Carpal tunnel syndrome is a medical condition in which the median nerve is compressed at the wrist, leading to paresthesias, numbness and muscle weakness in the hand. Night symptoms and waking at night is a characteristic of carpal tunnel syndrome was established. They can be managed effectively with night-time wrist splinting in most patients.Definitive treatment for carpal tunnel syndrome is carpal tunnel release surgery. This effectively eliminates the symptoms and prevent further nerve damage, but established nerve dysfunction in the form of static (constant) numbness, atrophy, or weakness are usually permanent.
Most cases of CTS are idiopathic (no particular reason). Some patients are genetically predisposed to develop the condition. The diagnosis of CTS is often misapplied to patients who have activity-related arm pain, such as RSI.
Most cases of CTS are idiopathic (no particular reason). Some patients are genetically predisposed to develop the condition. The diagnosis of CTS is often misapplied to patients who have activity-related arm pain, such as RSI.
Carpal Tunnel Syndrome History
Although the condition was first noted in the medical literature in the early 20th century, the first use of the "carpal tunnel syndrome" term in 1939. Pathology was identified by physician Dr. George S. Phalen of the Cleveland Clinic after working with a group of patients in the 1950's and 1960's.
Although the condition was first noted in the medical literature in the early 20th century, the first use of the "carpal tunnel syndrome" term in 1939. Pathology was identified by physician Dr. George S. Phalen of the Cleveland Clinic after working with a group of patients in the 1950's and 1960's.
Carpal Tunnel Syndrome Anatomy
The median nerve passes through the carpal tunnel, a canal in the wrist that is surrounded by bone on three sides, and the transverse carpal ligament on the fourth. Nine flexor tendons of the hand-pass through this channel. Median nerve can be compressed to decrease the size of the canal, increasing the size of the contents (such as swelling of the tissue around the tendon flexor lubricant), or both. Simply flexing the wrist to 90 degrees will reduce the size of the canal.
Compression of the median nerve as it runs deep to the transverse carpal ligament (TCL) causes wasting thenar eminence, weakness of the flexor pollicis brevis, m. Opponens pollicis, abductor pollicis brevis, and 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 avoided, and innervates the palm towards the thumb.
The median nerve passes through the carpal tunnel, a canal in the wrist that is surrounded by bone on three sides, and the transverse carpal ligament on the fourth. Nine flexor tendons of the hand-pass through this channel. Median nerve can be compressed to decrease the size of the canal, increasing the size of the contents (such as swelling of the tissue around the tendon flexor lubricant), or both. Simply flexing the wrist to 90 degrees will reduce the size of the canal.
Compression of the median nerve as it runs deep to the transverse carpal ligament (TCL) causes wasting thenar eminence, weakness of the flexor pollicis brevis, m. Opponens pollicis, abductor pollicis brevis, and 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 avoided, and innervates the palm towards the thumb.
Carpal Tunnel Syndrome Symptoms
Many people who have 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 sensation of burning and tingling sensation) in the thumb, forefinger, and middle finger, although some patients may experience symptoms in the palm as well. CTS is sometimes associated with trauma, pregnancy, multiple myeloma, amyloidosis, rheumatoid arthritis, acromegaly, mucopolysaccharidoses, or hypothyroidism.
Many people who have 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 sensation of burning and tingling sensation) in the thumb, forefinger, and middle finger, although some patients may experience symptoms in the palm as well. CTS is sometimes associated with trauma, pregnancy, multiple myeloma, amyloidosis, rheumatoid arthritis, acromegaly, mucopolysaccharidoses, or hypothyroidism.
Genetic
The most important risk factors for carpal tunnel syndrome are structural and biological rather than environmental or activity-related. The strongest risk factor is genetic predisposition.
Related Work
International debate regarding the relationship between CTS and repetitive motion in work is ongoing. 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.
The relationship between work and CTS is controversial, in many locations workers diagnosed with carpal tunnel syndrome are entitled to time off and compensation. Carpal tunnel syndrome results in billions of dollars in workers' compensation claims every year.
