Carpal Tunnel Syndrome(CTS)

Carpal tunnel syndrome(CTS) is really a compression neuropathy of median nerve.It's constriction of median nerve because it passes beneath the flexor retinaculum.Carpus is really a word derived from the Greek word "karpos" meaning "wrist."

CTS, or median neuropathy in the wrist is a nerve disorder within the wrist that causes pain,hand weakness,lack of feeling often within the thumb and the first three fingers.It calls for compression, stretching, irritation, of median nerve in the wrist joint and could greatly decrease athletic performance involving strong hand and wrist actions.The carpal canal in the wrist joint is really a cramped space,crowded with flexor tendons and also the median nerve.Any tension within this canal can compress the median nerve.It's more common in women compared to men and occurs typically later (40-60 yrs).Sometimes it is observed in young individuals secondary to trauma.

Night symptoms and waking at night-the hallmark of the illness-can be managed effectively with night-time wrist splinting in many patients. The role of medications, including corticosteroid injection in to the carpal canal, is unclear. Surgery to chop the transverse carpal ligament works well at relieving symptoms and preventing ongoing nerve damage, but established nerve dysfunction as static (constant) numbness, atrophy, or weakness are often permanent and do not respond predictably to surgery.

Anatomy of carpal tunnel

The carpal tunnel is definitely an inelastic fibro-osseous tunnel defined by the carpal bones and also the flexor retinaculum.Flexor retinaculum is a strong fibrous band which bridges anterior concavity of carpus and converts it into carpal tunnel.

Flexor retinaculum is marked by joining the next four points-

i)pisiform bone
ii)tubercle of scaphoid bone
iii)hook of hamate bone
iv)crest of trapezium
Top of the border is formed by joining the foremost and the second points,and also the lower border by joining the 3rd and fourth points.

Attachments

Medially towards the pisiform bone and to the hook from the hamate. Laterally to tubercle of scaphoid, and also the crest of the trapezium.

The structures passing superficial towards the flexor retinaculum are:

(i)the tendon of palmaris longus,(ii)the palmar cutaneous branch from the median nerve,(iii)the palmar cutaneous branch from the ulnar nerve;(iv)the ulnar vessels;and also the ulnar nerve.

The structures passing deep towards the flexor retinaculum are:

(i)the median nerve,(ii)the tendons from the flexor digitorum superficialis,(iii) the tendons from the flexor digitorum profundus,(iv)the tendon of flexor pollicis longus,(v) the ulnar bursa, and (vi)the radial bursa.


Reasons for carpal tunnel syndrome-

Any space occupying lesion inside the carpal tunnel may be responsible.Numerous factors may bring about the condition and these generally fall under one of the following categories.

(i)Factors which boost the structures within the carpal tunnel-

Inflammation from the flexor tendon sheath(tenosynovitis) as a result of repeated or sustained flexor activity (gymnast,cyclists).
Scarring and shortening from the ligament that covers the median nerve.
(ii)Factors which cuts down on the size of carpal tunnel-
Arthritic changes secondary to some colle's fracture.
Fluid retention while pregnant.
Other causes which might cause stretching from the nerve is prolonged hyperextension or hyperflexion.

Risk factor for carpal tunnel syndrome-

Diabetes,hyperthyroidism,pregnancy,rheumatoid arthritis symptoms, gout, ganglion cyst, prolonged forceful standing and walking on hands, tasks that need repititive hand or wrist actions.

Women are 3 times more likely than men to build up carpal tunnel syndrome, perhaps since the carpal tunnel itself might be smaller in women compared to men. The dominant hand is generally affected first and produces probably the most severe pain. Persons with diabetes or any other metabolic disorders that have an effect on the body's nerves making them more susceptible to compression will also be at high risk. Carpal tunnel usually occurs only in grown-ups.

The risk of developing carpal tunnel is not confined to folks a single industry or job, but is particularly common in those performing assembly line work - manufacturing, sewing, finishing, cleaning, and meat, poultry, or fish packing. Actually, carpal tunnel syndrome is 3 times more common among assemblers than among data-entry personnel.

Indications of carpal tunnel syndrome

Paraesthesias(numbness,burning,tingling) is felt within the first three fingers(radial) and radial 1 / 2 of the fourth.
the condition increase in the night when there is additional problem of normal lower resting blood pressure level.
Variable relief from nocturnal symptoms is obtained by hanging the arm within the side of the bed or shaking the hand,actions which boost the resting blood pressure and therefore blood supply to the nerve.
Sharp pain that could shoot from the wrist in the arm or to the fingers, especially during the night.
The hand might be clumsy and weak.
Morning stiffness or cramping of hand.
Thumb weakness,frequent dropping of objects,wherewithal to make a fist.
Shiny,dried-out skin of hand.
Reduced performance in almost any sport requiring grip.
Inside a severe case,there might eventually be evident wasting and weakness from the median nerve innervated small muscles from the hand.
Differential diagnosis-

Entrapment of C6/7 nerve root which doesn't give increased pain to repeated wrist movements.
Osteoarthritis of base of thumb.