### Date : 2024-06-19 12:05 ### Topic : Carpal Tunnel Syndrome #medicine #neurology ---- ### Carpal Tunnel Syndrome Overview **Carpal Tunnel Syndrome (CTS)** is a common condition that occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes compressed at the wrist. The carpal tunnel is a narrow passageway located on the palm side of the wrist, surrounded by bones and ligaments. When the median nerve is compressed, it can lead to pain, numbness, and tingling in the hand and arm. ### Pathophysiology The carpal tunnel contains the median nerve and several tendons. When these tendons become irritated or inflamed, they can swell and compress the median nerve. This compression can result from various factors, including repetitive hand movements, wrist anatomy, and certain health conditions. ### Causes and Risk Factors - **Repetitive Motion:** Frequent and repetitive movements of the wrist and hand, especially activities that involve flexing the wrist. - **Wrist Anatomy:** Smaller carpal tunnels or abnormalities in the wrist structure can predispose individuals to CTS. - **Medical Conditions:** Diabetes, rheumatoid arthritis, thyroid dysfunction, and obesity can increase the risk. - **Gender:** Women are more likely to develop CTS, possibly due to smaller carpal tunnel spaces. - **Pregnancy:** Fluid retention during pregnancy can increase pressure within the carpal tunnel. ### Clinical Features - **Numbness and Tingling:** Often felt in the thumb, index finger, middle finger, and the radial half of the ring finger. Symptoms may worsen at night. - **Pain:** Can radiate from the wrist to the arm or down to the fingers. Pain may also occur in the shoulder and neck area. - **Weakness:** Reduced grip strength and difficulty performing fine motor tasks (e.g., buttoning a shirt). - **Hand Clumsiness:** Tendency to drop objects due to impaired hand coordination. ### Diagnosis Diagnosis of Carpal Tunnel Syndrome involves a combination of clinical evaluation, physical examination, and diagnostic tests: 1. **Clinical History:** - Assessment of symptoms, including their duration, severity, and any associated factors. 2. **Physical Examination:** - **Tinel's Sign:** Tapping over the median nerve at the wrist to elicit tingling or numbness in the hand. - **Phalen's Maneuver:** Holding the wrists in flexion (back-to-back) for about 60 seconds to see if it reproduces symptoms. - **Durkan's Test:** Direct pressure applied over the carpal tunnel to reproduce symptoms. 3. **Diagnostic Tests:** - **Nerve Conduction Studies (NCS) - 신경전도검사:** Measure the electrical activity of the median nerve and assess any delays or blockages. - **Electromyography (EMG) - 근전도검사:** Evaluates the electrical activity of muscles and can help determine the severity of nerve involvement. ### Example Case Study **Patient Profile:** - **Name:** Jee Hoon Ju - **Age:** 45 - **Occupation:** Office Worker **Medical History:** - **Symptoms:** Jee Hoon Ju reports numbness and tingling in his right hand, especially at night. He also experiences occasional pain radiating from his wrist to his forearm and finds it difficult to grip objects. **Physical Examination:** - **Tinel's Sign:** Positive, with tingling sensation in the fingers when tapping over the median nerve at the wrist. - **Phalen's Maneuver:** Positive, with numbness and tingling in the hand when holding the wrists in flexion. **Diagnostic Tests:** - **Nerve Conduction Studies:** Show prolonged median nerve latency at the wrist. - **Electromyography:** Confirms the diagnosis with evidence of median nerve compression. **Diagnosis:** Based on the clinical presentation, physical examination, and diagnostic test results, Jee Hoon Ju is diagnosed with Carpal Tunnel Syndrome. ### Management 1. **Non-Surgical Treatment:** - **Wrist Splinting:** Wearing a wrist splint at night to keep the wrist in a neutral position and reduce pressure on the median nerve. - **Activity Modification:** Avoiding repetitive wrist movements and taking frequent breaks to reduce strain. - **Medications:** NSAIDs for pain relief and corticosteroid injections to reduce inflammation. - **Physical Therapy:** Exercises to strengthen and stretch the wrist and hand muscles. 2. **Surgical Treatment:** - **Carpal Tunnel Release Surgery:** Considered when symptoms are severe or do not improve with conservative treatments. The procedure involves cutting the ligament that forms the roof of the carpal tunnel to relieve pressure on the median nerve. ### Prognosis - With appropriate treatment, many patients experience significant relief from symptoms. - Early intervention and modification of activities can prevent progression and improve outcomes. - In cases requiring surgery, most patients recover well and regain normal function, although full recovery can take several months. ### Conclusion Carpal Tunnel Syndrome is a common condition that can significantly impact hand function and quality of life. Early diagnosis and a combination of non-surgical and, if necessary, surgical treatments can effectively manage symptoms and prevent long-term damage. Regular monitoring and lifestyle adjustments are essential to maintaining hand health and function.