[Occupational disease – Since they tend to associate it with repetitive activities such as typing or assembly line work in a factory, because the pain manifests in the hands]…
Carpal Tunnel Syndrome is a very common and poorly understood condition; to the point that in recent years it has received a lot of media attention and yet not even the scientific community fully understands it. The media classifies it as an “occupational disease” (since they tend to associate it with repetitive activities like typing or assembly line work in a factory, because the pain manifests in the hands), however public opinion is wrong and the reality is different: the cause is not the use of a keyboard; although there is a predisposition to this condition, repetitive activities (like typing) can aggravate it.
“Carpal Tunnel Syndrome” means that there is a compression of the Median nerve of the hand. This nerve is located inside a tunnel whose bottom and side walls are formed by the carpal bones (the top wall is formed by a structure called the “transverse carpal ligament”). In addition to the nerve, there are nine tendons that provide flexion to the fingers and line the tunnel; when the membrane that covers these tendons becomes inflamed, the reduction of space causes nerve compression, and this “compression of the central nerve” is what produces the symptoms of Carpal Tunnel Syndrome.
The symptoms most frequently associated with Carpal Tunnel Syndrome are: numbness and tingling of the hand (which usually begins during the night and feels numb upon waking up in the morning). Pain and weakness are frequently felt in the hand, especially in the thumb, and if allowed to progress untreated for a long time, the muscle at the base of the thumb can atrophy. In addition to the physical symptoms of Carpal Tunnel Syndrome, the diagnosis can be easily confirmed with a nerve conduction study, which measures the speed and latency of nerve impulses through the central nerve of the wrist and helps the doctor figure out if the patient suffers from a median nerve compression. The condition is more common in middle-aged women (often perimenopausal) but can also present in young women and can be caused by chronic conditions such as diabetes, gout or thyroid disease, and is common in women during the third trimester of pregnancy or when there is rapid weight gain. If the person is free of all these conditions, the cause is said to be idiopathic: caused by an unknown process.
Carpal Tunnel Syndrome is related to conditions such as: tendonitis in the fingers, trigger finger or tendonitis in the wrist (DeQuervain’s tenosynovitis, for example, causes wrist pain at the base of the thumb).
Treatment for Carpal Tunnel Syndrome frequently focuses on decreasing inflammation of the tendons (steroid injections like cortisone can help decrease inflammation) thus giving more space to the median nerve in the Carpal Tunnel and thereby decreasing the pain.
The most common treatment without the use of medication (or hateful injections), is splinting the hand at night, preventing movement of the wrist during sleep (when incorrect positions occur while sleeping). Symptoms increase at night because the position of the hand is at the same level as the heart, which produces a collection of fluid in the soft tissues inside the tunnel (known in English as thoracic outlet syndrome), in addition to quite complex hormonal changes that can increase fluid retention overnight (as a remedy, some researchers believe that a high dosage of vitamin B-6 could act as a diuretic and decrease fluid in the Carpal Tunnel, alleviating symptoms).
If the compression is severe enough and the patient does not respond to conservative treatments, the next step would be surgery (the public and doctors in general also have little understanding about surgery for Carpal Tunnel Syndrome; and there are many rumors about the outcome of this procedure, to the extreme of thinking they will lose the use of their hand if there is a surgery). The truth is that the surgery is highly successful, it is truly a very simple procedure: an incision is made dividing the ligament that crosses the top of the tunnel, increasing the space in the Carpal Tunnel, and allowing the median nerve to function much better.
The latest advancement in the treatment of Carpal Tunnel Syndrome (and which is commonly used at the Badia Hand to Shoulder Center) is called “Endoscopic Release”. In this procedure, an incision of less than one centimeter is made in the wrist crease and an endoscope with a small camera is inserted, which allows the surgeon to see inside the hand and make the necessary division in the ligament without the need for a larger incision. It should not be confused with laser surgery, since it uses fiber optic technology, allowing the surgeon to operate “from the inside out” (this means there is less incursion into soft tissues and post-procedure pain, if any, is minimal). The main advantage of this technique is not only to eliminate the “unpleasant scar”, but to decrease recovery time, which allows the patient to return to work as soon as possible.
The long-term results of endoscopic relief of Carpal Tunnel Syndrome are excellent, and with many more benefits than conservative treatments. Patients may barely complain of a slight pain in the palm of the hand when resting it on a hard surface, but other than this, complications or pain after the procedure are minimal.
The key to understanding Carpal Tunnel Syndrome is to consider it as “a compressed nerve in the wrist”: it produces symptoms like numbness and tingling. There are many other hand and wrist conditions that have to be evaluated by a surgeon specializing in those problems, and confirmation through a nerve conduction study is usually done by a rehabilitation medicine specialist or a neurologist (it is easy to diagnose and treat Carpal Tunnel Syndrome when the diagnosis is made by a trained doctor).
Hand Specialist.- If you have hand pain, do not quit your typing job; instead, make a decision and call the Badia Hand To Shoulder Center for an appointment: we will free you from that unnecessary pain. For more information about Carpal Tunnel Syndrome and other upper extremity problems, you can contact Dr. Alejandro Badia directly through his website www.drbadia.com, or at 0212-335.5156 (HAND). alejandro@drbadia.com Source of the News: PR Assistant Media Communications
