Do You Have Carpal Tunnel Syndrome?
What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is a compression neuropathy that occurs when the median nerve is compressed at the region (carpal tunnel) where it crosses the wrist. Carpal tunnel is the space between the transverse carpal ligament known as the flexor retinaculum and the carpal (wrist) bones, through which the median nerve and the flexor tendons of the fingers and thumb pass. It connects the forearm to the middle compartment of the deep plane of the palm. The median nerve is the only nerve that passes through the carpal tunnel together with the finger flexors of the hand.
Due to repetitive wrist motions creating repetitive micro stress to the carpal tunnel the nine flexor tendons passing through it become inflamed. The inflamed flexor tendons narrow the tunnel thus compressing the median nerve. This neurogenic disorder is termed as carpal tunnel syndrome or also known as the CTS of the wrist.
A nerve is a fiber that connects the brain and the spinal cord with the various parts of the body. The nerve functions to conduct impulses to and from the brains and spinal cord. The efferent fibers, also known as dendrites bring nerve impulses from different organs of the body to the brains to interpret. On the other hand, afferent fibers or the axons do bring nerve impulses from the brains to be delivered to different cells through the spinal cord to create a reaction. The nerve and the musculotendinous structures of our body provide function, feeling, and movement. These are the functions of the median nerve and the flexor tendons that pass through the narrow carpal tunnel.
The diagnosis of CTS is based on the symptoms and the distribution of the numbness in the hand. Other examinations like that of the neck, shoulders and affected extremity, the pulses and reflexes are needed to be done to exclude any other conditions that can mimic carpal tunnel syndrome. The symptoms of nocturnal pain and numbness in the affected hand, as well as clinical signs, point towards diagnosis of the carpal tunnel syndrome.
A thorough physical examination of the wrist needs to be done to look for any swelling, tenderness, deformities, the wrist and fingers’ range of motion, warmth and skin discoloration.
Tests for Carpal Tunnel Syndrome
The two most common tests that are used to help with diagnosing carpal tunnel syndrome are Tinel’s Test and Phalen’s Maneuver. These two special tests are done to irritate and elicit the symptoms to the affected part of the hand to confirm the diagnosis.
The Tinel’s sign is performed by slightly tapping on the volar wrist area just above the median nerve. There is a positive sign for carpal tunnel syndrome if the patient experiences tingling or pins and needles sensation on the thumb, index, middle and radial half of the ring fingers.
The next provocative test for this condition is the Phalen’s test. The wrist is flexed for up to 90 degrees through gravity assisted flexion with elbow bend and forearm held in vertical position. The wrist is bent for approximately 60 seconds to elicit the carpal tunnel syndrome symptoms if this happens the test is then considered a positive one.To avoid false positive result of the test, forced flexion done by the therapist grabbing the patient hand or by the patient themselves must not be done.
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The nerve conduction velocity (NCV) test and electromyography (EMG) are electrodiagnostic tests done to the median nerve to confirm the diagnosis. This can confirm the carpal tunnel syndrome even without the presence of classic symptoms of the disorder.
Blood tests may be useful to rule out other associated conditions (e.g. diabetes, rheumatoid arthritis, thyroid disease). These conditions may also show symptoms with tingling sensations on the hand due to compression of the nerve as a secondary effect of the diseases and not due to micro stresses on the wrist.
Radiological imaging can support other diagnostic findings for carpal tunnel syndrome. The X-ray’s radiographic imaging result though may not confirm the diagnosis but it only provides anatomical relationships among the structures in the wrist and hand especially if there is a physical trauma.
The CT scan and ultrasonography are more sensitive and useful tools for diagnosis as compared to radiographic image from X-ray. The MRI (magnetic resonance imaging) has increased sensitivity and specificity in diagnosing CTS as compared to other radiographic diagnostic procedures.
Carpal tunnel syndrome may be a temporary condition that completely resolves or it can recur and progress over time that surgical release of the median nerve is opted. Conservative treatments to address the symptoms of pain and numbness are done especially during the acute phase. Rest, wrist splinting, application of moist heat, cryotherapy and ultrasound and TENS (transcutaneous electrical nerve stimulation) are part of CTS palliative treatment. However, surgical procedures for this disease are considered only if conservative treatment fails or the severity of the disorder greatly affects the functions of the individual.
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