Carpel Tunnel Syndrome

Overview

Carpel tunnel is a fiberous tissue tunnel in the wrist which has specific contents. These include a set of tendons, nerves and vessels passing through it. Most symptoms occur because of compression of one of these structures. The hand is supplied by median, radial and ulnar nerves. They all have specific distribution in the hand. These nerves have both sensory and motor nerves which are responsible for sensations and strength respectively. Any symptoms pertaining to its compression is carpel tunnel syndrome.

Carpel tunnel syndrome distribution
Distribution of pain and numbness in Carpel tunnel syndrome

Pathophysiology

The median nerve is a content of the carpel tunnel and one of the most sensitive structure to increase in pressure. When it once gets compressed in the tunnel, it leads to malfunction. Typical areas of distribution of the nerve are affected. This typically includes weakening of the grip and numbness/tingling in the thumb, Index and middle finger. This is quite commonly seen in nursing mothers and is also affected by hormonal changes.

This is also seen in endocrine abnormalities namely hypothyroidism, diabetes and growth hormone disturbances. It is also seen in common part of a functional disease called as Fibrofasciitis/ Fibromyalgia. In this syndrome, the numbness is secondary to a dysfunctional or a abnormal shoulder function. These syndromes have become more common cause of carpel tunnel like symptoms in young population. The carpel tunnel syndrome carries close resemblance to cervical spondylosis , double crush syndrome and fibrofasciitis.

Rhematoid arthritis is also a common root cause of carpel tunnel syndrome. The main reason behind this is a compression of the median nerve which gives a typical numbness and tingling sensation and thinning of the muscular eminence of the palm. Most patients do well with physiotherapy and rehabilitation but a subset may require the surgical release of the carpel tunnel to relieve symptoms.

Treatment

Complete investigations of cause of carpel tunnel syndrome is important as its correction is essential to prevent recurrence. Nerve conduction velocity and MRI may be important tools to diagnosis of the disease.

Physiotherapy, medications and rehabilitation is the primary treatment. Few may require corticosteroid injections or a surgical procedure too.

Fibrofasciitis may lead to radiating pain similar to carpel tunnel syndrome
Trigger points and fibrofasciitis may be a cause of carpel tunnel like symptoms. https://www.indyspine.com/blog/what-is-a-trigger-point