Introduction
Carpal Tunnel Syndrome (CTS) is the medical term used to refer to a progressive and very painful condition that affects the wrists as a result of compression of the median nerve which is the key nerve that is found in the wrist area. The median nerve runs from the lower part of the arm and goes into the hand and when this nerve gets squeezed by any sort of pressure, the result is a gradual feeling of pain, numbness, and weakness that begins in the wrist and hand and then spreads up the whole arm. As the symptoms of carpal tunnel syndrome continue to get worse, the victims might experience a tingling sensation around the wrist during the day followed by a weakness that makes it difficult for the sufferers to perform such simple tasks as folding the fist, grasping onto small objects or even performing other manual but equally minor tasks. If left untreated for a long time, some of the victims of CTS gradually lose the power to differentiate between hot and cold things through the touch (NINDS ¶ 1).
Carpal Tunnel Syndrome
The median nerve runs through the carpal tunnel, a narrow passageway that is found in the wrists and acts as a message transmitted between the brain, thumb, middle, and index fingers as well as the inner section of the ring finger. Because it is surrounded by ligaments and bones, any swelling around the carpal tunnel causes compression or pinching of the median nerve that runs through it. The median nerve performs the function of controlling the muscles and sensation in the thumb as well as the sensation in the first three fingers and the palm. CTS normally results from a combination of various factors which exert pressure on the tendons and median nerve in the carpal tunnel. Although no specific cause of CTS has been identified, the disorder has mainly been associated with a congenital predisposition whereby some people have small carpal tunnels than others. Although both hands can be affected, carpal tunnel syndrome affects the hand that is dominantly used during activity and it is the hand that also produces much pain. CTS usually affects only adults and those persons with metabolic disorders such as diabetes are at greater risk because such disorders interfere with the nerves, making them more vulnerable to compression
CTS is the most commonly treated condition that hand surgeons have to deal with in contemporary society (Balch 310; NINDS ¶ 1-3).
A generation ago, this condition referred to as carpal tunnel syndrome was barely recognized in the medical circles but today, it is rapidly becoming too common. It is categorized under a group of injuries referred to as repetitive strain injuries (RSIs) which include such other conditions as nerve spasms and trigger finger. Previously, CTS was considered an occupational hazard among bookkeepers and check-out clerks especially in supermarket stores but with the introduction of the personal computer in the 1980s, the condition has become quite common among those who use the technology extensively. This is because most work is now being done while people are sitting down at computer desks and less time is spent in physical activity. When the keyboard is placed in the wrong position; either too low or too high, increased symptoms of CTS are very likely. Out of every one thousand people, one person is likely to develop CTS although it is more common within the 50 – 70 years age bracket. Carpal tunnel syndrome is more common in women than men because women’s carpal tunnel is smaller in size when compared with that of men. Also prone to CTS are people whose jobs involve a lot of repetitive and forceful movement of the hands especially those who bend the wrists quite often such as typists, carpenters, drivers, hairstylists, musicians especially violinists, athletes, upholsterers, waitresses as well as those who paint, crotchet, hook rugs, knit and gardeners or woodworkers. Also affected are assembly-line workers such as those working in fish, poultry, and meatpacking, manufacturing, cleaning, sewing as well as finishing industries. The condition is however accelerated by other conditions such as pregnancy, rheumatoid arthritis, hypothyroidism and work stress, development of tumors or cysts in the birth canal as well as fluid retention that is common during pregnancy among other factors. Full prove is however yet to be made about the relation between the forceful repetitive movement of hands or wrists during work or leisure and CTS (Balch 310; Carlson, Eisenstat & Ziporyn 123; Luchetti & Amadio 3 -4, 13).
When a patient visits the clinic with symptoms similar to those of CTS, a physical examination should immediately be carried out on the patient’s hands, arms, neck as well as shoulders to rule out any underlying disorder or other equally painful conditions that could be confused for CTS. The patient’s wrist should be checked to find out if there is any swelling, discoloration, tenderness, or warmth and all fingers tested for any sensation. The examiner should also check for any weakening or wasting away of hand muscles. To rule out such other conditions as fractures, arthritis, or diabetes, it is important to carry out X-rays and routine laboratory tests. One of the methods used by physicians to test for any symptoms of CTS is the Tinel test through which the clinician or doctor presses or taps on the patient’s median nerve. When shock-like sensation or tingling of the fingers occurs, this test is said to be positive. Another test used for assessing the possibility of CTS is the wrist-flexion test popularly referred to as the Phalen test in which a patient is asked to hold the forearms upright, point the fingers down, and then press together the back of his or her hands. If increasing numbness or tingling occurs in the fingers within 1 minute after starting the exercise, then carpal tunnel syndrome is said to be quite likely. But any diagnosis of CTS must be confirmed using electro-diagnostic tests whereby electrodes are used to send small electric shocks through the patient’s wrists or hands and measurements are made for the speed at which his or her nerves transmit impulses. Another test used is ultrasound imaging which is used to detect any impaired movement of the patient’s median nerve. Electromyography is also used in which process the patient’s muscle is injected using a fine needle and nay damage to the median nerve is assessed by viewing electrical activity on the screen. It is however very important that diagnosis of CTS is made early enough before any serious and permanent damage affects the median nerve (Balch 31; NIDS ¶ 5).
