Carpal tunnel vs: Carpal Tunnel Vs. Tendonitis: Identifying the Symptoms
Carpal Tunnel Vs. Tendonitis: Identifying the Symptoms
For years, you have probably heard about the risk of carpal tunnel or wrist tendonitis for people that spend most of their days typing at a computer. That’s a scary thought as technology is becoming a bigger part of our everyday lives.
Elizabeth King, M.D., an orthopedic surgeon with Henry Ford Health System, says not to worry.
“No studies have been able to demonstrate that carpal tunnel syndrome and wrist tendonitis are caused by typing,” says Dr. King. “Recent studies actually show jobs that require the repetitive use of power tools are more likely to cause these issues.”
The vibrations produced by using these tools are more likely to cause problems with the nerves and tendons in your wrist. Assembly line jobs can also cause issues due to the constant flexing and extending of the wrist. In many cases, age also plays a part on the onset of these conditions. Like arthritis and other related issues, people are more likely to develop carpel tunnel or tendonitis as they get older.
So what is the difference between carpal tunnel syndrome and wrist tendonitis? Here’s the two conditions broken down:
Carpal Tunnel Syndrome
Carpal tunnel syndrome is caused when the median nerve in the wrist becomes pinched. This can lead to numbness or tingling throughout the hand and through the thumb to ring finger. “Many patients experience these symptoms more at night,” Dr. King says. “Sometimes the pain is enough to wake them up.”
Treatment: Depending on the severity of the case, your doctor may recommend a series of different treatments. For most people, wearing a wrist brace, occupational therapy or steroid injections can help alleviate or lessen these symptoms. Your doctor will always try to treat carpal tunnel without invasive methods first, but many serious cases will need surgery. Surgery is used to repair nerve damage to get you back to having normal mobility in your wrist and hand.
Wrist tendonitis can occur when any of the tendons in your wrist become inflamed. “There are about 10 or so tendons that could possibly be affected,” says Dr. King. This condition causes swelling of the wrist. Sometimes, symptoms appear following a wrist injury.
Treatment: If you do experience symptoms, consider taking an over-the-counter anti-inflammatory (think Aleve or ibuprofen) before seeing a doctor. You can even try icing your wrist. Most doctors will recommend you do these things before other treatment is suggested. Like carpal tunnel, wrist tendonitis is treatable through wrist bracing, steroid injections and occupational therapy. However, unlike carpal tunnel, surgery is not used to treat this condition.
Overall, the biggest different between carpal tunnel syndrome and wrist tendonitis is that one affects the nerves and the other affects the tendons.
Unfortunately, there isn’t much that can be done to prevent these conditions from occurring. Despite the fact that typing and other repetitive office tasks may not be the causes of carpal tunnel or tendonitis, they can aggravate the problem and cause more pain. So, it is still best practice to take breaks and practice proper body position to avoid injury.
“If you feel these symptoms at your job, your doctor can make a note that you have a work restriction,” says Dr. King. If your symptoms ever get too bad for you to work or perform daily tasks, seek immediate medical attention.
To find a doctor at Henry Ford, visit henryford.com or call 1-800-HENRYFORD (436-7936).
Dr. Elizabeth King is an orthopedic surgeon, specializing in hand surgery, and sees patients at Henry Ford Hospital and Henry Ford Medical Center – Fairlane.
What’s the Difference Between Carpal Tunnel Syndrome and Cubital Tunnel Syndrome?
Carpal tunnel syndrome and cubital tunnel syndrome share similar symptoms, but they are distinct conditions affecting different nerves in the elbow and wrist.
If you’re experiencing pain and numbness in your fingers, you may assume you have carpal tunnel syndrome. But did you know another condition — called cubital tunnel syndrome — could also be the source of these symptoms?
Both carpal tunnel syndrome and cubital tunnel syndrome result from nerve compression; however, the damaged nerve for each is located in a different part of the body. In cubital tunnel syndrome, the ulnar nerve within the elbow becomes compressed due to injury or repeated bending of the elbow. The ulnar nerve sits inside the cubital tunnel, a passageway consisting of bone, muscle, and ligaments.
On the other hand, the compressed nerve causing carpal tunnel syndrome is the median nerve in the wrist. Repetitive motions of the hand and wrist (such as typing), fractures, and sprains are typically to blame. In addition, chronic conditions such as diabetes and arthritis are considered risk factors for carpal tunnel syndrome.
Despite some similarities — compressed nerves, hand pain, weakness when gripping objects — cubital tunnel syndrome and carpal tunnel syndrome are characterized by several differences. Knowing the symptoms for each can help you identify which condition you may have and determine the right treatment.
Carpal Tunnel vs. Cubital Tunnel
Both syndromes affect the hand and fingers, but the pain, tingling, and numbness of carpal tunnel syndrome is felt most acutely in the thumb, index finger, middle finger, and half of the ring finger. It’s also characterized by pain and burning in the hand and wrist that sometimes radiates up the forearm to the elbow.
Meanwhile, cubital tunnel syndrome is marked by numbness, pain, and tingling in the little and ring fingers as well as the inside of the hand. If you have cubital tunnel syndrome, you may notice these symptoms flare up at night when you bend your elbow for long periods as you sleep.
Diagnosing cubital tunnel syndrome or carpal tunnel syndrome begins with a physical examination. An orthopedist may also perform a nerve conduction study to assess nerve impulses in the wrist or elbow. Weak nerve activity in a certain area could indicate, for example, carpal tunnel syndrome.
Treating the Symptoms
Treatment options differ for each syndrome, although conservative therapies are recommended at first to reduce symptoms and restore function to the hand. Because cubital tunnel symptoms are more pronounced at night, you might be advised to wear a brace that straightens the elbow while you rest. Wrapping your arm in a towel to keep it straight can work as well.
If conservative treatments fail to relieve the nerve compression or muscle wasting is severe, surgery is another option. Two types of cubital tunnel surgery are currently performed: a medical epicondylectomy and an ulnar nerve transposition. In a medial epicondylectomy, the bony bump inside the elbow (the medial epicondyle) is removed. This allows the ulnar nerve to flex and straighten without pain. For an ulnar nerve transposition, the surgeon creates a new cubital tunnel and moves the ulnar nerve to the recreated tunnel.
Treating carpal tunnel syndrome non-surgically usually entails resting the hand, avoiding activities that aggravate symptoms, wearing a splint for several weeks, and applying ice to reduce swelling. Anti-inflammatories and steroids may also be prescribed. Once the pain subsides, you can practice exercises to stretch and strengthen the wrist and hand.
If these conservative treatments don’t alleviate carpal tunnel symptoms, surgery to relieve pressure on the median nerve by cutting the transverse carpal ligament may be necessary. This procedure is followed by physical therapy to strengthen the wrist.
What’s Causing Your Hand Pain?
If you’re experiencing hand and finger pain, you may be suffering from either cubital tunnel syndrome or carpal tunnel syndrome. The doctors at Comprehensive Orthopaedics can diagnose your condition and prescribe the proper treatment regimen. Whether through conservative therapy or surgery, our goal is to help our patients live pain-free. Contact us today for an appointment.
Carpal Tunnel Syndrome vs. Arthritis: What’s the Difference?
You’ve been experiencing pain in your wrists. At first you might chalk it up sleeping funny, or an overuse injury from your yoga class. But if the pain endures, and depending on the specific mix of your symptoms, you may be wondering whether it could it be carpal tunnel, a form of arthritis, or something else.
For some people, however, it’s often not an either-or situation. Having arthritis raises your risk of developing carpal tunnel, so you could have both conditions at the same time.
In this article, we’ll explain why arthritis may be a cause of carpal tunnel and share information about carpal tunnel symptoms, diagnosis, and treatment.
Arthritis vs. Carpal Tunnel Syndrome
While both arthritis and carpal tunnel can affect the wrists, hands, and fingers, the causes for the symptoms differ.
Rheumatoid arthritis is an autoimmune disease, which means your body’s own immune system attacks the joints, causing inflammation, pain, and swelling. Here are other common symptoms of rheumatoid arthritis.
Osteoarthritis is the “wear-and-tear” type that occurs when cartilage that cushions joints wears away. Here are other common osteoarthritis symptoms.
Carpal tunnel syndrome occurs when a major nerve in the hand — the median nerve — becomes compressed in the carpal tunnel, a narrow passageway on the palm side of your wrist that also houses the tendons that bend the fingers.
The floor and sides of this inch-wide tunnel are formed by small wrist bones called carpal bones, which are linked together by a ligament that overlies the top of the carpal tunnel. (The word carpal comes from the Latin “carpus,” which means wrist.)
Repetitive hand motions, such as those that occur when someone works on an assembly line, often contribute to carpal tunnel syndrome. With excessive motion, the tendons of the fingers can get swollen or inflamed and squeeze the median nerve. Despite common thinking that typing causes CTS, even heavy computer use did not make people more likely to develop it, according to one study.