Some speculate that carpal tunnel syndrome is triggered by grasping and manipulating activities repeatedly and that exposure can be cumulative. It has also been claimed that the symptoms are usually exacerbated by using powerful and repetitive hand and wrist in the employment industry, but it is unclear whether this refers to pain (which is not possible due to carpal tunnel syndrome) or the more typical numbness symptoms.
A review of the scientific data provided by the National Institute for Occupational Safety and Health (NIOSH) indicated that job tasks involving manual actions are highly repetitive or specific wrist postures were associated with incidents of CTS, but causation is not established, and difference of work-related arm pain that is not carpal tunnel syndrome is not clear. It has been proposed that the repeated use of the arm can affect the biomechanics of the upper limb or cause damage to the tissue. It has also been suggested that an assessment of your posture and spine along with ergonomic assessments should be included in determining the overall condition. While these factors have been found to improve comfort in some studies, there is no evidence that they affect the natural history of carpal tunnel syndrome.
International debate regarding the relationship between CTS and repetitive motion in work is ongoing. 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.
The relationship between work and CTS is controversial, in many locations workers diagnosed with carpal tunnel syndrome are entitled to time off and compensation. Carpal tunnel syndrome results in billions of dollars in workers' compensation claims every year.
Some speculate that carpal tunnel syndrome is triggered by grasping and manipulating activities repeatedly and that exposure can be cumulative. It has also been claimed that the symptoms are usually exacerbated by using powerful and repetitive hand and wrist in the employment industry, but it is unclear whether this refers to pain (which is not possible due to carpal tunnel syndrome) or the more typical numbness symptoms.
A review of the scientific data provided by the National Institute for Occupational Safety and Health (NIOSH) indicated that job tasks involving manual actions are highly repetitive or specific wrist postures were associated with incidents of CTS, but causation is not established, and difference of work-related arm pain that is not carpal tunnel syndrome is not clear. It has been proposed that the repeated use of the arm can affect the biomechanics of the upper limb or cause damage to the tissue. It has also been suggested that an assessment of your posture and spine along with ergonomic assessments should be included in determining the overall condition. While these factors have been found to improve comfort in some studies, there is no evidence that they affect the natural history of carpal tunnel syndrome.
Psychosocial Factors
Research has linked activities related upper extremity pain with psychological factors and social, but most pain is not specific but usually misinterpreted as carpal tunnel syndrome. Psychological distress correlated with increased pain in the workplace, as do other psychosocial stressors such as job demands, poor support from colleagues, and job dissatisfaction.
As mentioned elsewhere on this page, the carpal tunnel is characterized by numbness, not pain. Therefore, any association between stress and carpal tunnel syndrome can be debated.
Trauma-related
Research has linked activities related upper extremity pain with psychological factors and social, but most pain is not specific but usually misinterpreted as carpal tunnel syndrome. Psychological distress correlated with increased pain in the workplace, as do other psychosocial stressors such as job demands, poor support from colleagues, and job dissatisfaction.
As mentioned elsewhere on this page, the carpal tunnel is characterized by numbness, not pain. Therefore, any association between stress and carpal tunnel syndrome can be debated.
Trauma-related
- A fracture of one arm bone, especially Colles fracture.
- Dislocation of one of the carpal bones.
- Strong blunt trauma to the wrist or lower forearm, occurs for example by using the tip of the arm to cushion the fall or protect themselves from heavy objects falling.
- Internal bleeding in the wrist.
- Defects of abnormal fracture healing old.
- Electrical burns can cause acute carpal tunnel syndrome.
Carpal tunnel syndrome associated with other diseases
Non-traumatic causes generally happen over a period of time, and was not triggered by a specific event. Many of these factors are manifestations of physiologic aging.
Examples include:
Non-traumatic causes generally happen over a period of time, and was not triggered by a specific event. Many of these factors are manifestations of physiologic aging.