The most immediate form of treatment for CTS is putting to rest the affected wrist or hand at least for about 2 weeks or more during which time the victim is required to avoid performing any activities that are likely to worsen the symptoms as well as prevent any movement of the wrist by supporting it in a splint. For those patients experiencing mild symptoms of CTS, lasting relief can be obtained through resting the joints at night by wearing wrist splints or by modifying the work and recreational activities suspected to cause the condition. Pain relievers such as ibuprofen and aspirin can be used to ease the pain. To provide immediate temporary relief and also relieve the pressure that swelling exerts on the median nerve, prednisone and cool ice packs can be taken through the mouth or injection for the drug lidocaine administered directly into the wrist. Tremendous Care should however be taken when administering treatment for CTS using prednisone and other corticosteroids because they can distort the regulation of insulin levels. Exercises supervised by a trained occupational or physical therapist can also be helpful. Occupational therapists can also assist in assessing the patient’s working conditions to reduce the rate at which symptoms occur (Carlson, Eisenstat & Ziporyn 124-125; Balch 311).
Carpal tunnel syndrome is also corrected through surgery, the most common of which is the carpal tunnel release which is normally conducted under local anesthesia to relieve the amount of pressure on the median nerve by severing the tissue surrounding the wrist. This form of surgery often provides immediate relief for the condition while leaving a very small scar as evidence of an operation. CTS however recurs in some patients even after this form of surgery which has also reported very limited success among patients with work-related CTS. Open release surgery and endoscopic surgery are however the most common types of surgery used to correct the syndrome. Recently, however, an alternative to surgery has been developed by Dr. Sean Mahoney of Vermont, the U.S.A which is referred to as Erchonia Low-Level Laser. This new method of treatment either eliminates or reduces weakness and pain tingling in the wrists and allows the victims to return to work or stay on the job. The treatment method which is currently in use at Vermont’s Advance Spine Disc Joint Center has raised much hope in the treatment of CTS because health care costs will not only be reduced but workers will also be able to work or remain in their jobs. Though in use for over 25 years in Europe, it is only very recently that it has received the approval of the FDA. Herbal treatments such as wintergreen oil aids, aloe vera, and marshmallow root also help to relieve symptoms. Victims can also alleviate symptoms by keeping the place of work as warm as possible. Although CTS symptoms have been known to interrupt even deep sleep, they can be relieved by rubbing or shaking the affected hand or even hanging the whole arm over the bedside (PRWeb ¶ 5-7; Carlson, Eisenstat & Ziporyn 124-125).
Conclusion
Extensive research on CTS and other nerve-related conditions is being carried out by NIDS at the National Institute of Health (NIH) laboratories. NINDS also supports various major medical institutions in the U.S by providing them with grants to support their research on CTS and other similar conditions. Clinical studies have been and continue to be out among construction workers in which data about the syndrome is collected as a way of understanding specific work-related factors that lead to the condition besides helping to devise ways in which the occurrence of the disorder can be prevented among the construction workers and others. Scientists have also been engrossed in trying to find out other preventive measures as well as treatment methods for CTS and one of those being considered is acupuncture (NINDS ¶ 4).
Works Cited
Balch, Phyllis A. Prescription for Nutritional Healing. New York: Avery, 2006.
Carlson, Karen J, Eisenstat Stephanie A and Ziporyn Terra D. The New Harvard Guide to Women’s Health. Cambridge, MA: Harvard University Press, 2004.
Luchetti, Ricardo and Amadio P. Carpal Tunnel Syndrome. Warren, MI: Springer, 2006.
National Institute of Neurological Disorders and Stroke. NINDS Carpal Tunnel Syndrome Fact Sheet. National Institute of Health. 2008.
PRWeb. Burlington, VT Area. “Doctor Helps Carpal Tunnel Syndrome Sufferers Around Surgery with FDA Approved Low Level Laser.” 2009. Web.