CONDITIONS & CAUSES: Fractures/Trauma, The use of tools, especially those that vibrate (such as sanders),Prolonged knitting or needlework, Typing, data entry, use of a computer mouse, or bar code scanning, 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,  Obesity ,arthritis, hypertension,  pregnancy, Lupus, Gout, various drug ingestions (hormones having a weakly androgenic activity, postmenopausal estrogen use, and others),  hysterectomy, oophorectomy or, scleroderma.





CARPAL TUNNEL SYNDROME is 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.


NEURODIAGNOSTIC ASSOCIATES
ADVANCED NEURODIAGNOSTIC MEDICINE FOR THE PHYSICIAN
SYMPTOMS & DIAGNOSIS: How do you know if you have carpal tunnel syndrome? First, the symptoms are specific. There is tingling and numbness  into the thumb, index, long, and part of the ring finger ,pain into the hand, especially at night.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.
NERVE TESTING: (electromyography [EMG] and nerve conduction studies), to evaluate any loss of normal functioning in the median nerve. Nerve testing for carpal tunnel syndrome is used in specific situations, such as when surgery is being considered or the diagnosis is unclear.X-rays, to check for bone problems caused by past injury, arthritis, recently broken or dislocated bones, or tumors. X-rays are not used to diagnose carpal tunnel syndrome, but they can be helpful for identifying signs of arthritis or an old or new wrist or neck injury that may be contributing to your symptoms.


TREATMENT PLAN:
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. 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.A cortisone injection or cortisone pills can sometimes be useful when the condition is mild to moderately severe and the brace is not helping enough.Injections provides temporary relief from a few days to months. When the condition does not respond to non-surgical treatment or when the condition is severe, surgery is usually recommended. This method may bring relief immediately after surgery in 70 to 80 percent of cases.


PHYSICAL EXAM: When a patient is evaluated for carpal tunnel syndrome, the physician will likely look for numbness in the fingers, and evidence of muscle atrophy (wasting) or weakness in the hand.  There are physical examination tests he or she may do to try and recreate the symptoms of CTS. 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. 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.

Changing or avoiding activities that may be causing symptoms, and taking frequent breaks from repetitive tasks. Wearing a wrist splint to keep your wrist straight, usually just at night.Using nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and reduce inflammation. Ibuprofen, Motrin, Aleve .Although studies have not shown NSAIDs to be effective for carpal tunnel syndrome, they may help you to relieve symptoms. Doing exercises to stretch and strengthen the muscles in the hand and arm. Learning ways to protect your joints as you go through your daily activities
ULTRASOUND: to look at the size of the median nerve. It is inexpensive, comfortable, and quick. However, its use for carpal tunnel syndrome diagnosis is still unproven and relatively uncommon. MRI (magnetic resonance imaging), to look for swelling of the median nerve, narrowing of the carpal tunnel, or problems with circulation of blood through the carpal tunnel. Blood tests, which are occasionally done to check for a thyroid problem, rheumatoid arthritis, or other medical problem. If the cause of your symptoms is unclear and your medical history suggests other possible conditions, your health professional may order blood tests.

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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 and70.  While symptoms involve both hands, the dominant hand is usually most severely  affected.................................................................... 
SURGERY: for carpal tunnel  syndrome is to relieve the pressure on the median nerve. To achieve this, the thick ligament overlying the nerve and forming the ?roof?  of the carpal tunnel is released (cut).  This allows the tunnel to expand, taking the pressure off the nerve. The prognosis is best for patients with least severe symptoms for the shortest duration, stressing the importance of beginning treatment early.
CARPAL TUNNEL SYNDROME IN THE CLINICAL SETTING
NEURODIAGNOSTIC TESTING & IMAGING STUDIES
Research Article 11
LMDC, R.NCS, T.
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