Examples include:
- Rheumatoid arthritis and other diseases that cause inflammation of the flexor tendons.
- With pregnancy and hypothyroidism, fluid is retained in tissues, which swells tenosynovium.
- Acromegaly, growth hormone disorders, nerve compression by abnormal bone growth around the hand and wrist.
- Tumors (usually benign), such as ganglion or a lipoma, can protrude into the carpal tunnel, reducing the amount of space. It is very rare (less than 1%).
- Obesity also increases the risk of CTS: individuals who are classified as obese (BMI> 29) were 2.5 times more likely than lean individuals (BMI <20) to be diagnosed with CTS.
- '' Crush'' Double syndrome is a speculative and disputed theories that postulate that if 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 to nerve compression in the wrist. There is little evidence, however, that this syndrome really exists.
Carpal Tunnel Syndrome Diagnosis
Reference standard for the diagnosis of carpal tunnel syndrome is electrophysiological testing. Patients with intermittent numbness in the median nerve distribution and a positive Phalen and Durkan test, but normal electrophysiological testing has a worst-in-tunnel syndrome carpal very light. A dominance pain than numbness is not possible due to carpal tunnel syndrome no matter the results of electrophysiological testing.
Clinical assessment by history taking and physical examination can support a diagnosis of CTS.
There are several carpal tunnel release surgery variations: each surgeon has a different preference based on their personal beliefs and experiences. All techniques have several things in common, involving brief outpatient procedures; palm or wrist incision (s), and cutting the transverse carpal ligament.
Two main types of open carpal tunnel release surgery and endoscopic carpal tunnel release. Most surgeons have historically been open procedure, widely regarded as the gold standard. However, a growing number of surgeons now offer endoscopic carpal tunnel release, which has been available since the 1990s. Open surgery involves an incision somewhere on the palm about an inch or two in length. Through this incision, the skin and subcutaneous tissue is divided followed by the palmar fascia and transverse carpal ligament eventually. Endoscopic techniques involve one or two small incisions (less than half an inch each) through which instrumentation is introduced including a synovial elevator, probes, knives and endoscopy are used to fully visualize the transverse carpal ligament. Endoscopic methods do not divide the subcutaneous tissues or the palmar fascia to the same level as the open method does.
Many studies have been conducted to determine whether the perceived benefits of the release of a limited endoscopic or arthroscopic really significant. Brown et al. no prospective, randomized, multi-center study and found no significant differences between the two groups related to the secondary quantitative outcome measurements. However, the open technique produces more tenderness of the scar than the endoscopic method. A prospective randomized study conducted in 2002 by Trumble revealed that good clinical outcomes and patient satisfaction are achieved more quickly when the endoscopic method of carpal tunnel release are used. Single-portal endoscopic surgery is a safe and effective method of treating carpal tunnel syndrome. No significant differences in complication rates or operating costs between the two groups. However, the open technique produces scar tenderness greater during the first three months after surgery and a longer time until the patient can return to work.
Some surgeons have suggested that in their own hands endoscopic carpal tunnel release has been associated with a higher incidence of injury to the median nerve, and for this reason it has been abandoned at several centers in the United States. For example, at the 2007 annual meeting of the American Society for Surgery of the Hand, during the "Journal of retraction" event, one of the former supporters of endoscopic carpal tunnel release, Thomas J. Fischer, MD, drawn public advocacy techniques, based on the assessment that the benefits of the procedure (slightly faster recovery) did not outweigh the risk of injury to the median nerve.
Although this view is the other surgeons have embraced limited incision method and is considered the procedure of choice for many of these surgeons with respect to idiopathic carpal tunnel syndrome. Supporting this is the result of a series of previously mentioned that mentions no difference in the rate of complications for both methods of operation. So there has been broad support for surgical procedures: open or endoscopic carpal tunnel release using a variety of devices or incisions with the knowledge that the main goal of any carpal tunnel release surgery is to divide the transverse carpal ligament and the distal aspect of the volar ante brachial fascia thus decompress the median nerve. All surgical options (if done without complication) typically have relatively rapid recovery profiles (weeks to several months depending on the activities and techniques), and all usually leave a scar cosmetic accepted.
