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Carpal Tunnel Syndrome

CARPAL TUNNEL SYNDROME WHAT IS THE CARPAL TUNNEL? The Carpal Tunnel Transverse carpal ligament Median nerve Carpal tunnel Flexor tendons Carpal bones The carpal tunnel is a space under the base of the palm that the median nerve (one of the major nerves to the hand) runs through. The carpal tunnel has rigid, unyield- ing boundaries: Its back and sides are made up of the wrist bones and its front, just under the palm, is made up of a very thick ligament, the "transverse carpal liga- ment". The median nerve provides sensation to the thumb, index finger, middle finger and half of the ring finger. It also controls the group of muscles at the base of the thumb. The median nerve runs through the carpal tunnel accompanied by the nine tendons that flex (bend) the fingers and thumb, and the tendons' lining, which is called “tenosynovium". WHAT IS CARPAL TUNNEL SYNDROME? Carpal Tunnel Syndrome occurs when the median nerve becomes compressed in the carpal tunnel. As the boundaries of the carpal tunnel are rigid, and it contains only a limited amount of space, anything that takes up too much space in the carpal tunnel can compress and damage the median nerve. Carpal tunnel syndrome is, pure and simple, a space problem: There's too much stuff in too little space. The most common thing that takes up too much space is the tenosynovium (tendon lining), when it swells up. WHAT ARE THE SYMPTOMS OF CARPAL TUNNEL SYNDROME? The symptoms of carpal tunnel syndrome come from irritation of the median nerve. Remember that the median nerve supplies sensation to the thumb, index finger, middle finger and half of the ring finger, as well as motor control to the thick muscles at the base of the thumb. HOW IS CARPAL TUNNEL SYNDROME TREATED? Unless the carpal tunnel syndrome has been around for a long time, leading to permanent nerve damage, initial treatment often involves splinting the wrist at night. If that doesn't work, carpal tunnel syndrome should be cured by Carpal Tunnel Release. Carpal tunnel release is an outpatient procedure during which the transverse carpal ligament that is compressing the median nerve is cut. By cutting this ligament 25% more room is created in the carpal tunnel, relieving pressure on the median nerve, stopping progression of the nerve damage and allowing Transverse Carpal -Ligament Ulna Median Nerve Radius the median nerve to heal. Unless irreversible nerve damage is already present, a carpal tunnel release decreases the symptoms of carpal tunnel syndrome in over 95% of patients. MYTHS OF CARPAL TUNNEL SYNDROME MYTH #1 CTS IS RELATED TO TYPING OR COMPUTERS. Untrue. This theory is based upon very poorly done “junk science" from decades ago. Unfortunately, these studies were quoted by plaintiff attorneys and picked up by the lay press during a class-action lawsuit against keyboard manufacturers. However, more recently performed high-quality research studies have shown that not only is there no association between computer use/typing and CTS, but that people who use computers and/or keyboards more may actually have a decreased risk of CTS compared to people who do less typing. ΜΥΤΗ #2 CTS IS RELATED TO MY JOB. Mainly untrue. To be a significant risk factor for CTS both high force and high repetition over a prolonged period of time need to occur. That's why typing, which is high repetition but low force, is not a risk factor. Assembly line work and other commonly thought of "overuse occupations" are not related to CTS. Except for those with the following high risk jobs, CTS is much more likely to be due to genetic factors or personal issues (weight, age, diabetes, thyroid issues, rheumatoid diseases, etc.) than due to a job. The high risk operations are: Jackhammer operator (high-force vibration over a prolonged period of time; please note that riding in a vehicle is not the type of vibration l'm talking about here), poultry processor, meat packer, meat cutter and cake decorator. Please note that these careers have not been proven to lead to CTS, but some noted authorities have considered these occupations predisposing risk factors for CTS. ΜΥΤΗ #3 CTS SHOULD BE WORSE IN MY RIGHT HAND IF I'M RIGHT-HANDED OR WORSE IN MY LEFT HAND IF I'M LEFT-HANDED. Untrue. There is no predilection for the dominant hand. Again, CTS is not due to overuse (with the few exceptions noted above), so you're just as likely to develop it in either hand. MYTH #4 EXERCISES AND/OR THERAPY CAN HELP WITH MY CTS. Untrue. CTS is a space problem, which leads to the median nerve becoming pinched at the wrist. There's simply no way for exercises to help carpal tunnel syndrome. Confusion occurs because many things, such as massage, exercise, a few drinks, etc. can make almost any problem feel better in the short run. But exercises and/or therapy are not curative and will make no difference in the long run. MYTH #5 LASERS OR LASER SURGERY CAN HELP CTS. Untrue. These false claims have been totally debunked by scientific studies. And the only laser surgery that is currently done, as far as l'm aware, is in the eyes. In the rest of the body, lasers generate too much heat, kill much more tissue than does a knife and scissors, and have led to serious problems where ever they've been used in the arms and legs. CARPAL TUNNEL SYNDROME DURING PREGNANCY Carpal tunnel syndrome is very common during pregnancy. It's probably caused by all of the swelling and fluid shifts that child-bearing leads to. During pregnancy, extra fluid collects throughout the body, including inside the carpal tunnel. This compresses the median nerve about the wrist, leading to carpal tunnel syndrome. Night splints can be tried to prevent the wrist from flexing down during sleep. However, these are often ineffective. We don't operate on pregnant women, and so a carpal tunnel release is not an option until after child birth. Fortunately, a single steroid injection usually provides significant relief by decreasing the severity of symptoms for the remainder of the pregnancy. Steroid use is widely believed to be safe during pregnancy. And it's very effective. I've injected many pregnant women for carpal tunnel syndrome, including pregnant pediatricians and pregnant OB/GYNS (obstetrician-gynecologists). Once childbirth occurs, the carpal tunnel syndrome resolves in approximately 50%, and no further treatment is needed. For the other 50%, an endoscopic carpal tunnel release can be performed as soon as the new mother is no longer breast feeding. This usually provides a permanent solution to the problem. WHAT ARE THE SYMPTOMS OF TRIGGER FINGER? a Trigger Finger is a painful condition that causes the finger or thumb to catch or lock in a bent position. It causes soreness at the base of the finger. o The most common symptom is a painful clicking or snapping when straightening the finger. o One or more fingers get stuck, especially in the morning when waking up.

Carpal Tunnel Syndrome

shared by daniellewis on May 01
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The carpal tunnel is a space under the base of the palm that the median nerve (one of the major nerves to the hand) runs through. The carpal tunnel has rigid, unyielding boundaries: Its back and side...

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