A number of health problems can also cause swelling of this area. Arthritis is one, but diabetes and thyroid issues are also associated with carpal tunnel syndrome, as are hormonal changes that occur during pregnancy. Injuries, such as a wrist fracture, can contribute to the onset of carpal tunnel syndrome.
How Arthritis Can Cause Carpal Tunnel Syndrome
“It’s very common to have carpal tunnel syndrome when you have rheumatoid arthritis, especially if you have rheumatoid arthritis of the wrist,” says Vinicius Domingues, MD, a rheumatologist in Daytona Beach, Florida, and medical advisor for CreakyJoints.
If you have rheumatoid arthritis, chances are it does affect your wrists — research shows they’re the most common site for RA in the upper body and that 75 percent of people with RA have wrist involvement.
Though its impact isn’t usually as great as RA, even osteoarthritis (OA), the wear-and-tear type of arthritis, increases the risk of carpal tunnel too. OA in the wrist can cause swelling and bony changes that crowd the carpal tunnel.
“The wrist is a very small area and if it gets inflamed for any reason, it can cause pressure on the nerve that leads to carpal tunnel syndrome,” says Robert Gotlin, DO, a sports and spine physician in New York City and an associate professor of rehabilitation medicine and orthopedics at the Icahn School of Medicine at Mount Sinai.
Interestingly, carpal tunnel, like rheumatoid arthritis, is three times more likely to affect women than men, possibly because the carpal tunnel itself may be smaller in women than in men. The dominant hand is usually affected first and produces the most severe pain.
Like OA, carpal tunnel is more likely to occur with age; more than three-quarters of people develop symptoms between the ages of 40 and 70.
Luckily, despite some similarities in symptoms between carpal tunnel syndrome and arthritis, doctors usually don’t have much trouble telling the two conditions apart. Even better, there’s some overlap between treatments for both conditions.
Telltale Symptoms of Carpal Tunnel Syndrome
When carpal tunnel develops, it has a typical pattern, says Dr. Gotlin. Some key signs, which can help differentiate carpal tunnel from different kinds of arthritis, include:
1. Numbness and/or tingling in the first three fingers (thumb, index finger, and middle finger)
The median nerve provides sensation to these fingers, as well as to half of the ring finger (the pinky typically isn’t affected). It also provides strength to some of the muscles at the base of the thumb. Initially, numbness and tingling symptoms come and go, but as the condition worsens, they may become chronic.
2. Hand weakness
This may cause you to drop things or leave you unable to perform everyday tasks. “The thumb side of the hand provides precision grip, which is important when you want to do things like use a screwdriver or hold something carefully,” Dr. Gotlin explains. As carpal tunnel progresses, people may say their fingers feel useless or swollen, even though there’s no swelling. In the most severe cases, the muscles at the base of the thumb experience “gross atrophy,” which means they shrink in size.
3. Nighttime pain
Carpal tunnel tends to be especially painful at night. Blood pools because your hand isn’t moving, which creates swelling in the wrist. Many people also sleep with their wrists bent, which can also cause more pain at night.
4. ‘Flicking’ provides pain relief
Another tipoff it’s carpal tunnel is that in the early stages, people are usually able to relieve symptoms by shaking their hands rapidly (the “flick sign” in medicalese). “This gets the blood flowing again and reduces swelling, so the pain goes away,” says Dr. Gotlin.
Get more information here about how symptoms of arthritis affect the hands.
How Carpal Tunnel Syndrome Is Diagnosed
Your health care provider can diagnose carpal tunnel by taking a medical history and conducting a physical exam. He or she may tap the inside of your wrist to see if you feel pain or a shocking sensation (the Tinel test) or ask you to bend your wrist down for a minute to see if it causes symptoms (the Phalen test).
Lab tests and X-rays may be used to reveal problems like arthritis, diabetes, and fractures. Your doctor may also employ electromyography (EMG), a test that measures electrical activity of the nerve, to help confirm the carpal tunnel diagnosis.
How Carpal Tunnel Syndrome Is Treated
In most people, carpal tunnel gets worse over time, so early treatment is important. Ignoring symptoms can lead to permanent damage to the nerve and muscles, which can lead to loss of feeling, hand strength, and even the ability to distinguish hot and cold. It may also increase the need for surgery. Luckily, many people get better after first-step treatments, which include:
- Immobilization: Wearing a wrist splint provides support and braces your wrist in a straight, neutral position that takes pressure off the median nerve. A splint can be worn just at night or 24 hours a day.
- Rest: For people with mild carpal tunnel, avoiding activities or taking frequent breaks from repetitive-motion tasks that provoke symptoms may be all you need. If your wrist is red, warm, and swollen, applying cool packs can help.
- Over-the-counter drugs: Nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen may provide short-term relief by calming swelling, but they haven’t been shown to treat CTS itself.
- Prescription medication: In more severe cases, steroid injections are given to relieve pressure on the median nerve. Steroid injections usually aren’t effective in the long term, but research suggests improvement lasts 10 weeks to more than a year. Caution: If you have diabetes, be aware that long-term corticosteroid use can make it hard to regulate insulin levels.
- Alternative therapies: Yoga poses that emphasize opening, stretching, and strengthening the joints of the upper body were shown in one preliminary study to reduce pain and improve grip strength in those with CTS. People in one study who got acupuncture reported improvement in symptoms and functionality. Chiropractic manipulation has also been shown to be beneficial. Be sure to talk with your doctor before trying any of these treatments to be sure they’re appropriate for you.
If you’re diagnosed with both carpal tunnel syndrome and arthritis, the two conditions can be treated at the same time — and sometimes the treatment is even the same. For instance, NSAIDs can help relieve the pain of RA and OA as well as carpal tunnel. The same is true for corticosteroids. In addition to immobilizing the wrist to relieve symptoms of CTS, wearing a splint can provide rest and support for arthritis in the wrist, hand, and fingers.
The Last Resort: Surgery for Carpal Tunnel
When carpal tunnel symptoms are severe and/or don’t respond to these conservative measures, surgery may be required. It’s a very common surgery, performed more than 400,000 times each year.
The outpatient procedure, known as carpal tunnel release surgery, involves making one or more small incisions in the wrist or palm and cutting (“releasing”) the ligament that’s compressing the carpal tunnel to enlarge the area. “It’s no longer a tunnel, but more like a convertible car — the roof is gone,” explains Dr. Gotlin.
Following surgery, the ligaments usually grow back together and allow more space than before. Symptoms are usually relieved immediately after surgery, but full recovery can take up to a year. Recurrence of carpal tunnel following surgery is rare, though, according to Dr. Domingues, it’s more common in people with active rheumatoid arthritis. Be aware that fewer than half of people report that their hand(s) ever feel completely normal post-op. Some residual numbness or weakness is common. Still, it’s comforting to know that the surgery has a high success rate, providing a lasting, good outcome in up to 90 percent of cases in one study.
Carpal Tunnel vs. Arthritis: Differences, Symptoms, and Causes
When your wrist or hand starts to tingle and burn, it can be difficult to pinpoint the exact cause of the pain, whether it’s a result of carpal tunnel syndrome or arthritis. The anatomy of the hand is a tight space, and there are a lot of joints, nerves that can become swollen or pinched. Carpal tunnel syndrome and arthritis are similar conditions that can both result from overuse of the wrist and hands.
Grace Cary / Getty Images
What Is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is a condition that develops when the small space in the carpal tunnel is reduced even more by swelling or inflammation. Overuse or misuse of the wrist can cause inflammation in the tendons that pass through the carpal tunnel (an anatomical structure in the wrist and hand). This inflammation can lead to compression of the median nerve (one of the major nerves supplying the upper body) and result in repetitive strain injury.
Carpal Tunnel Anatomy
The carpal tunnel is an opening created between the transverse carpal ligament and the carpal bones. The median nerve passes through this tunnel. It begins in the shoulder and is rooted in the upper part of the spine. The nerve doesn’t branch out in the upper arm, but passes through the elbow to help provide movement and sensation in the forearm.
When the median nerve reaches the carpal tunnel, most branches pass through the tunnel, but the palmer branch passes over it. This is why the palm of the hand is typically not involved in carpal tunnel syndrome pain. Along with the median nerve, nine tendons pass through the carpal tunnel, putting the nerve at further risk of inflammation or compression.
As the median nerve is compressed—either by swollen tendons or by some other injury or inflammatory process—pain and even numbness may occur. The most common symptoms of carpal tunnel syndrome include:
- Discomfort gets worse at night or wakes you from sleep
- Pain that radiates to the forearm
- Weakness or clumsiness in the hand, especially in the thumb
- Reduced sensation
The symptoms experienced in carpal tunnel syndrome are limited to the areas affected by the sections of the media nerve that pass through the carpal tunnel. This includes the first three fingers and a part of the fourth finger closest to the thumb. Pain can also be at the center of the wrist or even the whole hand.