Reference standard for the diagnosis of carpal tunnel syndrome is electrophysiological testing. Patients with intermittent numbness in the median nerve distribution and a positive Phalen and Durkan test, but normal electrophysiological testing has a worst-in-tunnel syndrome carpal very light. A dominance pain than numbness is not possible due to carpal tunnel syndrome no matter the results of electrophysiological testing.
Clinical assessment by history taking and physical examination can support a diagnosis of CTS.
There are several carpal tunnel release surgery variations: each surgeon has a different preference based on their personal beliefs and experiences. All techniques have several things in common, involving brief outpatient procedures; palm or wrist incision (s), and cutting the transverse carpal ligament.
Two main types of open carpal tunnel release surgery and endoscopic carpal tunnel release. Most surgeons have historically been open procedure, widely regarded as the gold standard. However, a growing number of surgeons now offer endoscopic carpal tunnel release, which has been available since the 1990s. Open surgery involves an incision somewhere on the palm about an inch or two in length. Through this incision, the skin and subcutaneous tissue is divided followed by the palmar fascia and transverse carpal ligament eventually. Endoscopic techniques involve one or two small incisions (less than half an inch each) through which instrumentation is introduced including a synovial elevator, probes, knives and endoscopy are used to fully visualize the transverse carpal ligament. Endoscopic methods do not divide the subcutaneous tissues or the palmar fascia to the same level as the open method does.
Many studies have been conducted to determine whether the perceived benefits of the release of a limited endoscopic or arthroscopic really significant. Brown et al. no prospective, randomized, multi-center study and found no significant differences between the two groups related to the secondary quantitative outcome measurements. However, the open technique produces more tenderness of the scar than the endoscopic method. A prospective randomized study conducted in 2002 by Trumble revealed that good clinical outcomes and patient satisfaction are achieved more quickly when the endoscopic method of carpal tunnel release are used. Single-portal endoscopic surgery is a safe and effective method of treating carpal tunnel syndrome. No significant differences in complication rates or operating costs between the two groups. However, the open technique produces scar tenderness greater during the first three months after surgery and a longer time until the patient can return to work.
Some surgeons have suggested that in their own hands endoscopic carpal tunnel release has been associated with a higher incidence of injury to the median nerve, and for this reason it has been abandoned at several centers in the United States. For example, at the 2007 annual meeting of the American Society for Surgery of the Hand, during the "Journal of retraction" event, one of the former supporters of endoscopic carpal tunnel release, Thomas J. Fischer, MD, drawn public advocacy techniques, based on the assessment that the benefits of the procedure (slightly faster recovery) did not outweigh the risk of injury to the median nerve.
Although this view is the other surgeons have embraced limited incision method and is considered the procedure of choice for many of these surgeons with respect to idiopathic carpal tunnel syndrome. Supporting this is the result of a series of previously mentioned that mentions no difference in the rate of complications for both methods of operation. So there has been broad support for surgical procedures: open or endoscopic carpal tunnel release using a variety of devices or incisions with the knowledge that the main goal of any carpal tunnel release surgery is to divide the transverse carpal ligament and the distal aspect of the volar ante brachial fascia thus decompress the median nerve. All surgical options (if done without complication) typically have relatively rapid recovery profiles (weeks to several months depending on the activities and techniques), and all usually leave a scar cosmetic accepted.
Efficacy
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. In general, endoscopic techniques are as effective as traditional open carpal surgery, although a faster recovery time typically noted in endoscopic procedures is felt by some may have to be offset by a higher rate of complications. Success is greatest in patients with the most typical symptoms. The most common cause of failure is the correct diagnosis, and it should be noted that this operation will only reduce carpal tunnel syndrome, and will not relieve symptoms with alternative causes. Recurrence is rare, and apparent recurrence usually results from misdiagnosis of another problem. Complications can occur, but are rare to rare serious.
