B Y: R O S E M A R Y H E R S E Y

CARPAL TUNNEL SYNDROME

DEFINITION:

• A painful condition of the hand and first three fingers caused by compression of the median nerve in the narrow channel called the carpal tunnel

• The most frequent of the compressive syndromes

• Was first described by Paget in 1913 as a type of compression of the median nerve after a wrist fracture

• Phalen established the first principles of CTS in 1950

• People with carpal tunnel syndrome typically experience a tingling numbness in the thumb and first three fingers, often first appearing at night (1&4)

H T T P : / / M I N E R V I N I A C U P U N C T U R E . C O M / C I T I E S _ W E _ S E R V E / I M A G E S / C AR P A L _ T U N N E L _ D I A G R A M _ 6 0 0 _ P X _ 0 3 . J P G

PHOTO OF NERVE COMPRESSION

WHO IS AFFECTED?4%-5% OF POPULATIONMAINLY 40-60 YR OLDS

Risk Factors: (1 & 6)

• Wrist anatomy

• Underlying health conditions

• Repetitive motion

• Overuse

• A wrist fracture

• Patterns of hand use

• Sleeping with wrist sharply

bent

Predisposing Factors: (1& 6)

• Genetic predisposition

• Repetitive movements

• Injury or Trauma

• Pregnancy

• Breast Cancer

• Smoking

• Other medical conditions

SIGNS AND SYMPTOMS:

• Numbness

• Tingling

• Burning

• Pain

• Unable to make a fist/loss of grip strength

• Thumb muscle atrophy

• Clumbsy/dropping objects

• Unable to unscrew a jar lid

• Loss of sense of touch

• Difficulty doing tasks such as: brushing, blow drying or washing hair, texting, writing, driving (6)

PATHOPHYSIOLOGY

• Compressive symptoms combine the phenomena of compression and tension (1)

• The carpal tunnel is made up of a deep arch which is formed at the wrist by the carpal bones and the flexor retinaculum (1).

• CTS is caused by pressure on the median nerve, which runs through the wrist to the thumb, index, middle and ring fingers. The median nerve does not affect the little finger (3)

• Swelling of the tissue around the tendons, which results from inflammation, can pinch the nerve, producing pain (3)

• CTS is considered an entrapment syndrome. Nerve compression and traction may sequentially create problems relating to the intramural blood circulation, lesions on the myelin sheath, at the axonal level, and changes to the supporting connective tissue (2).

TREATMENT OPTIONS:

Conservative Treatment Includes: (1,2,5)

• Corticosteroids (injections or oral)

• Diuretics

• NSAIDS

• Pyrodoxine

• Large doses of Vitamin B6/other nutritional supplements

• Acupuncture/Acupressure

• Massage

• Nerve and/or tendon gliding exercises

• Therapeutic ultrasound

• Wrist splints (nocturnal and/or both day/night)

• Traction

• Anti-inflammatory diet

Surgery

RESOURCES:

• 1.) Abichandani, S., Shaikh, S., Nadiger, R. (2013) Carpal tunnel syndrome--an occupational hazard facing dentistry. International Dental Journal. Vol 63 Issue 5. p 230-236. 7p.

• 2.) Chammas, M., Boretto, J., Burmann, L. M., Ramos, R. M., dos Santos Neto, F. C., & Silva, J. B. (2014). //Carpal tunnel syndrome – Part I (anatomy, physiology, etiology and diagnosis)//. //Revista Brasileira de Ortopedia//, //49//(5), 429–436. http://doi.org/10.1016/j.rboe.2014.08.001

• 3.) Franklin, G.M., Haug, J., Heyer, N., et al (1991) Occupational carpal tunnel syndrome in Washington State, 1984-1988. Am J Public Heatlh 1991 81: 741-746.

• 4.) Funk & Wagnalls New World Encyclopedia. 2015. Carpal Tunnel Syndrome.1p. , Database: Funk & Wagnalls New World Encyclopedia

• 5.) Dr. Josh Axe (May 2015) How to get Rid of Carpel Tunnel in 24 Hours

https://www.youtube.com/watch?v=p9Z3iHZz7NM

• 6.) Sesto, M.E., Radwin, R.G., Salvi, F. J. (2003) Functional deficits in carpal tunnel syndrome. Amer J Indu Med 2003 44: 133-140.

• 7.) Stocksill, J.W., Harn, S.D., Strickland, D., et al (1993) Prevalence of upper extremity neuropathy in a clinical dentist population. JADA 1993 124: 67-72.