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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.
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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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