A Moving Target?
Carpal tunnel syndrome initially begins with pain in both hands in 65% of cases. However, most doctors encounter continued pain in just one hand or wrist. It’s common for carpal tunnel syndrome to go through periods where the pain gets better and then worse again.
Carpal tunnel syndrome is pretty common, affecting one out of every five people. Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself.
Contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture, an overactive pituitary gland, an underactive thyroid gland, and rheumatoid arthritis. Mechanical problems in the wrist joint, repeat use of vibrating hand tools, fluid retention during pregnancy or menopause, or the development of a cyst or tumor in the canal can also contribute to this condition. Often, no single cause can be identified.
Several risk factors are associated with the development of carpal tunnel syndrome, including:
Workplace factors may contribute to existing pressure on or damage to the median nerve. The risk of developing CTS is more commonly reported in those performing assembly line work—such as manufacturing, sewing, finishing, cleaning, and meatpacking—than it is among data-entry personnel.
What Is Arthritis?
Arthritis is a family of conditions that affects the joints, causing pain and inflammation. There are more than 100 types of arthritis, and it’s the leading cause of disability in the United States, affecting more than 50 million adults and 300,000 children. The most common types of arthritis are osteoarthritis and rheumatoid arthritis.
While pain, swelling, and stiffness are the hallmarks of arthritis, these conditions can also lead to permanent joint changes and disability. Some types of arthritis like rheumatoid arthritis even affect connective tissues in areas of the heart and lungs.
Osteoarthritis, also known as wear-and-tear arthritis, can present with no symptoms or very severe symptoms ranging from pain to limited movement. In this condition, the smooth cushion between bones (cartilage) breaks down and joints can get painful, swollen and hard to move. It can happen at any age, but it commonly starts in the 50s and affects women more than men. Osteoarthritis starts gradually and worsens over time.
This is the most common form of arthritis and is known to affect certain joints more than others, including the joints between each section of your fingers and the joint that connects your fingers to the rest of your hand. Osteoarthritis can also impact joints in the knees, hips, and lower spine.
Rheumatoid arthritis is a form of arthritis and an autoimmune disease where the immune system attacks healthy cells in the body, causing inflammation. Rheumatoid arthritis can cause inflammation so widespread and intense that it can interfere with daily activities. To diagnose this condition, pain and inflammation have to continue for at least six weeks.
RA mainly attacks the joints, usually many joints at once. It commonly affects joints in the hands, wrists, and knees. In a joint with RA, the lining of the joint becomes inflamed, causing damage to joint tissue. This tissue damage can cause long-lasting or chronic pain, unsteadiness, and deformity.
It can be detected by the presence of certain antibodies and inflammatory markers in the blood. People with rheumatoid arthritis may also have:
Osteoarthritis and rheumatoid arthritis have similar symptoms, but there are a few key differences.
Both osteoarthritis and rheumatoid arthritis can affect the hands. However, osteoarthritis often affects the joint closest to the tip of the finger, while rheumatoid arthritis usually spares this joint. And while rheumatoid arthritis can appear in any joint, its most common targets are the hands, wrists, and feet.
Mild morning stiffness is common in osteoarthritis and often goes away after just a few minutes of activity. Sometimes people with osteoarthritis also notice the same type of stiffness during the day after resting the joint for an hour or so. In rheumatoid arthritis, however, morning stiffness doesn’t begin to improve for an hour or longer. Occasionally, prolonged joint stiffness in the morning is the first symptom of rheumatoid arthritis.
Differences Between Carpal Tunnel and Arthritis
While several forms of arthritis and carpal tunnel syndrome can all cause hand and wrist pain, there are certain features of each disease that distinguish the two. Carpal tunnel syndrome pain is primarily the result of nerve compression, while arthritis is swelling and inflammation of the joint itself.
Can You Tell Which Condition You Have?
Joint swelling in arthritis may also cause compression of the nerves in the hand or wrist, which can then cause numbness, tingling, and pain. Your doctor will perform a few specific tests to pinpoint the problem.
- Reduced muscle mass in the fleshy part of the hand at the base of the thumb
- A positive Tinel’s Sign, or a burning or tingling sensation when the median nerve is tapped lightly
- A positive Phalen’s sign, a test that assesses for pain when your arms are held vertically and your wrists are flexed 90 degrees for 60 seconds
- Weakness or poor dexterity with pinching movements
- Pain that is worse at night or wakes your from your sleep
- Asymmetric patterns of joint involvement (in inflammatory arthritis)
- Swelling of other joints outside of the hands and wrists
- Systemic involvement with inflammatory arthritis, including fevers, malaise, or rash
- Antibodies or inflammatory markers present in blood testing (in inflammatory arthritis only)
- Pain that goes away after a few hours in the morning
Treatment Similarities and Differences
A few treatments can help you whether you suffer from carpal tunnel syndrome or arthritis, including:
In some cases, however, carpal tunnel syndrome becomes so severe that surgery is necessary to treat the problem. An outpatient surgery is performed, usually under local anesthesia, to increase the size of the space within the carpal tunnel and relieve the pressure on the median nerve by cutting the transverse carpal ligament at the base of the palm. This surgery usually relieves all symptoms of carpal tunnel syndrome once the incision is healed—about 10 to 14 days.
Arthritis may also become severe enough to warrant surgery, but the procedure is very different. Reconstructive surgery is sometimes required when deformity is severe in osteoarthritis, and joint replacement may be required for people with severe rheumatoid arthritis. Rheumatoid arthritis may also be treated with medications like disease-modifying anti-rheumatic drugs (DMARDs). Methotrexate is a DMARD commonly used to treat rheumatoid arthritis. Biologics like adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade) can also be used for this condition. These medications suppress the immune system to prevent further damage.
When to See a Doctor
You may be wondering when carpal tunnel and arthritis pain progress from annoyance to a medical problem. How concerned you should be about either of these conditions depends on how much it impacts your daily activities and how much pain you are having. If carpal tunnel pain is waking you at night or your arthritis is preventing you from holding certain items and performing daily activities, it’s probably time to see a doctor.
It’s important to note that the earlier you seek treatment for carpal tunnel syndrome and arthritis pain, the better your outcomes are usually.
A Word From Verywell
Pain from carpal tunnel syndrome and arthritis can be debilitating and affect your daily functioning. Knowing the exact cause of your pain can help you get the appropriate treatment as soon as possible and improve your outcomes and potentially preserve your mobility. Carpal tunnel and arthritis pain are caused by different issues, but can both cause severe pain and even deformity. Talk to your doctor about your symptoms and what kinds of treatment are appropriate for you. By managing the cause of your pain, you can avoid letting the pain disrupting your daily life.
Cubital Tunnel vs. Carpal Tunnel: Which Do I Have?: Maryland Orthopedic Specialists: Orthopedic Surgeons
Carpal tunnel syndrome gets all the press when it comes to hand pain and dysfunction, but another common syndrome, called cubital tunnel, can be just as debilitating and frustrating. The symptoms of both involve numbness, tingling, and hand pain.
Regardless of which syndrome you think you may have, our team at Maryland Orthopedic Specialists can help. Call our Bethesda or Germantown, Maryland practice to make an appointment.
About carpal tunnel syndrome
Carpal tunnel occurs when the median nerve that runs from your forearm into your wrist and hand becomes compressed. This nerve passes through a pathway, called the carpal tunnel. When the tunnel is inflamed, irritated, or injured, you experience the symptoms of carpal tunnel syndrome.
About cubital tunnel syndrome
Cubital tunnel syndrome is also caused by compression of a nerve in your arm, specifically the ulnar nerve at the elbow. This nerve passes through a tunnel of muscle, ligament, and bone called the cubital tunnel. When this tunnel is inflamed or injured, you experience the symptoms of cubital tunnel syndrome.
Both conditions make your hand and wrist tingle or go numb. You may have pain in your hand when you try to use it. A distinction, though, is in where you feel the pain. While carpal tunnel syndrome affects the thumb, index, and long fingers, cubital tunnel syndrome affects the small and ring fingers.
Cubital tunnel syndrome may also cause pain similar to when you hit your funny bone.
Both carpal tunnel syndrome and cubital tunnel syndrome can make everyday tasks such as buttoning a shirt or writing difficult. The long-term effects of both syndromes could be permanent nerve damage and dysfunction.
Slightly different causes
Carpal tunnel syndrome may result from overuse at the wrist — such as constant typing — a wrist fracture, or swelling from rheumatoid arthritis. Cubital tunnel syndrome also may occur due to overuse, but of the elbow. If you pull, reach, or lift a lot, lean on your elbows often, or experience an injury at the elbow joint, you may end up with cubital tunnel issues.
Arthritis and bone spurs could cause inflammation at both the wrist and elbow joint.
In some cases, we may not be able to determine the reason you developed carpal tunnel or cubital tunnel syndrome.
