CARPAL TUNNEL SYNDROME
A Term Paper Presented to the Faculty of
In Partial Fulfillment of the Requirements for the
Degree of Bachelor of Science in
Barros, Nikki Jezzel C.
Carpal Tunnel Syndrome or CTS is a condition where an affected person finds his hands being numb for quite some time and then suddenly feels a sharp, tingling pain from the wrists up to the arms. Also called median nerve entrapment, CTS occurs when the median nerve, a major nerve running from the forearm to the hand, is compressed, causing heightened and even painful sensations to the palm and wrist. The median nerve is mainly in charge of the hand movements, controlling impulses to the hand muscles and the sensations felt in the palm and fingers. The carpal tunnel, then again, is a narrow passageway of ligaments found in the base of the hand, and is where the median nerve can be found. Too much swelling of the tendons and muscles in the carpal tunnel pressures the median nerve, thus the pain.
At most cases, there are seldom problems with the median nerve itself, and the presented dilemma is mostly occurring because of factors affecting the median nerve. As stated by the National Institute of Neurological Disorders and Stroke (NINDS, 2009), there are cases of congenital predisposition, where an individual’s carpal tunnel is smaller compared to the common therefore enhancing the risk of developing the swells and compression.
Aside from this, other main factors include wrist trauma or injury, like fractures; over-activity of the pituitary gland, an important controller of the endocrine system attached to the brain which manages hormone secretion (Carter 2004); hypothyroidism, a condition where the thyroid gland, located at the lower part of the neck, does not make enough hormones essential for metabolism and growth (Hypothyroidism, 2010; Thyroid gland, 2010); rheumatoid arthritis, a condition characterized by the swelling and stiffness of the joints, but is often occurring in the wrists (Rheumatoid arthritis, 2010); work stress; repeated use of vibrating hand devices; fluid retention during pregnancy or menopause; and a cyst or tumor in the tunnel.
Symptoms and Diagnosis
During the beginning of minor CTS, an affected person may feel tingling, numbness, or stiffness in the hand especially the thumb, index finger, and middle finger. Often apparent during the night, some people experiencing CTS have awoke during the night only to satisfy the need to shake their hands. As the condition worsens, however, the hands may already suffer from decreased grip strength, resulting to the inability to crumple the hands into a fist or hold small objects. For the worst cases, muscles located at the bases of the fingers may wear out, and cases such as the inability to tell hot from cold by touch can happen.
Doctors are able to diagnose carpal tunnel syndrome through various methods. Physical examination of the hands, arms, shoulders, and neck will identify whether a person’s complaints can be attested as a passing circumstance or as symptoms of other conditions closely related to CTS. More specific tests conducted by physicians help reveal symptoms of carpal tunnel syndrome to be able to tell if the person is truly affected or not. Two of these are: the Tinel test, where the doctor “taps on or presses on the median nerve in the patient's wrist – the test is positive when tingling in the fingers or a resultant shock-like sensation occurs,” and the Phalen or wrist-flexion test, where:
“… the patient holds his or her forearms upright by pointing the fingers down and pressing the backs of the hands together. The presence of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing numbness, is felt in the fingers within 1 minute.”
Another type of test would be the use of electrodiagnostics....
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