are generally not used for this purpose because of significant side effects. The most common complications associated with long-term use of anti-inflammatory medications are gastrointestinal irritation and bleeding. Also, some anti-inflammatory medication have been linked to heart complications. Use of anti-inflammatory medication for chronic, long-term pain should be done with doctor supervision. This article is about the drug. ... Ibuprofen (INN) (IPA: ) (from the earlier nomenclature iso-butyl-propanoic-phenolic acid) is a non-steroidal anti-inflammatory drug (NSAID) originally marketed as Nurofen and since under various trademarks, including Act-3, Advil, Brufen, Dorival, Herron Blue, Panafen, Motrin, Nuprin and Burana (Finland), Ipren or Ibumetin (Denmark and Sweden), Ibuprom... Naproxen (INN) (IPA: ) is a non-steroidal anti-inflammatory drug (NSAID) commonly used for the reduction of mild to moderate pain, fever, inflammation and stiffness caused by conditions such as osteoarthritis, rheumatoid arthritis, psoriatic arthritis, gout, ankylosing spondylitis, injury (like fractures), menstrual cramps, tendonitis, bursitis, and the treatment of primary... Paracetamol (INN) (IPA: ) or acetaminophen (USAN), is the active metabolite of phenacetin, a so-called coal tar analgesic. ... Prednisone is a synthetic corticosteroid drug which is usually taken orally but can be delivered by intramuscular injection and can be used for a great number of different conditions. ...


A more aggressive pharmaceutical option is an injection of cortisone, to reduce swelling and nerve pressure within the carpal tunnel. Cortisone (IPA:ˈkôrtəˌsōn) is a steroid hormone. ...


Mecobalamin/Methylcobalamin has been helpful in some cases of CTS. [34] Mecobalamin is a Central Nervous System Drug which is used in Peripheral neuropathy, Diabetic neuropathy etc. ... Chemical structure of Vitamin B12 The term vitamin B12 (or B12 for short) is used in two different ways. ...


[edit] Carpal tunnel release surgery

When visiting a hand surgeon, the first step would be examination of the hands and a review of the symptoms. If CTS is suspected, depending on the severity and the situation, the surgeon may first prescribe non-operative treatment with splinting and anti-inflammatory drugs. Nerve conduction tests will positively determine the level of compression, if any.


[edit] Indications

If symptoms resolve with non-surgical interventions, surgery can frequently be avoided. If not, then the "carpal tunnel release" surgery is recommended.[35] In general, milder cases can be controlled for months to years, but severe cases are unrelenting symptomatically and likely will come to surgical treatment.[36]


[edit] Procedure

In carpal tunnel release surgery, the goal is to divide the transverse carpal ligament in two. This is a wide ligament that runs across the hand, from the base of the thumb to the base of the fifth finger. It also forms the top of the carpal tunnel, and when the surgeon cuts across it (i.e., in a line with the middle finger) it no longer presses down on the nerves inside, relieving the pressure.[37] The transverse carpal ligament (anterior annular ligament, or flexor retinaculum)) is a strong, fibrous band, which arches over the carpus, converting the deep groove on the front of the carpal bones into a tunnel, through which the Flexor tendons of the digits and the median nerve pass. ...


There are several carpal tunnel release surgery variations: each surgeon has differences of preference based on their personal beliefs and experience. All techniques have several things in common, involving brief outpatient procedures; palm or wrist incision(s); and cutting of the transverse carpal ligament. A hospital today is an institution for professional health care provided in part by physicians and nurses. ...


The two major types of surgery are open-hand surgery and endoscopic surgery. Most surgeons perform open surgery, widely considered to be the gold standard (test). However, many surgeons are now performing endoscopic techniques. Open surgery involves a small incision somewhere on the palm about an inch or two in length. Through this the ligament can be directly visualized and divided with relative safety. Endoscopic techniques involve one or two smaller incisions (less than half inch each) through which instrumentation is introduced including probes, knives and the scope used to visualize the operative field. In medicine, a gold standard test is the diagnostic test that is regarded as definitive in determining whether an individual has a disease process. ... In anatomy, the term ligament is used to denote three different types of structures:[1] Fibrous tissue that connects bones to other bones. ...


All of the surgical options typically have relatively rapid recovery profiles (days to weeks depending on the activity and technique), and all usually leave a cosmetically insignificant scar.


[edit] Efficacy

Surgery to correct carpal tunnel syndrome has high success rate, especially using endoscopic surgery techniques. Up to 90% of patients were able to return to their same jobs after surgery. [38][39][40] In general, endoscopic techniques are as effective as traditional open carpal surgeries,[41][42] though the faster recovery time typically noted in endoscopic procedures may be offset by higher complication rates.[43][44] Success is greatest in patients with the most typical symptoms. The most common cause of failure is incorrect diagnosis, and it should be noted that this surgery will only fix carpal tunnel syndrome, and will not relieve symptoms with alternate causes. Recurrence is rare, and apparent recurrence usually results from a misdiagnosis of another problem. Complications can occur, but serious ones are infrequent to rare.


Carpal tunnel surgery is usually performed by a hand surgeon, orthopaedic or plastic surgeon; some neurosurgeons and general surgeons also perform the procedure. This fracture of the lower cervical vertebrae, known as a teardrop fracture is one of the conditions treated by orthopaedic surgeons. ... For the album by The Huntingtons, see Plastic Surgery (album). ... Insertion of an electrode during neurosurgery for Parkinsons disease. ...


[edit] Long term recovery

Most people who find relief of their carpal tunnel symptoms with conservative or surgical management find minimal residual or "nerve damage".[45] Long-term chronic carpal tunnel syndrome (typically seen in the elderly) can result in permanent "nerve damage", i.e. symptoms of numbness, muscle wasting and weakness.


While outcomes are generally good, certain factors can contribute to poorer results that have little to do with nerves, anatomy, or surgery type. One study showed that mental status parameters, alcohol use, yield much poorer overall results of treatment.[46]


Many mild carpal tunnel syndrome sufferers either change their hand use pattern or posture at work or find a conservative, non-surgical treatment that allows them to return to full activity without hand numbness or pain, and without sleep disruption. Other people end up prioritizing their activities and possibly avoiding certain hand activities so that they can minimize pain and perform the essential tasks.


Changing jobs is also commonly done to avoid continued repetitive stress tasks. Others find success by adjusting their repetitive movements, the frequency with which they do the movements, and the amount of time they rest between periods of performing the movements.


While recurrence after surgery is a possibility, true recurrences are uncommon to rare.[47] Such recurrence can also be non-CTS hand pain. Such hand pain may have existed prior to the surgery, which is one reason it is very important to get a proper diagnosis.


[edit] References

  1. ^ Michelsen H, Posner M (2002). "Medical history of carpal tunnel syndrome". Hand Clin 18 (2): 257-68. PMID 12371028. 
  2. ^ Treaster DE, Burr D (2004). "Gender differences in prevalence of upper extremity musculoskeletal disorders". Ergonomicdsvss 47 (5): 495-526. PMID 15204301. 
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