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Information for the General Public
Carpal Tunnel Syndrome If   you   suffer   from   pins   and   needles   or   numbness   affecting   the   thumb,   index   or   middle   fingers   you   are   probably   suffering   from carpal   tunnel   syndrome.   It   affects   about   5%   of   the   population   and   women   are   affected   more   often   than   men.   The   first   time   it happens is usually at night when you wake up with an uncomfortable tingly feeling in your fingers. The   carpal   tunnel   is   a   narrow   passage   in   the   wrist   through   which   the   tendons that   move   the   fingers   and   a   major   nerve   (median   nerve)   passes   through.   The nerve   innervates   a   few   small   muscles   in   the   hand   and   is   also   responsible   for sensation   of   the   thumb,   index,   middle   and   half   of   the   ring   finger.   The   tunnel   is made   up   of   wrist   bones   on   one   side   bridged   by   a   tough   ligament   for   the   roof on   the   other.   When   the   space   in   the   tunnel   occupied   by   the   tendons   and nerve   is   reduced   from   any   cause,   the   nerve   gets   squeezed   and   carpal   tunnel syndrome results. Incidence:    It   often   affects   people   who   indulge   in   continuous   repetitive   work involving   the   hands   and   wrist.   Among   people   involved   with   manual   labour,   it     affects   those   who   use   a   pneumatic   drill   or   a   jack   hammer   at   work.   Among office   workers,   secretaries,   clerks   and   software   engineers,   it   may   affect   those who   constantly   use   a   key   board.   It   can   also   occur   after   an   injury   to   the   wrist.   Symptoms   may   also   appear   when   excessive   fluid collects in the body as during pregnancy or when you suffer from diabetes. Symptoms:    When   mild,   symptoms   are   noticed   during   the   night.   People   usually   wake   up   with   numbness   and   a   feeling   of   pins and   needles   in   the   fingers.   Symptoms   may   ease   when   you   shake   your   hand   vigorously   or   let   your   hand   hang   by   the   side   of   the bed.   With   increased   pressure   on   the   nerve   symptoms   become   constant   and   often   noticed   during   the   daytime   while   at   work. When   it   progresses   further   the   small   muscles   that   move   the   thumb   become   weak   and   appear   wasted.   Pain   may   sometimes radiate in to the forearm. Diagnosing   Carpal   Tunnel   Syndrome :    It   is   usually   diagnosed   by   clinical   examination.   Tapping   the   nerve   at   the   wrist   may produce   pins   and   needles   shooting   to   the   fingers.   Similarly   bending   the   wrist   to   its   extreme   position   can   cause   numbness   in any of the fingers supplied by the nerve. Electromyogram   and   nerve   conduction   study   are   tests   that   will   confirm   increased   pressure   on   the   nerve.   They   are   simple tests done in the outpatient clinic. Treatment:    Treatment   can   vary   from   simple   measures   when   symptoms   are   mild   to   surgery   when   they   are   severe   affecting ones   daily   activities.   If   possible,   the   person   affected   must   be   advised   to   rest   the   hand   and   wrist   and   avoid   any   activity   causing repetitive strain on the wrist. If   symptoms   occur   during   pregnancy,   they   normally   settle   down   after   the   baby   is born.    In    diabetics,    symptoms    improve    when    sugar    levels    are    well    controlled. When   there   is   excessive   fluid   build-up,   the   cause   for   increased   fluid   in   the   body must be found and treated. Wrist    Splint:    The    splint    usually    worn    at    night,    will    support    the    wrist.    It    will prevent   the   wrist   from   bending   that   normally   increases   the   pressure   on   the nerve.      You   may   be   able   to   purchase   it   from   a   chemist   or   an   online   supplier.   The splint is useful when symptoms are mild. Steroid    Injection :     Injecting    steroid    in    to    the    carpal    tunnel    may    reduce    the inflammation   and   thereby   the   swelling   relieving   the   symptoms.   Care   must   be taken not to inject the drug in to the nerve or the tendons. Oral anti-inflammatory medication only rarely helps. Surgery:   Surgery is recommended when other treatments have failed. Surgery    is    usually    done    as    an    outpatient    procedure    under    a    local anaesthetic.   The   procedure   is   fairly   simple   where   the   tough   ligament forming    the    roof    of    the    tunnel    is    divided    completely.    The    nerve    is protected   when   the   ligament   is   divided   and   the   surgeon   will   make   sure that the pressure on the nerve is completely relieved. Following   surgery   the   wound   will   be   protected   for   about   10   days.   It   may take   about   a   month   to   six   weeks   before   any   strenuous   activity   can   be undertaken using the operated hand. Complications   of   Carpal   Tunnel   Syndrome :    When   the   pressure   on   the   nerve   is   severe   and   unrelieved   for   a   long   time,   it   will result   in   permanent   numbness   of   the   fingers   with   poorly   functioning   thumb   muscles.   This   indicates   permanent   damage   of   the nerve. It is therefore vital that you do not delay treatment if the fingers are continuously numb. K. Badrinath  
Wrist Splint