Utah, Salt Lake City - Report by Olivia. Today, we will give information about Carpal tunnel syndrome: median nerve at the wrist .
Carpal tunnel syndrome refers to symptoms caused by compression of the median nerve in the carpal tunnel. "Carpal" itself means "wrist", carpal tunnel if one is nothing more than a wrist tunnel. This particular tunnel can be a crowded place, because it contains not only the median nerve, but nine tendons as well. The "syndrome" consists of a combination of pain, numbness and weakness.
The pain, numbness, or both, are the first common symptoms of carpal tunnel syndrome. The pain can affect the fingers, hand, wrist and forearm, but usually the upper arm or shoulder. Numbness affects the palm side of the thumb and fingers, but usually saves little finger because that finger is connected to a different nerve.
When weakness is present, it usually indicates that the condition is already severe, and when muscles atrophy (fade) this means that the condition is even worse. The affected muscles are those downstream of where the nerve is pinched, and may include those which control one of the three movements of the thumb. In addition, the bending of the proximal phalanges of the index and middle fingers can be assigned, as is the straightening of the second articulations of these same fingers. When muscle atrophy is present, it is more evident in muscle ball at the base of the thumb.
Carpal tunnel syndrome occurs more frequently in women than in men. People who work with their hands a lot - for example sewing, operate hand tools or perform the assembly line work - are at increased risk of developing this condition. Various medical conditions can also increase the risk of carpal tunnel syndrome, including injuries, arthritis, diabetes, low levels of thyroid hormones and pregnancy. In the case of pregnancy, carpal tunnel syndrome often appears in the third quarter and decides after the woman offers.
optimal diagnosis of this condition combines the traditional methods of making the story of a doctor and a physical examination with nerve function test called nerve conduction studies. Nerve conduction studies are extremely sensitive in detecting impairment of the median nerve at the wrist, especially when the median nerve is compared to a healthy nerve in proximity to the same patient.
In nerve conduction studies, the nerve on one side of the carpal tunnel is activated by a small shock to the skin. A measure of the oscilloscope the time it takes for the pulse-nerve due to arrive on the other side of the carpal tunnel. When the median nerve is pinched, the nerve-impulse is delayed or blocked. Nerve conduction studies are so sensitive that sometimes they show problems that are not even cause symptoms. That's why nerve conduction studies are not alone in the diagnosis of carpal tunnel syndrome. The examining physician must decide if the results are meaningful to the patient.
nerve conduction studies show not only whether or not the median nerve is impaired at the wrist, but also to provide accurate data on how bad the loss is. In addition, these studies investigating the function of other nerves in the arm and hand. Sometimes, a nerve in an adjacent tunnel (ulnar nerve in Guyon's canal) may also be pinched. In other cases, nerve conduction studies show that the problem is not a single nerve-pinches, but a more diffuse pattern of impaired nerve-called polyneuropathy. Of course, sometimes studies are entirely normal and suggest that the symptoms are due to something else.
To treat carpal tunnel syndrome, beginning with the treatment "conservative" makes sense in most cases, especially when symptoms are still in the light-to-moderate. Conservative treatment usually includes a wrist splint that keeps the wrist in a neutral position. In a 2005 study, researchers from the University of Michigan studied the effectiveness of wrist splints for carpal tunnel syndrome among workers of an automobile factory in the Midwest. In a randomized controlled trial - the method of the gold standard to assess treatment - about half of the workers received personalized wrist splints at night they wore for six weeks. Other workers have received training on safe work procedures, but not splints. After treatment the workers with splints had less pain than those without, and the difference in the outcome was still evident after one year.
Conservative treatment may further include the use of anti-inflammatory drugs such as aspirin or naproxen, or even steroids drugs. This could benefit selected patients, but in a randomized 2005 study controlled for patients with mild to moderate symptoms, researchers at the University of Mersin in Turkey showed that patients receiving splints did better than those who received steroid injections.
Surgeons can relieve pressure on the median nerve pinched by cutting a constriction band of fabric covering. A 2002 study at the Vrije University in Amsterdam, compared surgical treatment for six weeks of wrist splints. After 18 months 90% of operated patients had a positive result against 75% in the secured group.
In some cases, it may be reasonable to try conservative treatment without first confirming the diagnosis with nerve conduction studies. However, in the opinion of the author, this type of risk-free test must be performed before carpal tunnel surgery. (Full disclosure: The author performs nerve conduction studies)
(C) 2005 by Gary Cordingley
Gary Cordingley, MD, PhD, a neurologist, a clinical professor and researcher works in Athens, Ohio. For more health-related articles see his website at: http://www.cordingleyneurology.com and http://www.neurologyarticles.com
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