Carpal Tunnel Syndrome
Carpal tunnel syndrome is the most common cause of peripheral nerve compression. The median nerve is compressed as it traverses the carpal tunnel in the wrist and hand. The tunnel is composed of the carpal bones dorsally and the transverse carpal ligament ventrally. It contains flexor tendons and the median nerve.
Carpal tunnel syndrome tends to affect the dominant hand but over half the patients experience bilateral symptoms. The predominant age is 40 to 60 and it is more common in women (Female:Male = 3-6:1).
Symptoms include tingling or prickling sensations in the fingers and burning pain in the fingers particularly at night (acroparesthesias). Symptoms characteristically are confined to the thumb, index and middle finger but many patients do not distinguish this localization and feel the entire hand is affected.
Causes include disorders which affect the musculoskeletal system in the region of the wrist, including trauma or Colles' fracture, degenerative joint disease, rheumatoid arthritis, ganglion cyst, scleroderma. Hypothyroidism and diabetes are frequently associated with this condition which also occurs with increased frequency during pregnancy. Other miscellaneous causes includes acromegaly, lupus erythematosus, leukemia, pyogenic infections, sarcoidosis, primary amyloidosis and Paget's disease. Hyperparathyroidism and hypocalcemia are also associated.
Risk factors include jobs which involve repetitive flexion and extension of the wrist may influence the development of carpal tunnel syndrome. Occupation as a seamstress, and more recently, that of computer operator may aggravate carpal tunnel syndrome. There is, however, no universal agreement that carpal tunnel syndrome is job related.
No lab tests are specific. Glucose levels and thyroid tests may be helpful.
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