Treatments for both conditions
Both carpal tunnel syndrome and cubital tunnel syndrome are treated similarly. Resting the elbow or wrist is a critical part of treatment; you simply must stop activities that aggravate the pain and dysfunction.
For carpal tunnel syndrome, our doctors at Maryland Orthopedic Specialists may offer a wrist brace or splint. For cubital tunnel, though, you may receive an elbow brace to wear at night.
Anti-inflammatory medications and steroid injections ease the pain and numbness of each syndrome. In severe cases, both syndromes may require surgery to make the affected tunnel larger so the compressed nerve has more room to function.
If you have pain and numbness in your hand, come to Maryland Orthopedic Specialists for a definitive diagnosis. Call for an appointment or book online.
Carpal Tunnel & Other Nerve Problems
Carpal Tunnel Syndrome
If you experience intermittent or persistent pain, tingling, weakness, or numbness in your hand, you may have carpal tunnel syndrome. The carpal tunnel is a narrow, rigid passageway on the palm side of your wrist. The median nerve, which controls feeling and movement in the thumb and first three fingers, runs through the carpal tunnel, along with tendons that run from the forearm to the thumb and fingers. Carpal tunnel syndrome occurs when the median nerve is pinched or compressed in this tunnel.
Symptoms of carpal tunnel syndrome tend to develop gradually and often first appear during the night or when waking. Some people sleep with their wrists flexed in a positon that puts pressure on the nerve, making the symptoms worse. The first symptoms are often tingling – that “pins and needles” feeling – and/or numbness that can be alleviated by shaking the hand. As the syndrome progresses, the tingling and numbness may increase and be felt more often throughout the day. Decreased strength and sensitivity may make it difficult to perform manual tasks, such as grasping small objects, working with tools, or buttoning a shirt. Some patients experience pain in the hand and wrist, which may radiate upward into the arm.
Conditions that may contribute to carpal tunnel syndrome include:
- Injury to the wrist
- Rheumatoid arthritis
- Fluid retention during pregnancy
- Repetitive motion that causes pressure or inflammation in the wrist
- Development of a tumor or cyst in or near the carpal tunnel
Women are three times more likely to be affected than men. It can occur in one or both hands, and usually starts in the dominant hand.
If you haven’t had the symptoms very long, treatment can begin with immobilizing the wrist in a brace or splint. Ice packs and non-steroidal anti-inflammatory drugs are often recommended to relieve discomfort and inflammation. For severe symptoms, corticosteroids may be recommended. Once the symptoms have abated, your doctor may recommend physical therapy to stretch and strengthen the hand to keep it strong and mobile.
Some cases may require surgery on the ligament overlying the carpal tunnel. Cutting the carpal ligament relieves pressure by enlarging the opening. The surgery is performed under regional anesthesia and sedation in an outpatient facility.
For more information, see the website of the National Institute of Neurological Disorders and Stroke.
Other Nerve Problems
Cubital tunnel syndrome and radial tunnel syndrome aren’t as well-known as carpal tunnel syndrome, but they can cause similar symptoms due to increased pressure on nerves in the hand, wrist or arm. Cubital tunnel syndrome and radial tunnel can cause severe pain, numbness, tingling, and muscle weakness in the hands and arms.
Cubital Tunnel Syndrome
Cubital tunnel syndrome, also known as ulnar neuropathy, is caused by increased pressure on the ulnar nerve, which passes close to the skin’s surface in the area of the elbow commonly known as the “funny bone.” You’re more likely to develop cubital tunnel syndrome if you repeatedly lean on your elbow, or bend your elbow for long periods of time.
Some of the early symptoms of cubital tunnel syndrome include pain and numbness in the elbow, and tingling, especially in the ring and little fingers. More severe symptoms may include weakness affecting the ring and little fingers, decreased ability to pinch the thumb and little finger, decreased overall hand grip, muscle wasting in the hand, and a claw-like deformity of the hand.
Radial Tunnel Syndrome
Radial tunnel syndrome is caused by increased pressure or compression on the radial nerve, which runs by the bones and muscles of the forearm and elbow. The radial nerve is one of three nerves that provide motor and sensory function to the arm.
Conditions that may contribute to radial tunnel syndrome include:
- Noncancerous fatty tumors (lipomas)
- Bone tumors
- Inflammation of surrounding tissue
The most common symptoms of radial tunnel syndrome are cutting, piercing, or stabbing pain at the top of the forearm or back of the hand, especially when you try to straighten your wrist and fingers. The pain is located in the forearm a couple inches below the elbow. Unlike cubital tunnel syndrome and carpal tunnel syndrome, radial tunnel syndrome rarely causes numbness or tingling, because the radial nerve principally affects the muscles.
Mild cases of cubital tunnel syndrome often respond to physical therapies such as, avoiding pressure on the elbow, wearing a protective elbow pad, or wearing a splint. In cases where splinting doesn’t help or nerve compression is more severe, surgery to release pressure on the ulnar nerve may be needed.
Conservative treatments for radial tunnel syndrome include medications such as nonsteroidal anti-inflammatory drugs to reduce soft tissue swelling, corticosteroid injections to relieve inflammation and pressure on the radial nerve, and wrist and/or elbow splints to reduce irritation of the radial nerve.
Some patients also may benefit from ergonomic education to reduce the effects of repetitive stress, nerve-gliding exercises, stretching/strengthening exercises, and other interventions such as heat, cold, and ultrasound. If these conservative measures fail to provide relief after three months, your doctor may consider surgery to reduce pressure on the radial nerve.
In most cases, cubital tunnel syndrome and radial tunnel syndrome can be managed with conservative treatments. But more severe cases may require surgery to reduce pressure on the affected nerve.
For more information about cubital and radial tunnel syndrome, visit the following website: http://www.webmd.com/pain-management/cubital-radial-tunnel-syndrome#3.
Is My Hand and Wrist Pain Caused by Carpal Tunnel Syndrome or Something Else?
When pain, tingling, numbness, and/or weakness occurs in the hands or wrist, many people assume it is caused by carpal tunnel syndrome. Although carpal tunnel syndrome is a common disorder, there are several conditions that can trigger nearly identical symptoms.
See What Is Carpal Tunnel Syndrome?
Distinctive Carpal Tunnel Syndrome Symptoms
Carpal tunnel has several symptoms that differentiate it from other causes of hand pain.
See Distinctive Carpal Tunnel Syndrome Symptoms
This guide discusses the most common causes of hand and wrist pain that may potentially be mistaken for carpal tunnel syndrome.
See Diagnosing Carpal Tunnel Syndrome
Keep in mind that carpal tunnel syndrome is much more common than many of these conditions. For example, the estimated prevalence for carpal tunnel syndrome among manual labor workers may be as high as 20%,1 while prevalence for Reynaud’s syndrome is estimated to be about 5% in the general population.2
See Treatment Options for Carpal Tunnel Syndrome
Hand and Wrist Pain from Nerve Problems
Carpal tunnel syndrome is caused by impingement of the median nerve, but damage or impingement of other nerves can also cause symptoms in the hand.
Several nerve roots that originate in the cervical spine—particularly C6 and C7—innervate the hand and fingers. If they become impinged from a degenerated or herniated disc, stenosis, or cervical osteoarthritis, the resulting pain and numbness can be very similar to carpal tunnel syndrome.
See Is My Shoulder Pain Caused by a Neck Injury?
Cubital tunnel syndrome
The ulnar nerve passes over the outside of the elbow, runs down the arm, and into the outside of the hand; this is the nerve that causes a “funny bone” reaction when it is struck at the elbow.
Repeated use or pressure on the elbow can cause inflammation that affects this nerve, which can cause symptoms of pain and tingling in the hand, similar to carpal tunnel syndrome. However, carpal tunnel syndrome symptoms occur in the thumb, index, and middle fingers, whereas ulnar nerve symptoms typically affect the ring and pinky fingers.
In This Article:
Thoracic outlet syndrome
This is a rare condition in which the space between the collarbone and upper ribs is unusually narrow, causing compression of the blood vessels and nerves that run through this space. This compression can result in pain, numbness, or weakness in the hands, as well as pain in the neck and shoulders.
Approximately 60 to 70 percent of people with diabetes will eventually develop form of neuropathy, or nerve damage, according to the National Institute of Diabetes and Digestive and Kidney Diseases.3 This nerve damage can happen anywhere, but tends to affect the extremities (hands and feet) first.
See Soft Tissues of the Wrist
- 1.Dale AM, Harris-adamson C, Rempel D, et al. Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies. Scand J Work Environ Health. 2013;39(5):495-505.
- 2.Garner R, Kumari R, Lanyon P, Doherty M, Zhang W. Prevalence, risk factors and associations of primary Raynaud’s phenomenon: systematic review and meta-analysis of observational studies. BMJ Open. 2015;5(3):e006389.
- 3.“Nerve Damage (Diabetic Neuropathies).” National Institute of Diabetes and Digestive and Kidney Diseases. November 2013.
