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Carpal tunnel syndrome

C. A. V. Nogueira, M.D. |
These days more and more people suffer from carpal tunnel syndrome. That's a very painful sensation in wrist and in the most cases the cause is - a computer mouse.

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Carpal tunnel syndrome is caused by compression of one nerve in the wrist, called median nerve. The median nerve passes through the wrist in a narrow channel called the carpal tunnel, and if it's compressed the wrist hurts and movement is painful and almost impossible.

Carpal tunnel syndrome can be caused by a number of factors including traumatic wrist injury such as fractures, repetitive use of the wrist (think about computer mouse!), use of vibrating machinery, or it can be caused by arthritis. The cause can be of genetic origin too, some people are born with smaller, narrower carpal tunnel.

All these conditions can make the space through which the median nerve passes very narrow, and then the nerve is compressed. If that compression last for a longer time, the nerve is damaged, it starts to hurt, then the movement is limited, and in the end the function of the wrist totally disappears. It is known that carpal tunnel syndrome is three times more common in women, and that logical because women have a smaller carpal tunnel. People with a condition that affects the nervous system are at greater risk of carpal tunnel syndrome.

Since the cause in the most cases is some repetitive doing, carpal tunnel syndrome usually occurs in the dominant hand and some professions are more at risk than others. To put it shortly, if you are doing the same movement over and over again, the chance is you will get this painful syndrome.

Symptoms usually increase slowly and at the beginning can be present only at night. Carpal tunnel syndrome are a dull ache in the wrist, pain which radiates into the thumb and four fingers (not in the little finger), and sensations of burning in the hand or four fingers. The pain is usually worse at night, and then it spreads to the elbow or shoulder. Add to that a weakness in the affected fingers and hands, and it's obvious that affected hand with time becomes useless.

You can perform a simple test if you think that you have Carpal tunnel syndrome. The first test is called Tinels sign: it's simple tapping with two fingers over the palm side of the wrist. If that causes the pain, then you have carpal tunnel syndrome. The second test is called Phalens test: place your hands in front of you at chest height with the fingers of the two hands touching. Flex the wrists so that you put the backs of your hands together and hold this position for a minute. If that is painful, you have carpal tunnel syndrome. In most cases there's no need for advanced test like an MRI scan or ultrasound.

How this syndrome can be treated? At first the treatment is conservative, without a surgery. The first period of treatment should include complete rest for the wrist and your doctor may prescribe some anti-inflammatory medication to reduce inflammation. After the resting stretching exercises can help prevent a re-occurrence of symptoms. It is important that all exercises must cause no pain. So, if pain occurs again, go back to rest with your wrist.

The bad thing is, in people with naturally narrow tunnel and in harder cases, a more aggressive approach is needed. Your doctor may give you injections against inflammation, and if that doesn't help, then the surgery is needed. The good thing is that a carpal tunnel release is a very common operation. The surgeon will cut the carpal ligament to make more space for the median nerve. That is a very simple procedure, you don't have to stay in hospital more than few hours and in a few weeks your wrist will be as new.


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