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Carpal tunnel syndrome

Carpal tunnel syndrome is a medical condition in which the median nerve is compressed at the wrist causing symptoms like tingling, pain, coldness, and sometimes weakness in parts of the hand. It is the best known of a class of disorders called repetitive strain injuries. more...

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Anatomy

The median nerve runs through the carpal tunnel, a canal in the wrist that is surrounded by bone on three sides, and a fibrous sheath (the flexor retinaculum) on the other. In addition to the nerve, many of the hand's tendons pass through this canal. The median nerve is usually compressed by swelling of the contents of the canal. Other causes include soft tissue swelling in and around the tunnel or even by direct pressure from part of a broken or dislocated bone. However, bone dislocations are a rare cause of carpal tunnel syndrome that are a result of severe traumatic events.

Incidence

The syndrome is much more common in women than it is in men. It has a peak incidence around age 50 but can occur in any adult.

Symptoms

The first symptoms usually appear when trying to sleep. Symptoms range from a burning, tingling numbness in the fingers (especially the thumb and the index and middle fingers) to difficulty gripping, making a fist, or dropping things. Most early sufferers mistakenly blame the tingling numbness on their sleeping position, thinking their hands have had restricted circulation and are "falling asleep". If left untreated the symptoms often progress to intense pain which restricts hand functionality. It is known as a hidden disability, because people can do some things with their hands and appear to have normal hand function, but often live with severely restricted hand activity due to the pain.

Important: unless you have numbness as one of your predominant symptoms, it is unlikely your symptoms are primarily caused by carpal tunnel syndrome. In effect, pain of any type, location, or severity with the absence of significant numbness is not likely carpal tunnel syndrome.

Causes

Some cases of carpal tunnel syndrome are due to work-related cumulative trauma of the wrist. It is commonly caused by strain placed on the hand, for instance gripping and typing, which are usually performed repetitively in a person's occupation. The condition was first diagnosed in Australia in the 1980s when musicians started to use synthesizers heavily and people using these instruments started to get hand and wrist pain. The condition went mostly undiagnosed in the US until the mid 1990s when computers became more popular in the workplace.

There are a number of causes of carpal tunnel syndrome. They can be either traumatic, or non-traumatic.

Repetitive stress induced carpal tunnel strain is the leading cause of carpal tunnel syndrome in most industrialized countries. In the USA for instance, repetitive stress induced carpal tunnel syndrome is the biggest single contributing factor to lost time at work. This type of carpal tunnel syndrome results in billions of dollars of workers compensation claims every year.

Read more at Wikipedia.org


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Steroid injection equivalent to surgery for carpal tunnel syndrome
From Journal of Family Practice, 5/1/05 by D. Ly-Pen

Ly-Pen D, Andreu JL, de Bias G, Sanchez-Olaso A, Millan I. Surgical decompression versus local steroid injection in carpal tunnel syndrome: a one-year, prospective, randomized, open, controlled clinical trial. Arthritis Rheum 2005; 52:612-619.

* Clinical Question

Is local steroid injection for carpal tunnel syndrome as effective as surgery?

* Bottom Line

Patients with carpal tunnel syndrome do better with local steroid injections than with surgery in the short term, but at the end of 12 months, the outcomes appear comparable, though more than 20% of patients had discontinued the study by this time period. (Level of evidence [LOE] = 2b)

Study Design

Randomized controlled trial (nonblinded)

Allocation Concealed

Setting Outpatient (specialty)

Synopsis

Adults with carpal tunnel syndrome referred to a special carpal tunnel clinic were eligible to participate in this study if they had symptoms for more than 3 months and didn't respond to 2 weeks of nonsteroidal anti-inflammatory drugs and splinting. The authors confirmed carpal tunnel syndrome by electrodiagnostic testing. Patients were randomly assigned to surgery (n = 80) or local steroid injection (n = 83). The allocation was concealed. One surgeon performed all surgeries and another surgeon performed all the steroid injections.

The main outcome--severity of symptoms on a 100-point visual analog scale--was assessed via intention-to-treat. The authors defined treatment success as a 20% reduction in symptoms. This is consistent with other literature that suggests a 15% to 20% improvement is the minimum difference that is clinically meaningful. Since more than 80% of patients in the steroid injection group received 2 injections, the therapy in this study should be attributed to a course of 2 local steroid injections, not a single injection.

The patients in each group were similar at baseline; by the end of the study, more than one fifth of each group dropped out. After 3 months, 94% of the patients treated with steroid injections improved compared with 75% of the surgical patients (number needed to treat = 5; 95% confidence interval, 3-13). But by the end of 12 months, there was no significant difference in improvement between groups (70% and 75%, respectively). The high dropout rate in this study may confound these data.

CONTINUED

What is a POEM?

Each month, the POEMs (Patient-Oriented Evidence that Matters) editorial team reviews 105 research journals in many specialties, and selects and evaluates studies that investigate important primary care problems, measure meaningful outcomes, and have the potential to change the way medicine is practiced. Each POEM offers a Bottom Line observation and summarizes the study's objective, patient population, study design and validity, and results. InfoPOEMs, Info-Retriever and POEMS for Primary Care are registered trademarks of InfoPOEM, Inc. POEMS and Patient-Oriented Evidence that Matters are trademarks of InfoPOEM, Inc. These POEMs are copyrighted by, and published with the express permission of InfoPOEM, Inc. and may not be copied or otherwise reproduced without the prior written consent of InfoPOEM, Inc.

COPYRIGHT 2005 Dowden Health Media, Inc.
COPYRIGHT 2005 Gale Group

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