Traumatology: Carpal tunnel syndrome – diagnosis and treatment in St. Petersburg, price
Description of the disease
Vessels, nerves, synovial membranes, tendons pass through the carpal (carpal) canal. Here is the median nerve – the main nerve of the hand, going from the brachial plexus to the fingertips. Responsible for coordinating movement, fine motor skills of the hands, constriction and expansion of blood vessels from external stimuli, regulates the work of sweat glands.The width of the canal is limited on three sides by the bones and the transverse ligament.
The carpal tunnel itself is quite narrow, which contributes to the formation of various pathologies. Any additional narrowing entails squeezing of the processes of nerve fibers and blood vessels, blood supply is disrupted. Pathological processes proceed slowly, begin with a loss of physiological sensitivity, lead to motor, trophic disorders. The picture of the disease has clear symptoms with a characteristic clinic, which makes it easy to make a diagnosis even at the initial stage.
Symptoms of the disease
1. Decrease in brush sensitivity. Patients initially begin to notice numbness in the fingers immediately upon waking. Over time, the periods of paresthesia increase, and feelings of burning, pain, cold or heat are added to it. Carpal tunnel syndrome is characterized by a simultaneous, radically opposite change in sensitivity. In one area, it rises, but the other part of the palm does not feel anything.
2. Burning pain in palms with shooting in fingers. Initially, pain is felt in the pinched nerve zone, then it gradually begins to affect the entire arm: from the shoulder to the fingertips. This is accompanied by swelling of the wrist. As a rule, the dominant hand hurts: the right hand in the right-hander, the left in the left-hander, but there are also bilateral symptoms.
3. Muscle weakness and impaired motor activity. As a result of prolonged pinching and inflammation of the nerve fibers, the hand loses muscle strength, and there is a restriction in movement. It becomes difficult to handle small objects such as buttoning up buttons. The function of grasping and then holding objects weakens. A gradual decrease in the working capacity of the hand leads to muscle atrophy and deformation of the hand.
4. Lesions of the autonomic nervous system. This is expressed in a pale and sometimes bluish color of the hand, dry skin, brittle nails, cold hand.
Naturally, carpal tunnel syndrome affects the general physical and mental state of the patient. He loses his ability to work, the quality of life decreases. Regular pain and constant discomfort are worse at night, which interferes with normal sleep and causes insomnia.
A characteristic feature of this disease is that the patient can relieve discomfort on his own, without resorting to medications. To do this, it is enough to put your hands down, move your fingers, shake your hands, stretch them, do massage, gymnastics.These manipulations help to restore blood supply, but, unfortunately, not for long, since they do not get rid of the causes.
It is easy to diagnose this disease, it is enough to interview the patient and conduct several tests, since carpal tunnel syndrome has vivid distinctive features. Among them are the symptoms described above and the preservation of the functions of the little finger, which is not affected when the nerve and blood vessels in the carpal canal are pinched.
The doctor also conducts palpation and the following tests:
Hoffman-Tinel test: tapping the median nerve area.With carpal tunnel pathology, the patient feels numbness, tingling, burning with his palm.
Phalen’s test: the patient feels pain and numbness of the palm by flexing the hand as much as possible in the wrist joint.
It is difficult to hold the arms raised above the head for more than 1 minute, pain syndrome and numbness of the extremities begins.
It is impossible to connect (touch) the thumb with the little finger.
To confirm the correctness of the diagnosis, to determine the degree of damage and associated complications, additional examinations are prescribed:
Electroneuromyography to assess the conduction of nerve impulses is the gold standard for diagnosing tunnel syndrome.
Ultrasonography helps detect damage and inflammation.
A neurologist, physiotherapist and hand surgeon can diagnose and treat.
Treatment of carpal tunnel syndrome
All measures taken are aimed at eliminating the cause of the disease – complete or partial elimination of the compression of the median nerve. The method of therapy depends on the severity of the syndrome. Choose between conservative and surgical treatment. Also, the doctor’s tasks include identifying the cause of the onset of the disease in order to limit movements that worsen the symptoms.
1. Conservative treatment
Patients are prescribed wearing an orthosis, which keeps the wrist joint in a position that is safe for blood vessels and nerves. It is recommended to wear it constantly, during the day and at night. According to statistics, orthotics are effective in the early and middle stages of the development of the disease. It is recommended to switch to a salt-free diet and limit fluid intake to reduce swelling.
Prescribes and Medications:
Non-steroidal anti-inflammatory agents to reduce pain and inflammation.
Oral or injectable corticosteroids to relieve pain and restore joint mobility.
Vascular drugs to improve tissue blood supply.
Diuretics to relieve puffiness.
Vitamin B6 to relieve symptoms and increase the effectiveness of treatment.
Physiotherapy helps to speed up the process of therapy, to achieve a positive result faster: electrophoresis, UHF, magnetotherapy and other methods. Physical therapy and massage are often prescribed. The complex combination of these methods of therapy and the use of medications leads to remission in 59% of patients. The rest are forced, on average, after 1-2 years to turn to a wrist surgeon for an operation.
2. Surgical treatment
If conservative treatment is ineffective and if the disease is neglected, a surgical operation is prescribed.They are dealt with only by hand surgeons – narrow-profile specialists who conduct surgical aids on the hand. The purpose of the operation is to release the median nerve, relieve pressure. There are two ways to open the carpal tunnel:
Open surgery, in which an incision is made in the wrist about 3 cm long. Having gained access, the surgeon dissects the ligament, increasing the volume of the carpal tunnel.
Endoscopy is characterized by a shorter incision length, which is up to 1.5 cm, but is performed in two places.They are necessary for the introduction of a microcamera, using which the ligament can be dissected.
Both types of surgery are performed under local anesthesia. Sometimes excision of tissue around the nerve and tendons is required, with cicatricial changes, ovaries and strands. On average, the procedure is carried out within 20 minutes.
At first, the patient may feel pain in the area of the scars and physical weakness in the wrist. It will take several months to fully recover, the period is individual in each case.Rehabilitation consists of gymnastics, massage, physiotherapy. During the recovery period, many have to give up their activity if it affects recovery.
According to statistics, up to 90% of patients who underwent surgical treatment fully restore physical activity of the hands and get rid of the symptoms of carpal tunnel syndrome. Relapses occur in 8-12% of cases.
3. Alternative treatments.
You can relieve the symptoms of tunnel syndrome without medication and surgery.This requires:
Reduce the stress on the hands and wrists, exclude activities that worsen the condition.
Fix the arm with a splint, orthosis, or an elastic bandage to restrict movement.
Remove puffiness with ice, limit fluid and salt intake.
Perform arm gymnastics aimed at stretching the joints.We recommend exercising under the supervision of a physiotherapist.
If there is no improvement, then you should not delay seeking medical attention.
What will happen if you do not receive treatment?
Carpal tunnel syndrome is not life threatening, it is a slowly ongoing pathological process. The disease has a favorable prognosis for recovery, but due to the neglect of their health, some people are in no hurry to visit a doctor.Over time, this leads to a decrease in motor activity, muscle strength, and fine motor impairment. If left untreated, irreversible processes will begin, the median nerve will atrophy. This will lead to the loss of the brush functionality, which will no longer be possible to return.
Causes of the syndrome
Carpal tunnel syndrome develops under the influence of several factors. A decrease in the diameter of the carpal tunnel can occur due to compression of the nerve.Swelling of the surrounding tissues and for both reasons at the same time. The root cause is trauma, both one-time and microtrauma inflicted on a regular basis due to lifestyle or work.
1. “Dangerous” professions. Among the professions going into the risk zone:
sign language interpreters;
conveyor workers and others.
Most often, the syndrome is diagnosed in women over 40 years old, mainly due to their professional choice and hormonal changes in the body. However, the disease can occur at any age.
2. Concomitant diseases.
A number of diseases increase the risk of developing carpal tunnel syndrome, including:
Injuries, dislocations, fractures causing hematomas and edema.
Neoplasms, tumors of ligaments and tendons.
Frequent intra-tunnel pressure and swelling of the limbs.
Chronic heart failure and other diseases of the heart and blood vessels.
Diabetes mellitus, thyroid diseases and other endocrine pathologies.
Obesity, regardless of the causes of its occurrence.
Chronic arthritis, sclerosis, collagenosis and vasculitis.
Tuberculosis and non-tuberculous bacterial infections.
Alcoholism, smoking, drug use.
3. External factors.
Work in low temperatures. For example, fishermen, butchers, workers of public transport services.
Working with heavy tools and vibrating devices. For example, builders, repairmen, industrial workers.
Any of the listed influences or a number of factors in combination causes a narrowing of the carpal tunnel and pathology develops.Most often, the disease develops according to the following scheme: trauma — aseptic (non-infectious) inflammation, passing to the carpal tunnel — swelling of the subcutaneous fat layer. Then everything goes in a new circle:
increasing pressure on the nerves and blood vessels leads to even greater trauma and inflammation, causing the progression of the disease and the transition to the chronic stage.
