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Carpal tunnel cases need prompt treatment
Mark Saleh

Carpal tunnel syndrome is a common cause of pain, numbness and sometimes weakness of the hand. It affects 3 to 6 percent of the population, and recognizing the symptoms may lead to early diagnosis, which can help prevent irreversible nerve damage.

Carpal tunnel syndrome occurs when the median nerve at the wrist becomes compressed, resulting in pain, tingling and numbness in the thumb, index finger, middle finger and half of the ring finger. At times, the sensory symptoms may seem to extend to the entire hand, forearm, arm and occasionally the shoulder.

The symptoms often worsen during sustained or repetitive hand use. The discomfort can be enough to awaken a patient from sleep, and when that happens, sufferers often report that they find relief by shaking out the hand or dangling the arm from the side of the bed. The symptoms may become more constant if the condition worsens. In more severe cases, muscle weakness occurs, impacting grip strength or manual dexterity.

Risk factors for carpal tunnel syndrome include obesity, pregnancy, diabetes, rheumatoid arthritis, hypothyroidism and genetic predisposition. Women are at higher risk than men. Interestingly, data have not demonstrated a strong link between computer keyboard time or texting and carpal tunnel syndrome.
The diagnosis of carpal tunnel syndrome can be made through a review of history and a physical examination that demonstrates the expected distribution of weakness, pain and numbness. However, a particular type of testing called electromyography/nerve conduction study is often needed to confirm the diagnosis and to exclude other causes, such as a pinched nerve in the cervical spine.

The test can also help assess the severity of carpal tunnel syndrome, which may help guide treatment options or provide prognostic information. Severe cases may not respond well, no matter what treatment is provided. This explains why symptoms sometimes remain even after surgical correction of carpal tunnel syndrome. In more severe cases, the treatment goal may be to stabilize and prevent worsening, as opposed to a complete reversal of symptoms.

There are three primary treatment options for carpal tunnel syndrome. The most conservative approach involves avoiding activities that bring on the symptoms and wearing a wrist splint that can be obtained over the counter to immobilize the wrist. The second treatment option involves injection of cortisone in the carpal tunnel to help reduce inflammation. The third is a surgical procedure to release the carpal tunnel.

Other treatments that may be recommended include yoga and physical and occupational therapy techniques, but data about the benefits of these measures are limited.

It is important to seek medical attention if you develop upper-extremity discomfort, numbness or weakness to rule out potentially serious causes and to avoid permanent nerve injury if the cause is carpal tunnel syndrome.

Dr. Mark Saleh is a neurologist at the Sutter Pacific Medical Foundation and the director of General Neuroconsultative and Referral Services at California Pacific Medical Center.

Resources:
http://www.sfgate.com/health/article/Carpal-tunnel-cases-need-prompt-tre...
http://jama.jamanetwork.com/article.aspx?articleid=1104666
http://www.scienceclarified.com/Ca-Ch/Carpal-Tunnel-Syndrome.html
http://www.medicinenet.com/carpal_tunnel_syndrome/article.htm