Carpal tunnel surgery is usually performed by a hand surgeon, orthopedic or plastic surgery, some neurosurgeons and general surgeons also perform the procedure.
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. In general, endoscopic techniques are as effective as traditional open carpal surgery, although a faster recovery time typically noted in endoscopic procedures is felt by some may have to be offset by a higher rate of complications. Success is greatest in patients with the most typical symptoms. The most common cause of failure is the correct diagnosis, and it should be noted that this operation will only reduce carpal tunnel syndrome, and will not relieve symptoms with alternative causes. Recurrence is rare, and apparent recurrence usually results from misdiagnosis of another problem. Complications can occur, but are rare to rare serious.
Carpal tunnel surgery is usually performed by a hand surgeon, orthopedic or plastic surgery, some neurosurgeons and general surgeons also perform the procedure.
Tunnel Syndrome Syndrome Long Term Recovery
Most people who seek relief from the symptoms of carpal tunnel their conservative or surgical management find "nerve damage" minimal residual or. Long-term chronic carpal tunnel syndrome (typically seen in the elderly) can result in permanent "nerve damage", ie irreversible numbness, muscle wasting and weakness.
While the results are generally good, certain factors can contribute to poor results that had nothing to do with nerves, anatomy, or surgery type. One study showed that mental status parameters, alcohol use, yield much poorer overall than treatment.
Many mild carpal tunnel syndrome sufferers either change their hand, pattern or posture at work or find a conservative, non-surgical treatments that enable them to return to full activity without hand numbness or pain, and uninterrupted sleep. Some find relief by adjusting their repetitive movements, the frequency of which they do the movements, and the amount of time they rest between periods of movement. Other people end up prioritizing their activities and possibly avoiding certain hand activities so that they can minimize pain and perform important tasks. Keyboard re-mapping software can help people whose condition is exacerbated by the hands of key strokes that involve a combination of Shift, Control or Alt key and alpha-numeric key. Programs like AutoHotkey allows one to disable key combinations while they train themselves to use two hands to carry out the offending key strokes.
Recurrence of carpal tunnel syndrome after successful surgery is rare. If a person has hand pain after surgery, most likely not because of carpal tunnel syndrome. It may happen that a person who has hand pain after carpal tunnel release was diagnosed incorrectly, such that carpal tunnel release does not have a positive influence on the patient's symptoms.
Most people who seek relief from the symptoms of carpal tunnel their conservative or surgical management find "nerve damage" minimal residual or. Long-term chronic carpal tunnel syndrome (typically seen in the elderly) can result in permanent "nerve damage", ie irreversible numbness, muscle wasting and weakness.
While the results are generally good, certain factors can contribute to poor results that had nothing to do with nerves, anatomy, or surgery type. One study showed that mental status parameters, alcohol use, yield much poorer overall than treatment.
Many mild carpal tunnel syndrome sufferers either change their hand, pattern or posture at work or find a conservative, non-surgical treatments that enable them to return to full activity without hand numbness or pain, and uninterrupted sleep. Some find relief by adjusting their repetitive movements, the frequency of which they do the movements, and the amount of time they rest between periods of movement. Other people end up prioritizing their activities and possibly avoiding certain hand activities so that they can minimize pain and perform important tasks. Keyboard re-mapping software can help people whose condition is exacerbated by the hands of key strokes that involve a combination of Shift, Control or Alt key and alpha-numeric key. Programs like AutoHotkey allows one to disable key combinations while they train themselves to use two hands to carry out the offending key strokes.
Recurrence of carpal tunnel syndrome after successful surgery is rare. If a person has hand pain after surgery, most likely not because of carpal tunnel syndrome. It may happen that a person who has hand pain after carpal tunnel release was diagnosed incorrectly, such that carpal tunnel release does not have a positive influence on the patient's symptoms.
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