People who are prone to developing carpal tunnel syndrome need to take timely measures:
Perform feasible physical activity, without overexerting the wrist, without sudden movements.
If possible, exclude activities involving prolonged monotonous hand work.
Maintain the correct posture during sedentary work, follow the rules for choosing office equipment and furniture.
Periodically perform light gymnastics for the hands, take breaks during work.
Lead a healthy lifestyle.
Get serious about organizing your workplace. The office chair should change in height to suit your height, be equipped with a back and armrests. Use an ergonomic keyboard, computer mouse, and dedicated wrist rest. The hands should be relaxed during work. You do not have to perform additional actions, including shoulders, in order to press the key. Most studies indicate that in modern people, the main cause of the development of the syndrome is the incorrect position of the arms and trunk while working at the PC.
The correct position of the hands is the position of the hand in relation to the forearm at a right angle. Avoid flexion and extension of the wrist. The brush should lie completely on the work surface and not be suspended.
Correct Fit is the right angle between the lower back and the hips. The working area of the monitor (text, graphics) should be at eye level or lower, but not more than 15 cm, to prevent neck bending.You need to sit leaning on the back, with your shoulders relaxed. The feet should completely touch the floor, if this is not possible, a stand should be used.
Implementation of preventive recommendations does not require a lot of time, complex equipment or skills. Therefore, everyone can protect themselves or at least significantly reduce the likelihood of developing carpal tunnel syndrome. Do not self-medicate at the first signs of the disease – immediately consult a doctor (if possible, to hand surgeons).
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carpal, ulnar carpal tunnel syndrome
Carpal tunnel syndrome is a condition when there is compression in the carpal (carpal) canal of the median nerve.It can be provoked by compression or injury.
The concept of tunnel syndrome is not universal for the area of the wrist; this condition can also manifest itself in other anatomical areas, where the nerves run rather superficially and close to bone structures at the same time. The syndrome in question manifests itself in the form of a decrease or lack of sensitivity in the thumb, index, middle and half of the ring finger, as well as impaired motor function in them.
Carpal tunnel syndrome is a common pathology and occurs in 1-3% of the population, and mainly in people, an occupation that is associated with fine, monotonous motor skills of the hand. Half of all those suffering from this syndrome are people, the type of employment, which is associated with the use of a computer. Also, this disease can be considered an occupational pathology in musicians, tailors, office workers, etc. The syndrome occurs in the active working-age population at an already mature age (40-60 years), and in 105 cases at a younger age.Scientists have concluded that active PC users have a 15% higher risk of developing the syndrome, especially in women.
Causes of carpal tunnel syndrome
The median nerve in the area of the hand passes through the tunnel formed by the transverse ligament and the carpal bones of the hand. Compression of the nerve in the canal can be provoked by:
Traumatic injuries of the hand. Bruises, dislocations, sprains, fractures can provoke swelling of the ligaments and muscles, or even displacement of the wrist bones.All this can compress the nerve in the canal and cause impairment of its function. With proper treatment, all these processes are reversible, but if you do not provide assistance in time and correctly, then the contractures of muscles and ligaments, as well as deformation of the bones, can already be irreversible.
Arthrosis, arthritis and other pathological articular processes of various etiology and genesis. The edema and inflammatory reactions caused by these pathologies, up to tissue necrosis, can also cause compression of the nerve.With the permanent course of inflammation and the progression of degenerative-dystrophic processes, the articular surfaces of the wrist lose their properties and wear out, resulting in deformation and compression of the nerve in the canal by bone structures.
Inflammation of the tendons or tenosynovitis. Inflammation can be septic (caused by microorganisms) and aseptic (caused by exertion, hypothermia, etc.).Septic inflammation can be provoked by such diseases as purulent wounds of the hand, including panaritium, improper technique of taking blood from a finger, etc. Non-infectious inflammation can be caused by chronic traumatic stress, for example, frequent monotonous hand motility, static load on it, temperature trauma.
Diseases that lead to water retention in the body can cause swelling of the extremities and, as a result, lead to an increase in soft tissue volume and compression of the median nerve.Violation of the water-electrolyte composition can cause: pregnancy, taking hormonal contraceptives, menopause, kidney disease, etc.
Rarely, but there are tumors of the nervous tissue and the median nerve in particular. Most of these are benign neoplasms (schwannomas, neurofibromas, perineuromas), but there are also malignant ones arising from the nerve sheaths. With its growth, the tumor compresses the nerve, which leads to its damage.
Diabetes mellitus. Under the influence of the enzyme protein kinase C, sorbitol and fructose accumulated in the course of the disease begin to break down in nerve tissues. Because of this, as well as due to a violation of the trophism of neurons and their processes, aseptic inflammation of the nerves and surrounding tissues occurs. Edema increases, which in turn leads to compression of the nerves, including the median.
Acromegaly. As a result of prolonged and intensive growth of a person suffering from acromegaly, processes of disproportionate growth of bone and soft tissues occur. The median nerve can become pinched in a narrowed carpal tunnel due to increased bone volume and narrowing of the lumen.
Congenital malformations . The transverse wrist ligament can be thickened from birth, and there is also poor production of tendon lubrication.One of the factors of predisposition to carpal tunnel syndrome can be an anatomical feature of the structure, the so-called “square wrist”.
Symptoms of the tunnel syndrome
Feeling of numbness in the fingers. The syndrome in question, as a rule, develops gradually and mainly the lesion manifests itself on one side. Basically, the pathological process occurs in that limb, which is the leading one, in the right-handed – the right hand, and in the left-handed – the left.Carpal tunnel syndrome develops gradually. However, a two-way process can also be observed, with diseases of the endocrine system, pregnancy, etc.
Paresthesia . Manifested as tingling sensations and loss of sensitivity in the fingers. Appear in the morning, after waking up and disappear within a few hours. But over time, these manifestations become more stable and more intense and can already become permanent.This can lead to disruption of the normal function of the limb: strength, dexterity, etc., the patient has to change hands when performing actions, to rest the affected limb. Special inconveniences are caused by manipulations requiring static tension of the limb.
Pain. With the manifestation of the disease, a burning sensation and tingling sensation may appear in the hand, which is rather quickly eliminated by lowering the limb down and shaking it.The blood flow in the arm resumes, and the painful sensations disappear. As a rule, this occurs during sleep due to the static position of the hand, or during monotonous work performed by the limb. Pain is not common in any specific joint and is common. With the progression of the disease, pain can affect not only the fingers, but the entire hand and arm up to the elbow joint, which often complicates the diagnosis. The patient cannot carry out his duties, because pain can occur during the daytime.
Loss of agility and strength. Over time, if the disease is not treated, the limb begins to lose strength and dexterity in movements. It is difficult for the patient to hold objects in his hands, especially small ones, they seem to spontaneously fall out. The ability to perform fine motor skills is lost (grabbing small things, opposing the thumb, etc.).
Decrease in sensitivity. Over time, the patient may begin to notice that he does not distinguish the temperature of objects well, stops feeling touches or even pricks. There is a painful burning sensation in the hand, numbness.
Muscle atrophy. With advanced forms of the syndrome, atrophy of the musculo-ligamentous apparatus of the arm may develop, the muscles and ligaments not only lose strength, but also decrease in size. Over time, the hand deforms and takes on a shape resembling a monkey’s paw.
Skin discoloration. Due to the fact that when the innervation of the hand is disturbed, the nutrition of the skin cells also occurs, a change in the color of the skin occurs, they become lighter and unevenly colored.
Diagnosis of tunnel syndrome
For an accurate diagnosis, it is necessary to consult a neurologist. In this case, the doctor conducts a number of specific tests, and laboratory and instrumental research methods can also be used.
Carpal Tunnel Syndrome Tests:
- Tinel test. In the narrowest part of the carpal tunnel, from the side of the palm, when tapping, there is an unpleasant tingling sensation.
- Phalen test. When the wrist is bent as much as possible, pain and paresthesia appear in the wrist for a minute or less.
- Cuff test. A cuff from a blood pressure monitor is placed on the forearm and inflated to the maximum.Within one minute, with a positive test and the presence of the syndrome, a feeling of numbness and tingling appears.
- Hands Raised Test. The upper limbs are lifted vertically upward and held in this position for a minute. With a positive result, discomfort appears within 30-40 seconds.
All of the above tests can be done at home, and if you have at least one positive test, be sure to see your doctor.
Instrumental research methods are used such as:
- X-ray examinations;
To identify the causes of the onset of the disease, the patient is prescribed a blood and urine test:
- blood biochemistry;
- blood and urine analysis for sugar;
- analysis for thyroid-stimulating hormones;
- clinical analysis of urine and blood;
- blood test for rheumatoid factor, C-reactive protein, antistreptolysin-O;
- blood test for circulating immune complexes;
- blood test for antistreptokinase.
