Carpal Tunnel Syndrome
Carpal tunnel syndrome is pressure on the median nerve -- the nerve in the wrist that supplies feeling and movement to parts of the hand. It can lead to numbness, tingling, weakness, or muscle damage in the hand and fingers.
The median nerve provides feeling and movement to the "thumb side" of the hand (the palm, thumb, index finger, middle finger, and thumb side of the ring finger).
The area in your wrist where the nerve enters the hand is called the carpal tunnel. This tunnel is normally narrow, so any swelling can pinch the nerve and cause pain, numbness, tingling or weakness. This is called carpal tunnel syndrome.
Carpal tunnel syndrome is common in people who perform repetitive motions of the hand and wrist. Typing on a computer keyboard is probably the most common cause of carpal tunnel. Other causes include:
? Assembly line work
? Use of tools (especially hand tools or tools that vibrate)
? Sports such as racquetball or handball
? Playing some musical instruments
The condition occurs most often in people 30 to 60 years old, and is more common in women than men.
A number of medical problems are associated with carpal tunnel syndrome, including:
• Bone fractures and arthritis of the wrist
• Kidney failure and dialysis
• Menopause, premenstrual syndrome (PMS), and pregnancy
• Rheumatoid arthritis, systemic lupus erythematosus (SLE), and scleroderma
• Numbness or tingling in the thumb and next two or three fingers of one or both hands
• Numbness or tingling of the palm of the hand
• Pain extending to the elbow
• Pain in wrist or hand in one or both hands
• Problems with fine finger movements (coordination) in one or both hands
• Wasting away of the muscle under the thumb (in advanced or long-term cases)
• Weak grip or difficulty carrying bags (a common complaint)
• Weakness in one or both hands
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, oral contraceptives, 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
Carpal tunnel syndrome associated with other diseases
A variety of patient factors can lead to CTS including heredity, size of the carpal tunnel, associated local and systematic diseases and certain habits contribute to its etiology. Non-traumatic causes generally happen over a period, and are not triggered by one certain event. Many of these factors are manifestations of physiologic aging.
Rheumatoid arthritis and other diseases that cause inflammation of the flexor tendons.
With pregnancy and hypothyroidism, fluid is retained in tissues, which swells the tenosynovium.
During pregnancy, women experience CTS due to hormonal changes (high progesterone levels) and water retention that is common during pregnancy.
Previous injuries including fractures of the wrist.
Medical disorders that lead to fluid retention or are associated with inflammation such as inflammatory arthritis, Colles' fracture, amyloidosis, hypothyroidism, diabetes mellitus, acromegaly, and use of corticosteroids and estrogens.
Carpal tunnel syndrome is also associated with repetitive activities of the hand and wrist, particularly with a combination of forceful and repetitive activities.
Acromegaly causes excessive growth hormones. This causes the soft tissues and bones around the carpel tunnel to grow causes compression of the median nerve.
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%).
Obesity also increases the risk of CTS: individuals who are classified as obese (BMI > 29) are 2.5 times more likely than slender individuals (BMI < 20) are to be diagnosed with CTS.
Double crush syndrome is a debated hypothesis that compression or irritation of nerve branches contributing to the median nerve in the neck, or anywhere above the wrist, increases sensitivity of the nerve to compression in the wrist. There is little evidence, however, that this syndrome really exists.
Heterozygous mutations in a gene, SH3TC2, associated with Charcot-Marie-Tooth, confer susceptibility to neuropathy, including the carpal tunnel syndrome. Parvovirus b19 has been associated with carpel tunnel syndrome
Avoid or reduce the number of repetitive wrist movements whenever possible. Use tools and equipment that are properly designed to reduce the risk of wrist injury.
Ergonomic aids, such as split keyboards, keyboard trays, typing pads, and wrist braces, may be used to improve wrist posture during typing. Take frequent breaks when typing and always stop if there is tingling or pain.
A 2007 study, conducted by Lozano-Calderon et al. in the Department of Orthopedic Surgery at Massachusetts General Hospital, states that carpal tunnel syndrome is primarily determined by genetics and structure. Therefore, carpal tunnel syndrome is probably not preventable
Carpal tunnel syndrome can affect anyone. In the U.S., roughly 1 out of 20 people will suffer from the effects of carpal tunnel syndrome. Caucasians have the highest risk of CTS compared with other races such as non-white South Africans. Women suffer more from CTS than men with a ratio of 3:1 between the ages of 45–60 years. Only 10% of reported cases of CTS are younger than 30 years.
Symptoms often improve with treatment, but more than 50% of cases eventually require surgery. Surgery is often successful, but full healing can take months.
If the condition is treated properly, there are usually no complications. If untreated, the nerve can be damaged, causing permanent weakness, numbness, and tingling.
