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Carpal Tunnel Syndrome

submitted by Dr. Sarim Mir

Carpal tunnel syndrome is a condition brought on by increased pressure or a pinched nerve at the wrist. Symptoms may include numbness, tingling and pain in the arm, hands and fingers.

There is a space in the wrist called the carpal tunnel where the median nerve and nine tendons pass from the forearm into the hand. Carpal tunnel syndrome happens when pressure builds up from swelling in this tunnel and puts pressure on the nerve.

When the pressure from the swelling becomes great enough to disturb the way the nerve works, numbness, tingling, and pain may be felt in the hands and fingers.

Usually, the cause is unknown. Pressure on the nerve can happen several ways including swelling of the lining of the flexor tendons, called tenosynovitis; joint dislocations; fracture; and arthritis, and keeping the wrist bent for long periods of time.

Fluid retention during pregnancy can cause swelling in the tunnel and symptoms of carpal tunnel syndrome, which often go away after delivery. Thyroid conditions, rheumatoid arthritis, and diabetes also can be associated with carpal tunnel syndrome. There may be a combination of causes.

Carpal tunnel syndrome symptoms usually are pain, numbness, tingling or a combination of the three. The numbness or tingling most often takes place in the thumb, index, middle and ring fingers.

The symptoms usually are felt during the night, but also may be noticed during daily activities such as driving or reading a newspaper. Patients sometimes notice they have a weaker grip, occasionally clumsiness and may drop things. In severe cases, sensation may be permanently lost and the muscles at the base of the thumb slowly shrink (thenar atrophy).

Diagnosis should include a detailed history of their medical conditions, how the hands have been used, and whether there were any prior injuries are important. An X-ray may be taken to check for other causes of the complaint such as arthritis or a fracture. In some cases, laboratory tests may be done if there is a suspected medical condition.

An EMG or electromyogram test may be done to check nerve problems as well as to evaluate the carpal tunnel.

Symptoms can often be relieved without surgery, identifying and treating medical conditions, changing the patterns of hand use, or keeping the wrist splinted may reduce the pressure on the nerve.

Wearing wrist splints at night may relieve the symptoms that interfere with sleep. Anti-inflammatory medication taken by mouth may relieve the carpal tunnel symptoms. When symptoms are severe or do not improve, surgery may be needed to make more room for the nerve.

Dr. Mir, M.D., is Board Certified in Neurology and Clinical Neuro Physiology, with offices at the Robinwood Medical Center in Hagerstown.

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