http://ameblo.jp/takemotoseikeigeka/entry-10016783853.html 2006-09-14 18:59:50
Carpal tunnel syndrome
Carpal tunnel syndrome is typical of disorders with symptoms such as numbness in hands. It is thought that many people are confused as to which specialist to consult with such symptoms.
The cause of numbness in hands, apart from carpal tunnel syndrome, can be neck complaints (lumbar vertebra disease), blood vessel disorders (arterial disease) or disorders in cerebral blood vessels or nerves. Brain problems are referred to a neurosurgery or a physician, disorders in blood vessels are seen by vascular surgery and the rest are dealt with by orthopaedic surgery. Among those who are well (no general symptoms such as impairment in consciousness), many are thought to be carrying orthopaedic disorders.
What is Carpal Tunnel Syndrome (CTS)?
Carpal tunnel syndrome is a disorder of median nerve, which runs through a carpal tunnel (made of carpal bone and ligament) near a wrist. They are affected when the tunnel narrows. Apart from the median nerve, carpal tunnel passes finger flexor tendon (tendon of a muscle used to bend fingers). The illness can be seen among middle aged women and it is not uncommon to see symptoms appear in both hands at the same time. The combination of original room in individual carpal tunnels, narrowing of tunnels due to ageing and the inflammation from overuse is believed to be the cause of developing the symptom.
Symptoms
Basically, the functions of a median nerve are to pass a hand’s sensation to the brain and to send a command to move the thumb muscle and hold something.
The numbness or little sensation in hands and fingers is a typical symptom of sensory nerve disorders (nerve which passes the sensation). Three nerves share the task of passing senses in hands and fingers. A median nerve is in charge of passing the senses from a thumb to halfway across a ring finger on the palm side, along with 2/3 of the palm on the thumb side. It is also in charge of the tips of the same fingers on the back of a hand. The numbness in carpal tunnel syndrome seems to be prominent during sleep at night or waking up in the morning.
As the disorder of the motor nerve in a median nerve progresses, it becomes difficult to hold things and feel tired or painful to use hands. In order to hold things, a thumb comes face to face with another of the fingers. This is called opposition. With a disorder in median nerves, it is difficult to make a circle with a thumb and an index finger. Thenar (ball of the foot of the thumb) withers and becomes thin at advanced stages.
When carpal tunnel is narrowed, tendon used to bend fingers (finger flexor tendon) becomes constrained. Some patients complain of stiffness in fingers first thing in the morning.
Diagnosis
When in doubt of carpal tunnel syndrome, there is the Phalen's maneuver and the Tinel's sign to help with the diagnosis as positive tests are indicative of the illness. In the Phalen's maneuver, the wrist is bent downward and kept right-angled for a minute to find out if the numbness worsens. In the Tinel's sign, carpal tunnel area (palm side of the wrist) is tapped to find out if pain goes into finger tips or the numbness spreads.
If it was likely to be carpal tunnel syndrome from above tests, nerve conduction speed test will be carried out. The median nerve is stimulated electrically and measured how many nano seconds it takes to reach the thumb muscle. If an abnormal figure is detected in the carpal tunnel area, it is almost certainly carpal tunnel syndrome.
Treatment
In advanced cases, surgeries are needed to relieve the nerves. Delay in procedures will deny the nerves of restoring its functions. It is reckless to leave it untreated for months. Other treatments, although supplementary, include taking vitamin (B12) tablets, anti inflammatory medication, splint to prevent wrists from moving while sleeping, electrotherapy and medication and anti inflammatory injection, which help the nerves to recover.