Your symptoms do not respond to regular treatment, such as rest and anti-inflammatory medications, or if there seems to be a loss of muscle mass in your fingers
According to the 2007 guidelines by the American Academy of Orthopedic Surgeons, early surgery with carpal tunnel release is indicated where there is clinical evidence of median nerve denervation or the patient elects to proceed directly to surgical treatment. Otherwise, the main recommended treatments are local corticosteroid injection, splinting (immobilizing braces), oral corticosteroids and ultrasound treatment. The treatment should be switched when the current treatment fails to resolve the symptoms within 2 to 7 weeks. However, these recommendations have sufficient evidence for carpal tunnel syndrome when found in association with the following conditions: diabetes mellitus, coexistent cervical radiculopathy, hypothyroidism, polyneuropathy, pregnancy, rheumatoid arthritis, and carpal tunnel syndrome in the workplace.
Surgery to correct carpal tunnel syndrome has a high success rate. Up to 90% of patients were able to return to their same jobs after surgery.
Medications used in the treatment of carpal tunnel syndrome include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofenor naproxen. Corticosteroid injections, given into the carpal tunnel area, may relieve symptoms for a period.
Carpal tunnel release is a surgical procedure that cuts into the ligament that is pressing on the nerve. Surgery is successful most of the time, but it depends on how long the nerve compression has been occurring and its severity.
You may try wearing a splint at night for several weeks. If this does not help, you may need to try wearing the splint during the day. Avoid sleeping on your wrists. Hot and cold compresses may also be recommended.
There are many changes you can make in the workplace to reduce the stress on your wrist:
Special devices include keyboards, different types of mouses, cushioned mouse pads, and keyboard drawers.
Someone should review the position you are in when performing your work activities. For example, make sure the keyboard is low enough so that your wrists are not bent upward while typing. Your doctor may suggest an occupational therapist.
You may also need to make changes in your work duties or recreational activities. Some of the jobs associated with carpal tunnel syndrome include those that involve typing and vibrating tools. Carpal tunnel syndrome has also been linked to professional musicians.
The hallmarks of carpal tunnel syndrome are pain (burning, tingling, numbness) and inflammation with use of the wrist as a result of compression of the median nerve which is one of the nerves that goes to your hand (specifically the thumb, index, middle and half of the ring finger and the palm next to the thumb) Most commonly it is tied to overuse (repetitive motion) involving the affected wrist. The pain can cause significant discomfort with loss of sleep and loss of the ability to perform simple tasks pain free. Other causes can be physical abnormalities (bone spurs, tumors, old healing fractures) and some systemic diseases such as diabetes or rheumatoid arthritis.
It is typically recommend that patients use medical marijuana to help reduce pain, reduce inflammation and improve sleep as an alternative to NSAID’s and sleeping pills at night. If patients work during the day then NSAIDS can be appropriate, as it is illegal to drive and use cannabis.
Marijuana is a great medication for sleep. Patients typically only have to use very small amounts of an INDICA strain that is much less psychoactive. Meaning they do not have to experience the “high” that most patients associate with marijuana use. It can be vaporized 20 minutes prior to lying down. Patients using the vaporization method are NOT exposing themselves to any smoke and there is next to NO SMELL.
The cannabinoids in the plant also act as potent anti-inflammatory agents. Therefore any inflammation of the tendons (attach muscle to bone vs. ligaments which attach bone to bone) will also be reduced thus relieving the patient of their symptoms.
Best Strains: Indica dominant hybrid
White Russian, Blueberry, OG Kush, Juicy Fruit, Diesels, Hindu Kush, Durban Poison, Hash Plant, Black Domina, Grand Daddy Purple, Haze hybrids, No. Lights #5.
Use Medical Marijuana: extracts, decoctions, cannabutter, edibles, salve/balm, vaporizer
Jarvik JG, Comstock BA, Kliot M, Turner JA, Chan L, Heagerty PJ, et al. Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomized parallel-group trial. Lancet. 2009;374(9695):1074-1081. [PubMed]
Keith MW. American Academy of Orthopaedic Surgeons clinical practice guidelines on the diagnosis of carpal tunnel syndrome. J Bone Joint Surg Am. 2009;91(10):2478-2479. [PubMed]
Keith MW. American Academy of Orthopaedic Surgeons clinical practice guidelines on the treatment of carpal tunnel syndrome. J Bone Joint Surg Am. 2009;91(1):218-219.
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8Carpal tunnel syndrome fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm. Accessed Dec. 20, 2010.
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12Wright PE. Carpal tunnel, ulnar tunnel, and stenosing tenosynovitis. In: Canale ST, et al. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa.: Mosby Elsevier; 2008. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-323-03329-9..50076-3&isbn=978-0-323-03329-9&type=bookPage§ionEid=4-u1.0-B978-0-323-03329-9..50076-3--cesec9&uniqId=230418749-3. Accessed Dec. 20, 2010.
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14Clinical practice guideline on the treatment of carpal tunnel syndrome. Rosemont, Ill.: American Academy of Orthopaedic Surgeons. http://www.aaos.org/research/guidelines/CTSTreatmentGuideline.pdf. Accessed Dec. 21, 2010.
15Scott KR, et al. Treatment of carpal tunnel syndrome. http://www.uptodate.com/home/index.html. Accessed Dec. 21, 2010.
16Amadio PC (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 21, 2010.