Treatment of tunnel syndrome
The most important thing in the treatment of carpal tunnel syndrome is compliance with measures to prevent the development of the disease. Even with the best and highest quality treatment, preventive measures cannot be avoided, because the effect may simply not be achieved.
- Preventive measures for carpal tunnel syndrome. When the first signs of the disease appear, it is necessary to rigidly fix the hand so that there is no possibility of movement in the joint and, as a result, nerve injury.The brace can be applied by a doctor or you can purchase an elastic bandage from a pharmacy for temporary use. For two to three weeks, it is necessary to avoid activities that aggravate the symptoms of the disease. Also, to reduce swelling, it is recommended to apply cold to the wrist area for 2-3 minutes 2-3 times a day. In the subsequent period, treatment is prescribed depending on the severity of the pathological process and its severity. If necessary, the treatment is based on the treatment of the underlying disease (traumatic injury, hypothyroidism, diseases of the urinary system, diabetes mellitus, etc.).), causing compression of the nerve in the canal.
Local treatment. Includes the use of compresses, the introduction of drugs into the canal cavity. These procedures can quickly relieve painful manifestations and relieve local inflammation.
- Drug therapy. Drug therapy in each case is selected individually, depending on the underlying or concomitant disease. At the same time, B vitamins, non-steroidal anti-inflammatory drugs, vasodilators, diuretics, anticonvulsants, muscle relaxants, glucocorticosteroids, antidepressants, etc. are often prescribed.
- Physiotherapy. Can be used both in drug therapy and in the postoperative period during rehabilitation. When this is used: acupuncture; manual therapy techniques; ultraphonophoresis; shock wave therapy. Before using physiotherapy procedures, it is necessary to consult a specialist for contraindications.
Surgical treatment of tunnel syndrome
If, for 6 months or more, conservative therapy does not give the desired effect, then it makes sense to think about the surgical resolution of the disease.The main task of the surgical intervention is to eliminate the pressure on the median nerve by expanding the carpal canal.
Most operations are performed under local anesthesia. The following methods are used:
By open access: through an incision (5 mm) in the region of the cranial canal, the carpal ligament is dissected.
Endoscopic surgery. There are two types of endoscopic intervention, two incisions and one incision. In the first case, an endoscope is inserted into one incision, and an instrument for dissecting the ligament into the second. In the second case, both tools are inserted in one hole.
At the end of the surgery, a plaster cast is applied to the arm to immobilize the limb. After removing the plaster, a course of physiotherapy and physiotherapy is carried out. As a rule, full restoration of hand function occurs within six months.After recovery, the patient can return to work, subject to the observance of a protective regime so as not to provoke a relapse of the disease.In the modern world, where computer technologies have already been introduced everywhere, the pathology we are considering is becoming more and more common. Timely and qualified assistance and prevention in the event of carpal tunnel syndrome allows complete and sufficient remission to be achieved.
Carpal tunnel syndrome | EMC
One of the diseases that often occurs in employees who work for a long time in the office is carpal tunnel syndrome.It occurs when the median nerve is mechanically compressed between the three bony walls of this canal and the flexor retainer, which is a dense ligament stretched between the ulnar and radial elevations of the wrist and performs the function of fixing the tendons flexing the hand and fingers.
The European Clinic of Sports Traumatology and Orthopedics (ECSTO) provides round-the-clock diagnostics, all types of treatment and rehabilitation of carpal tunnel syndrome. When providing medical care, qualified specialists of the ECSTO clinic use modern equipment and European experience to return patients to their usual life as quickly as possible.
Carpal tunnel syndrome, as a rule, affects older women, as well as workers performing flexion-extension movements of the hand, or fixing the wrist joint in static tension, as is the case when working with a personal computer.
This disease is often referred to as “tunnel syndrome”. However, this definition is a general term, and carpal tunnel syndrome is just one variant of carpal tunnel syndrome.
Causes of the disease
The canal of the wrist is a space limited from all sides by bone structures and ligamentous apparatus, resembling a tunnel through which a number of tendons and the median nerve pass to the fingers of the hand.With edema or another type of change in the size of the anatomical structures that make up the canal with the volume of the canal, the median nerve is compressed, which is the main cause of its dysfunction and pain syndrome.
Other reasons for the development of this disease include:
- activities in which the hand is constantly bent and broken;
- wrist injuries;
- bone spurs in the hand;
- Thyroid dysfunction;
- rheumatoid arthritis;
- diabetes mellitus;
- hormonal changes.
Symptoms of the disease often disturb the patient at night. Among them are:
- Tingling, pain, burning, itching and trembling in fingers;
- Weakness of fingers when squeezing;
- numbness of some fingers or hand;
- pain from wrist to elbow;
The main diagnostic method is electromyography, i.e.e. study of the contractile activity of muscles depending on the level of electrical stimulation. This study allows you to determine the localization of the lesion of the median nerve, as well as identify other causes of carpal tunnel syndrome.
Other diagnostic methods are:
- Tapping over the nerve passage, which produces a tingling sensation in the fingers;
- Passive flexion and extension of the wrist in the wrist joint, with increased tingling, numbness and pain;
- cuff test.
If left untreated, carpal tunnel syndrome can result in permanent permanent nerve damage and severe hand dysfunction.
Treatment of carpal tunnel syndrome
Currently, depending on the severity of the disease, medication, non-medication and surgical treatment are distinguished.
The action of the drugs that the specialist recommends will be aimed at eliminating the cause of the disease, as well as reducing pain, swelling of the median nerve.
Non-drug treatment involves the immobilization of the wrist with a splint, which allows you to rest the wrist joint and thereby reduce the mechanical impact on the median nerve.
The operation of opening the carpal tunnel is one of the methods of surgical treatment. Surgery is recommended for those patients whose symptoms persist for six months or more.
Carpal tunnel opening surgery involves separating the bundles of connective tissue that surround the wrist to relieve pressure on the median nerve. The operation is performed under local anesthesia and does not require a lengthy hospital stay. Note that there are two types of surgery:
open access surgery, in which an incision is made up to 5 cm, after which the ligament is transected in order to increase the volume of the carpal tunnel;
Endoscopic intervention, in which two incisions up to 1.5 cm long are performed in the palm and wrist, after which a video camera is inserted, the tissues are examined, and the wrist ligament is dissected.This type of intervention is the most effective, characterized by a fast recovery period and the absence of large postoperative scars.
For patients with mild symptoms, exercise that stretches and strengthens the hand may be beneficial. Note that the exercises should only be carried out under the supervision of a qualified physiotherapist or rehabilitation therapist, otherwise they can aggravate the situation.
90,000 Carpal tunnel syndrome – surgical treatment of the carpal tunnel in St. Petersburg at the surgery center SM-Clinic
Carpal tunnel syndrome (or CZK) is the most common syndrome in which fingers become numb. This is a condition in which the median nerve is compressed in the wrist area.
Development of carpal tunnel syndrome
The median nerve runs down the center of the wrist (hence called the median nerve) along the palmar side.If we look at the palm, we will see two bumps – thenar and hypotenar. And in the depression between them there is a carpal canal. The bottom of the canal is formed by the bones of the wrist; inside there are 9 tendons and, in fact, our nerve. The canal is closed from above with a dense carpal ligament. With narrowing of the canal or with inflammation of the nerve, it is compressed in this tunnel. Therefore, SZK is often referred to as tunnel syndrome.
Tendons suffer less because they are dense and practically not compressed. Therefore, the entire load falls on the nerve.It is more prone to crushing. First of all, the vessels in the sheath of the nerve, which feed it, are pinched. Ischemia (“starvation”) occurs, and the main function is gradually lost – the conduction of a nerve impulse.
Carpal tunnel syndrome is manifested by numbness of the fingers along the palmar surface of the hand. Fingers 1 to 4 (thumb to ring) go numb. Often there are night pains, you have to wake up at night to shake your hand, rub it, and then the pain recedes a little.Also, the fingers are freezing, a feeling of “creeping” may appear, the strength of the hand is weakened, fine motor skills suffer, objects begin to fall out.
- Typical complaints.
- Electroneuromyography (ENMG) of the upper limb is the most effective method of follow-up examination after a doctor’s examination. This study allows you to check how much the nerve suffers and the conduction of the nerve impulse along it.
- Ultrasound diagnostics can also detect compression of the median nerve in the carpal canal.
“Carpal tunnel syndrome (or CTS) is the most common syndrome in which the fingers become numb. This is a condition in which the median nerve is compressed in the wrist. The most effective treatment is the surgical method, in which the carpal ligament is dissected and the nerve physically released from compression. “
There are conservative methods for the treatment of this problem:
- Use of a plastic night tire.At night, the hand is most vulnerable to an incorrect position, therefore, rigid fixation in the orthosis allows you to reduce the risk of crushing and give the nerve a little “rest”;
- during the day you need to perform special exercises that will prevent the deterioration of the disease;
- blockade in the area of compression of the median nerve, which allows you to quickly and effectively relieve inflammation in the area of compression and reduce pain. However, it is not recommended to perform more than 2-3 blockades, since the injected drug is not harmless.
