Carpal Tunnel Syndrome (CTS) is an entrapment idiopathic median neuropathy, causing paresthesia, pain, and other symptoms in the distribution of the median nerve due to its compression at the wrist in the carpal tunnel. The pathophysiology is not completely understood but can be considered compression of the median nerve traveling through the carpal tunnel. The National Center for Biotechnology Information and highly cited older literature say the most common cause of CTS is typing. Carpal Tunnel Syndrome can be associated with any condition that causes pressure on the median nerve at the wrist. Some common conditions that can lead to CTS include obesity, oral contraceptives, hypothyroidism, arthritis, diabetes, and trauma. Carpal tunnel is also a feature of a form of Charcot-Marie-Tooth syndrome type 1 called hereditary neuropathy with liability to pressure palsies. Other causes of this condition include intrinsic factors that exert pressure within the tunnel, and extrinsic factors (pressure exerted from outside the tunnel), which include benign tumors such as lipomas, ganglion, and vascular malformation. More recent research by Lozano-Calderón has cited genetics as a larger factor than use, and has encouraged caution in ascribing causality.
A review of available scientific data by the National Institute for Occupational Safety and Health (NIOSH) indicated that job tasks that involve highly repetitive manual acts or specific wrist postures were associated with incidents of CTS, but causation was not established, and the distinction from work-related arm pains that are not carpal tunnel syndrome was not clear. It has been proposed that repetitive use of the arm can affect the biomechanics of the upper limb or cause damage to tissues. It has also been proposed that postural and spinal assessment along with ergonomic assessments should be included in the overall determination of the condition.
Patients with CTS experience numbness, tingling, or burning sensations in the thumb and fingers, in particular the index, middle fingers, and radial half of the ring fingers, which are innervated by the median nerve. Less-specific symptoms may include pain in the hands or wrists and loss of grip strength (both of which are more characteristic of painful conditions such as arthritis). Before the median nerve enters the carpal tunnel it passes first through the thoracic outlet and then the two heads of the pronator teres muscle of the forearm. As a consequence, inflammation, edema, or hypertrophy in the thoracic outlet or the forearm can impinge the median nerve, mimicking the effects of carpal tunnel syndrome, and patients may also report pain in the arm and shoulder. Long-standing CTS leads to permanent nerve damage with constant numbness, atrophy of some of the muscles of the thenar eminence, and weakness of palmar abduction.
Pain in carpal tunnel syndrome is primarily numbness that is so intense that it wakes one from sleep. Pain in electrophysiologically verified CTS is associated with misinterpretation of nociception and depression.
Generally accepted treatments, may include splinting or bracing, steroid injection, activity modification, physiotherapy, regular massage therapy treatments, chiropractic, medications, and surgical release of the transverse carpal ligament.
A 2007 study, conducted by Lozano-Calderon et al. in the Department of Orthopaedic Surgery at Massachusetts General Hospital, states that carpal tunnel syndrome is determined primarily by genetics and structure. It is presumed, therefore, that carpal tunnel syndrome is not preventable.[original research?]
However, others[who?] think it can be prevented by developing healthy habits like avoiding repetitive stress, practicing healthy work habits like using ergonomic equipment (wrist rest, mouse pad), taking proper breaks, using keyboard alternatives (digital pen, voice recognition, and dictation), and employing early passive treatment like taking turmeric (anti-inflammatory), omega-3 fatty acids, and B vitamins. Scientists have long abandoned the potential role of B-vitamins in carpal tunnel syndrome.
Those favoring activity as a cause of carpal tunnel syndrome speculate that activity-limitation might limit the risk of developing carpal tunnel syndrome, but there is little or no data to support these concepts. and they stigmatize arm use in ways that risks increasing illness.
drsnehamaheshwari