Carpal tunnel syndrome is a disorder in which the median nerve is compressed at the wrist causing symptoms like tingling, pain, coldness, and sometimes weakness in parts of the hand. It is the most famous of a class of disorders called repetitive strain injuries.

Anatomy
The median nerve runs through the carpal tunnel, a canal in the wrist that is surrounded by bone on three sides, and a fibrous sheath (the flexor retinaculum) on the other. As well as the nerve, many of the hand's tendons pass through this canal. The median nerve can be compressed by swelling of the contents of the canal, by soft tissue swelling in and around the tunnel or even by direct pressure from part of a broken or dislocated bone. However, bone dislocations are a rare cause of carpal tunnel syndrome.

Incidence
The syndrome is much more common in women than it is in men.

Symptoms
The first symptoms usually appear at night. Symptoms range from a burning, tingling numbness in the fingers (especially the thumb and the index and middle fingers) to difficulty gripping, making a fist, or dropping things. Most early sufferers mistakenly blame the tingling numbness on their sleeping position, thinking their hands have had restricted circulation and are "falling asleep". If left untreated the symptoms often progress to intense pain which restricts hand functionality. It is known as a hidden disability, because people can do some things with their hands and appear to have normal hand function, but often live with severely restricted hand activity due to the pain.

Causes
Some cases of carpal tunnel syndrome are due to work-related cumulative trauma of the wrist. It is commonly caused by strain placed on the hand, for instance gripping and typing, which are usually performed repetitively in a person's occupation.

There are a number of causes of carpal tunnel syndrome. They can be either traumatic, or non-traumatic.

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Repetitive stress induced carpal tunnel strain is the leading cause of Carpal Tunnel Syndrome in most industrialized countries. In the USA for instance, repetitive stress induced CTS is the biggest single contributing factor to lost time at work. This type of CTS results in billions of dollars of workers compensation claims every year.

Repetitive hand and wrist action often results in subcutaneous tissues becoming injured and swollen. These tissues include fascia, muscle, ligament, tendon, sheaths, retinaculum and peripheral nerve and blood vessels. In restricted passages of the body, swollen soft tissue can become compressed together creating intense pressure. Adjacent soft tissue can adhere together when compressed under these conditions over a prolonged period.

Trauma-based causes:

Fractures of one of the arm bones, particularly a Colles' fracture.
Dislocation of one of the carpal bones of the wrist.
Hematoma forming inside the wrist, because of internal haemorrhaging.
Deformities due to abnormal healing of old bone fractures.

Non-traumatic causes, generally happen over a period of time, and are not triggered by one certain event. Examples include:

Tenosynovitis, which is inflammation of the joint. Part of the process of inflammation is swelling, and this compresses the nerve.
With pregnancy and hypothyroidism, fluid is retained in tissues, which swells the joint.
Acromegaly, a disorder of growth hormones, compresses the nerve by the abnormal growth of bones around the hand and wrist.
Tumours (though not necessarily cancer), such as a ganglion or a lipoma, can protrude into the carpal tunnel, reducing the amount of space.
Diabetes, rheumatoid arthritis, and obesity tend to cause swelling, thus decreasing the amount of space in the carpal tunnel.
Idiopathic causes, which no-one can explain, can also cause this disease.

Common activities that have been identified as contributing to repetitive stress induced CTS include:

Computer Keyboarding or typing
Playing video games
Playing a musical instrument
Driving a vehicle, motorcycle or flying a plane
Any activity where hand use is vigorous and routine could contribute.
An exhaustive list can be found in the external links below
Often people suffering from CTS can have multiple contributing factors which are aggravated by vigorous hand activities and repetitive stress trauma to the hand.


Proper attention to ergonomic considerations can reduce or eliminate these kinds of injuries.

Diagnosis
Tinel's sign is a way to detect irritated nerves. It is performed by lightly banging (percussing) over the nerve to elicit a sensation of tingling or "pins and needles" in the distribution of the nerve. In a person with carpal tunnel syndrome where the median nerve is compressed at the wrist, Tinel's sign is often "positive" and causes tingling in the thumb, index, and middle fingers. Tinel's sign is sometimes referred to as "distal tingling on percussion" or DTP.

Phalen's maneuver is another test for carpal tunnel syndrome. The patient is asked to keep their wrist at the extremity of flexion for 30 seconds. The aim is to compress the carpal tunnel and thus elicit the characteristic symptoms of the carpal tunnel syndrome. If the patient experiences a burning, tingling or numb sensation over the thumb, index, middle and ring fingers, then the test is positive. Phalen's maneuver is more sensitive than Tinel's sign.

Treatment
In general, if a specific action or movement (such as typing on a keyboard, or gripping a hammer) is causing pain, then simply avoiding this action may be enough to alleviate symptoms. Unfortunately, this doesn't always work and a person's job may preclude simply stopping.

Carpal tunnel syndrome is treated by immobilizing the wrist in a splint to minimize or prevent pressure on the nerves (the use of splints for anything other than a short time is considered by many to be non productive). These rigid plastic splints are uncomfortable and limit hand activity. Muscle attrophy is a common result of wearing immobilizing hand and wrist braces or splints.

Patients suffering from CTS are sometimes given anti-inflammatory drugs or injections of cortisone,a steroid, in the wrist to reduce the swelling. This is quite effective in relieving symptoms for a few months while the CTS sufferer evaluates other options. It is not a long-term solution as repeated exposure to steriod injections have the potential for serious side effects.

There is also a surgical procedure in which doctors can open the wrist and cut the ligament (the flexor retinaculum) at the bottom of the wrist to relieve the pressure. However, surgery should be considered as a last resort and only after all conservative treatments have been exhasuted. The surgery itself is brief, and only a local anaesthetic is needed. The carpal ligament is severed, relieving pressure on the median nerve. The incision is then sutured and the ligament left to scar back together on its own, with the hope that there will be more space left after recovery. Full recovery is only achieved in less than 60% of recipients. Downtime and rehabilitation can take up to three months. Also, since CTS is a syndrome, not a disease, if repetitive stress activities are continued, then surgery will likely have to be repeated within a year or two. Like many surgical procedures, Carpal Ligament Release Surgery can also be done endoscopically, but due to the proximity to the medium nerve the risk of damaging the median nerve in this tight space is increased in this procedure, a skilled surgeon is essential for this type of surgery.

There is a new class of medical products and active release techniques that utilize soft tissue therapy to allow proactive healthcare consumers to treat debilitating disorders like carpal tunnel syndrome without the complications of oral medication, steroid therapy, the limitations of immobilizing braces or the risks of invasive surgery. By treating pain and dysfunction at the source, soft tissue therapy offers people a new more reliable alternative in pain management where conventional medical techniques have failed to deliver reliable results. Carpal Tunnel Syndrome is a classic case where the results of conventional treatment have left many CTS sufferers in long-term pain and hand dysfunction.
The source of this article is Wikipedia, the free encyclopedia. The text of this article is licensed under the GFDL

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