The most effective is the surgical method , in which the carpal ligament is dissected and the nerve is physically released from compression. Its restoration and normalization of function are gradually taking place. Night pains pass, strength returns, sensitivity is restored.
If numbness or pain in the arm bothers you, come for a consultation, we will help. You can sign up for a consultation with an orthopedic traumatologist by phone +7 (812) 435-55-55
The author of the article: Nikitin Alexander Vladimirovich operating traumatologist at the “SM-Clinic”
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Carpal tunnel or carpal tunnel syndrome
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What is carpal tunnel syndrome?
The carpal tunnel is located at the base of the hand, along its palmar surface.Its posterior wall and both lateral ones are formed by the bones of the wrist, and in front it is bounded by the thick carpal ligament. The carpal tunnel can be compared to a narrow tunnel. Inside the canal, nine tendons are tightly located that flex the phalanges of all five fingers of the hand. Also in the canal is the median nerve, which contains thousands of nerve fibers that provide skin sensitivity along the palmar surface of the thumb, index, middle and half of the ring fingers. The median nerve lies directly under the carpal ligament and is pressed against it when the hand and fingers are flexed.
Carpal tunnel syndrome develops when the median nerve is compressed due to an increase in pressure within the canal. As a rule, the cause is a thickening, swelling of the membranes of the tendons. In this case, the median nerve is pressed against the carpal ligament. Compression of a nerve damages its blood supply, which leads to impaired conduction of nerve impulses, manifested by “tingling” in the fingers, and in advanced cases, numbness.
What are the causes of carpal tunnel syndrome?
Carpal tunnel syndrome develops in the following diseases and conditions:
- inflammation, swelling of the sheaths of the flexor tendons;
- fractures of the radius in the “typical site”, displacement and dislocation in the wrist joint;
- rheumatoid and other specific arthritis;
- fluid retention in the body for any reason;
- diabetes mellitus;
- tumors and neoplastic diseases in the carpal tunnel region;
A relationship has been established between the development of the syndrome and certain professional activities. For example, for any work that requires monotonous flexion of fingers and hands or the use of any vibrating tools. The development of the syndrome is also possible with a hobby for knitting, prolonged use of scissors, as a result of prolonged driving and other similar specific actions. Moreover, the development of the syndrome does not always occur with the above conditions.Changing the position of the hands during work, regular breaks, changes in rhythm and a comfortable workplace can minimize the possibility of developing pathology. We approach the establishment of the cause of the syndrome in each case individually.
With the development of carpal tunnel syndrome with severe neurological symptoms, surgical treatment is indicated – dissection of the carpal ligament, while pressure on the median nerve is excluded. Neurological symptoms (numbness, tingling) gradually disappear.
Carpal tunnel syndrome
Carpal tunnel syndrome (carpal tunnel syndrome) is a condition of the hands that causes numbness in the fingers of the hand due to a pinched median nerve at the level of the wrist.
The median nerve provides sensitivity to the thumb, middle, and index fingers of the hand. Swelling or a change in the position of tissues in this area can lead to compression, as well as irritation of this nerve.
The carpal tunnel is the space at the level of the wrist through which the median nerve passes to the hand.Formed between the bones of the wrist and the carpal ligament.
Typical signs of carpal tunnel syndrome:
tingling sensation, burning sensation, “goose bumps”
numbness of fingers
night pain in the hand
with advanced degrees of atrophy of the muscles of the hand
At the initial stages of the disease, with the appearance of numbness for less than six months, therapeutic anti-inflammatory blockades, physiotherapy, and the manufacture of individual splints are used.
With the ineffectiveness of blockades, as well as with a disease duration of more than 6 months, with obvious signs of nerve compression, recorded on ENMG and ultrasound, surgical treatment is indicated.
The essence of the operation is to dissect the carpal ligament, which compresses the nerve. There are many types of incisions for performing the operation – from wide to very small. In our clinic, we use two mini-incisions, each about 1.5 centimeters long. The operation is performed under local anesthesia.
What is needed for treatment in one visit?
Thanks to modern information technologies, the treatment of carpal tunnel syndrome in one day is a very real possibility. To do this, you only need to send photographs of your hands to [email protected]
or on whatsapp by number 8 (996) 766-76-08, describe complaints and answer questions. Our specialists will study the information received and draw up an individual treatment plan.
Most likely, to clarify the diagnosis, it will be necessary to undergo a special examination – electroneuromyography (ENMG). This is the study of muscle contractions depending on the level of electrical stimulation, which helps to objectively determine the place of compression or damage to the nerve.
It is desirable to indicate in the letter:
Full name and year of birth
Contact phone number and city of residence
Does your hand grow numb or do you feel as if your hand was lying down?
Do you experience hand pain, especially at night?
How long has the disease been going on and who made the diagnosis?
Did the disease start gradually or after an injury?
Have you been operated on before? If so, where and when (it is advisable to send a copy of the discharge summary after the operation, and mark the postoperative scar on the photo of the hand with a marker).
Have you had ENMG? If so, send a copy of the opinion.
Indicate the desired dates for the operation (consultation).
Attach photographs of the hand with a highlighted marker or pen of the area of numbness and pain.
In free form, describe the problem (what worries and for how long), to whom you turned for help (what treatment you received and whether there was an effect), what studies were carried out (if any, you must attach copies of medical documents).
In addition, you can simply make an appointment by phone 8 (812) 406-88-88 for an operation for carpal tunnel syndrome without answering questions and sending photos. If there are no contraindications, you may also be offered treatment in one visit.
Hand Surgery Center
Treatment of carpal tunnel syndrome in the physiotherapy department
Carpal tunnel syndrome is a complex of symptoms caused by compression of a nerve in the wrist.
The main manifestations of carpal tunnel syndrome are finger numbness, physical weakness and pain in the hand.
Carpal tunnel syndrome refers to tunnel neuropathies and is also called carpal tunnel syndrome.
Recently, there has been an increase in the incidence of carpal tunnel syndrome, which is primarily associated with prolonged work at the computer (with a keyboard and computer mouse).
How do we treat carpal tunnel syndrome?
The main cause of carpal tunnel syndrome is chronic overstrain of the hand and wrist at the border between the tendon and bone, where the median nerve passes.It is with such a localization of diseases (in particular, tunnel syndromes) that shock wave therapy, the main method used in our clinic for the effective treatment of carpal tunnel syndrome, is especially effective.
Thanks to the treatment of carpal tunnel syndrome with shock wave therapy (SWT) in combination with laser therapy and other methods of physiotherapy, a quick and lasting result is achieved:
- pain and other unpleasant sensations (tingling, shooting) in the hand disappear,
- physical strength, motor activity and sensitivity of the fingers are restored, numbness disappears,
- muscle atrophy is prevented, further development and complication of the disease with the need for surgical treatment, – efficiency and quality of life are improved.
Why and how does carpal tunnel syndrome occur?
Carpal tunnel syndrome can be caused by any professional activity associated with monotonous hand movements. In particular, carpal tunnel syndrome is considered an occupational disease for musicians (pianists, drummers), assembly line workers, sign language interpreters, artists and representatives of a number of other specialties.
Unpleasant, painful sensations in carpal tunnel syndrome can occur both during the day (more often with prolonged tension of the hand – holding the steering wheel of a car, a book, a mobile phone), and at night, during sleep.Often, such sudden painful sensations in the form of a lumbago are the cause of nighttime awakenings.
The prevalence of this syndrome is explained by the narrowness of the channel between the wrist bone and the carpal ligament, along which the median nerve passes, which innervates the thumb, index, middle and partly the ring fingers. At the same time, even slight swelling can cause compression of this nerve and the occurrence of pain, numbness, physical weakness, and other neurological symptoms.
Physical weakness is most felt in the thumb and forefinger.
How does shock wave therapy work?
The immediate cause of median nerve compression and carpal tunnel syndrome is swelling. To eliminate it, you can use non-steroidal anti-inflammatory drugs (NSAIDs), but they have only a temporary effect and inevitably cause negative side effects. If they are ineffective, you can use a more radical remedy – corticosteroid drugs. They are even more fraught with side effects.
In addition, such treatment does not interfere with the further development of the disease, which may lead to the need for a surgical operation – dissection of the transverse wrist ligament.
Unlike drug treatment, shock wave therapy stimulates natural regenerative processes and simultaneously has an anti-inflammatory, analgesic and decongestant effect without side effects.
The anti-inflammatory effect of shock wave therapy is enhanced when combined with laser therapy. Thanks to this, the fastest and most long-term result of the treatment of carpal tunnel syndrome is achieved.