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Carpal tunnel syndrome

Due to the increasing use of typewriters and computers carpal tunnel syndrome has become a major disability claim. In the classic syndrome the median nerve is pathologically compressed at the wrist as it passes deep to the flexor retinaculum. Additional causes include pregnancy, myxedema, primary amyloidosis, rheumatoid arthritis.

Clinical suspicion

Manifestation include parasthesia in the distribution of the median nerve and pain that could wake a patient up at night (pain in the wrist). Severe forms are accompanied by wasting and sensory loss.

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. Some carpal tunnel 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. Some people are unable to tell between hot and cold by touch.

Diagnosis

Diagnosis is based on clinical symptoms and the demonstration of nerve conduction block.

Treatment

Treatment is rest and splinting. If that fails then surgical section of the transverse carpal ligament and decompression of  the nerve maybe required.

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