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Frozen Shoulder
(Adhesive Capsulitis)
carpal tunnel syndrome
What is carpal tunnel syndrome?
Carpal tunnel syndrome occurs when the median nerve, which runs from the elbow into the hand, becomes pressed or squeezed as it passes through the wrist into the hand. The median nerve controls sensations to the palm side of the thumb and fingers (except the little finger), as well as impulses to some small muscles in the hand that allow the fingers and thumb to move. The carpal tunnel is a narrow, rigid passageway composed of the ligaments and bones of the wrist . Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed. The result may be pain, weakness, or numbness in the hand and wrist, radiating up the arm.
What are the symptoms of carpal tunnel syndrome?
Symptoms usually start gradually, with frequent burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers. Often sufferers say their fingers feel useless and swollen, even though little or no swelling is apparent. The symptoms often first appear in one or both hands during the night, since many people sleep with flexed wrists. A person with carpal tunnel syndrome may wake up feeling the need to "shake out" the hand or wrist. As symptoms worsen, people might feel tingling during the day. Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In chronic and/or untreated cases, the muscles at the base of the thumb may waste away.
What are the causes of carpal tunnel syndrome?
Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. Most likely the disorder is due to the carpal tunnel is being smaller in some people than in others. Other contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture; mechanical problems in the wrist joint; work stress; repeated use of vibrating hand tools; fluid retention during pregnancy or menopause;
Who is at risk of developing carpal tunnel syndrome?
Women are three times more likely than men to develop carpal tunnel syndrome, perhaps because the carpal tunnel itself may be smaller in women than in men. The dominant hand is usually affected first and produces the most severe pain. Persons with diabetes or other metabolic disorders that directly affect the body's nerves and make them more susceptible to compression are also at high risk. Carpal tunnel syndrome usually occurs only in adults.
How is carpal tunnel syndrome treated?
Treatments for carpal tunnel syndrome should begin as early as possible. Underlying causes such as diabetes or arthritis should be treated first. Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms, and immobilizing the wrist in a splint to avoid further damage from twisting or bending. If there is inflammation, applying ice packs wrapped in a damp cloth, for 20 minutes every 2 hours can help reduce swelling.
Physiotherapy can consist of mobilization of the bone of the wrist and forearm. Nerve mobilizations may be carried out, in conjunction with mobilizations of the cervical spine. Rehabilitation exercises may be prescribed to stretch and strengthen muscles around the wrist and forearm, and biomechanical advice may be provided to help reduce the causes of the dysfunction.
In some cases, an injection of steroid may be required.