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Body Wrapping and Weight Loss - Slim Down or Slim Scam?
One particularly enticing aspect of low-carbohydrate dieting is that you can lose weight. The down side
of it is, unless you are careful, you can end up gaining it all back - plus more. While low-carbohydrate diets do help you to lose weight, it's...
Breaking the Breakfast Barrier
Why was breakfast fun when you were a kid? Because Mom made it, it was probably sugary, and you didn’t have to do the dishes!
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Most aging adults don't get enough physical activity. Exercise, though, can improve health impairments and prevent some diseases. It can also improve mood and emotional well being. The keys, though, to a sensible senior workout are to...
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Osteoporosis
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Carpal Tunnel Syndrome: Pinched Median Nerve at the Wrist
Carpal tunnel syndrome is by far the most common and widely
known of the "pinched nerve" conditions. This article addresses:
What is it? Who is at risk for this condition? How is it
diagnosed? What kinds of treatments work best?
Carpal tunnel syndrome refers to symptoms caused by entrapment
of the median nerve in the carpal tunnel. "Carpal" itself means
"wrist," so a carpal tunnel is nothing more than a wrist tunnel.
This particular tunnel can be a crowded place, as it contains
not just the median nerve, but nine tendons as well. The
"syndrome" consists of some combination of pain, numbness and
weakness.
Pain, numbness, or both, are the usual earliest symptoms of
carpal tunnel syndrome. Pain can affect the fingers, hand, wrist
and forearm, but not usually the upper arm or shoulder. Numbness
affects the palm side of the thumb and fingers, but usually
spares the little finger because it's connected to a different
nerve.
When weakness is present, it usually indicates that the
condition is already severe, and when muscles atrophy (wither)
it means the condition is even worse. The affected muscles are
those downstream from where the nerve is pinched, and can
include those controlling any of three motions of the thumb. In
addition, bending of the first knuckles of the index and middle
fingers can be affected, as can straightening of the second
knuckles of the same fingers. When muscle atrophy is present, it
is most evident in the muscular ball at the base of the thumb.
Carpal tunnel syndrome occurs more frequently in women than in
men. People who work with their hands a lot - for example to
sew, operate hand-tools or perform assembly-line work - are at
increased risk for developing this condition. Various medical
conditions can also increase the risk of carpal tunnel syndrome,
including injuries, arthritis, diabetes, low levels of thyroid
hormone and pregnancy. In the case of pregnancy, carpal tunnel
syndrome often appears in the third trimester and resolves after
the woman delivers.
Optimum diagnosis of this condition combines the time-honored
methods of a doctor's history-taking and physical examination
with tests of nerve function called nerve conduction studies.
Nerve conduction studies are exquisitely sensitive in detecting
impairment of the median nerve at the wrist, particularly when
the median nerve is compared with a nearby healthy nerve in the
same patient.
In nerve conduction studies, the nerve on one side of the carpal
tunnel is activated by a small shock to the skin. An
oscilloscope measures how long it takes for the resulting
nerve-impulse to arrive on the other side of the carpal tunnel.
When the median nerve is pinched, the nerve-impulse is delayed
or blocked. Nerve conduction studies are so sensitive that
sometimes they show problems that aren't even causing symptoms.
That's why nerve conduction studies don't stand alone in
diagnosing carpal tunnel syndrome. The examining physician needs
to decide if the results make sense for the particular patient
in question.
Nerve
conduction studies not only show whether or not the median
nerve is impaired at the wrist, but also provide precise data
concerning how bad the impairment is. In addition, these studies
survey the function of other nerves in the arm and hand.
Occasionally, a nerve in an adjacent tunnel (the ulnar nerve in
Guyon's canal) can also be pinched. In other cases, nerve
conduction studies show that the problem is not one of single
nerve-pinches, but rather a more diffuse pattern of
nerve-impairment called polyneuropathy. Of course, sometimes the
studies are completely normal and suggest that the symptoms are
due to something else.
To treat carpal tunnel syndrome, starting with "conservative"
treatment makes sense in most cases, especially when the
symptoms are still in the mild-to-moderate range. Conservative
treatment usually includes a wrist-splint that holds the wrist
in a neutral position. In a study published in 2005 researchers
at the University of Michigan investigated the effectiveness of
wrist-splinting for carpal tunnel syndrome in workers at a
Midwestern auto plant. In a randomized, controlled trial - the
gold standard method for judging treatments - about half the
workers received customized wrist-splints that they wore at
night for six weeks. The remaining workers received education
about safe workplace procedures, but no splints. After treatment
the workers with splints had less pain than those without, and
the difference in outcome was still evident after one year.
Conservative treatment might additionally include use of
anti-inflammatory medications like aspirin or naproxen, or even
steroid drugs. A more intrusive, though still non-surgical,
treatment consists of injecting steroid medication into the
carpal tunnel itself. This might benefit selected patients, but
in a 2005 randomized, controlled study of patients with
mild-to-moderate symptoms, researchers at Mersin University in
Turkey showed that patients receiving splints did better than
those who received steroid injections.
Surgeons can relieve pressure on a pinched median nerve by
cutting a constricting, overlying band of tissue. A 2002 study
at Vrije University in Amsterdam compared surgical treatment to
six weeks of wrist-splinting. After 18 months 90% of the
operated patients had a successful outcome compared with 75% in
the splinted group.
In some cases it can be reasonable to try conservative
treatments without first confirming the diagnosis with nerve
conduction studies. However, in the author's opinion, this
risk-free form of testing should be performed prior to any
carpal tunnel surgery. (Full disclosure: The author performs
nerve conduction studies!)
(C) 2005 by Gary Cordingley
About the author:
Gary Cordingley, MD, PhD, is a clinical neurologist, teacher and
researcher who works in Athens, Ohio. For more health-related
articles see his websites at: http://www.cordingleyne
urology.com and http://www.neurologyartic
les.com
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