Carpal Tunnel Syndrome

Word Count: 1797 |

I. Definition: Carpal Tunnel Syndrome, also known as CTS, is the compression or pinch of a nerve in the carpal tunnel. The carpal tunnel is a narrow, rigid passageway of ligaments and bones located at the base of the hand. This nerve, called the median nerve, is housed inside the carpal tunnel which runs from the forearm to the hand. The median nerve is connected to the brain and spinal cord controlling different sensations to the palm side of the thumb and fingers, however not the little finger. It also controls impulses to some small muscles in the hand that allow the movement of the fingers and thumb. In some people, irritation from tendons causes thickening or swelling of the tunnel resulting in the compression or trauma of the median nerve. This will result in weakness, pain, or numbness in the wrist and hand, proceeding up the arm.

II. Etiology: Carpal Tunnel Syndrome is caused by a combination of many factors. These factors increase the pressure on the carpal tunnel, which then affects the median nerve. Factors can include sprains, fractures, or dislocations of the wrist which causes trauma or injury swelling the carpal tunnel. Consistent use of the pituitary gland, hypothyroidism, rheumatoid arthritis, and mechanical problems in the joint of the wrist are also factors. The repetitive use of the wrist, including typing, flexion and extension stress from occupations such as carpentry and carpet weaving, or use of mechanical tools like vibrating jackhammers are more factors. Infection, diseases, fluid retention during pregnancy and menopause, the development of cysts or tumors in the canal, or intraneural hemorrhages are also factors that may cause carpal tunnel syndrome. This is most common in women and workers requiring the use of the mechanical tools in the afore mentioned. Other occupations that may cause carpal tunnel syndrome include poultry and meat cutters, mechanics, truck drivers, key punch operators, hairdressers, clothing factory workers, journalist, and piano players. The age range of those people affected is usually around 40 to 60; however the syndrome may occur at any age.

III. Symptoms: Symptoms of carpal tunnel syndrome usually start gradually and work their way to more severe problems. Frequent burning, itching, tingling, and numbness in the palm of the hand and fingers, mainly focusing on the thumb, index, and middle fingers are the most common symptoms many patients complain of. These symptoms are most often felt during the night because most people sleep with their wrists flexed. When the wrist is flexed, tingling in the wrists become more aggressive and cause the complaints. Motor skills are affected in ways such as clumsiness in the hand affected, like dropping things from not being able to hold them, and difficulty in writing. Weakness of the muscle of the thumb and the loss of pinch, grip strength, and edema of the fingers are also symptoms associated with carpal tunnel syndrome. The sense of temperature is also lost in some cases.

IV. Social Symptoms/Manifestations: On an intrapersonal level, or inside the individual’s mind, many people affected with this syndrome fear losing their jobs because of not being able to perform certain tasks efficiently. They also fear becoming permanently disabled from carpal tunnel syndrome. On an interpersonal level, or the relations between persons, people may refuse social events because of the pain and embarrassment of being disabled. Manifestations of carpal tunnel syndrome may cause people to become unable to continue their jobs if those jobs are the cause or will make the disorder worse. As for leisure activities, patients of this disorder may be unable to continue certain activities.

V. Prognosis: If treated as early as possible, patients will demonstrate improvement.

VI. Diagnostic Evaluations/Assessments: Many different aspects are tested when trying to diagnose carpal tunnel syndrome. Such include range of motion, grip and pinch tests, strength of muscles in the hand, hand functions, fine motor coordination, manipulation, dexterity, work tolerance, habits, patterns, tactile sensation, daily living skills, and leisure interests and activities. Tests are also preformed to prove the complaints.
 Tinel’s Sign- This test is preformed by tapping the median nerve along the wrist. The test comes out positive when the tapping of the nerve causes the tingling to become worse in the fingers.
 Phalen’s Sign- This test is done by pushing the back of your hands together for about one minute. During this minute, the carpal tunnel is being compressed and comes out positive when it causes the same symptoms the patient experiences with the carpal tunnel syndrome.
 Moberg pick-up test- This test is designed to evaluate the level of sensation by measuring motor ability which is affected by sensation. The constant touch and constant pressure and how they affect the fine motor skills are what are being studies.
 Semmes-Weinstein Monofilaments- This test measures diminishing and returning cutaneous sensation. Cutaneous sensation defined is any feeling originating in sensory nerve endings of the skin, including pressure, warmth, cold, and pain. (http://www.answers.com)
 Jebsen Hand Function Test- This test is designed to test a broad range of everyday functions someone would use their hands for.
 Nerve Conduction Velocity Test (NVC)- This tests the speed of signals through a nerve. This is done by placing patches, similar to the kind used for ECG’s, on the patients skin over various locations of a nerve. The patch then gives off a small electrical impulse that will then stimulate the nerve. The results of the nerve are then recorded by other electrodes. The speed of the nerve signals are determined by the time it takes the electrical impulses to travel between electrodes and the distances they are at.
 EMG- This detects abnormalities in the nerve impulse conduction. These abnormalities are the cause for the carpal tunnel syndrome symptoms a patient would feel. This test does not necessarily need to be preformed; however it is used when symptoms that are not of carpal tunnel syndrome are present.

VII. Treatment (Non-surgical): Treatment for carpal tunnel syndrome starts with very minor adjustments to daily life. The first step would be to stabilize the wrist using a wrist brace. By doing this, the carpal tunnel is widest and the nerve is leased compressed. Usually worn at night, the splint causes the wrist to stay in place and not flex at night as previously mentioned above. Also, using a brace during other activities that would cause the wrist to bend less and stay in a position that is comfortable for the carpal tunnel. Another minor helper would be anti-inflammatory medications such as Advil or Motrin. These medications can cause a decrease in the swelling in the carpal tunnel as well as decrease the symptoms caused by carpal tunnel syndrome. In some studies that have been preformed, high doses of Vitamin B-6 has shown to decrease the symptoms. Evidence also suggests that exercise will help with the symptoms. Acupuncture and chiropractic care have also shown to benefit some patients. Yoga has been shown to reduce the pain in the wrist and improve grip strength.

VIII. Treatment (Surgical): There are many different surgical procedures that can be chosen to reduce carpal tunnel syndrome. There are a few different release procedures that can be preformed. Such procedures include:

• Carpal Tunnel Release: One of the most common surgical procedures in the United States, this surgery is recommended for 6 months. This surgery involved cutting the band of tissue around the wrist which will reduce the pressure on the median nerve. This procedure is done under a local anesthesia and is not an over night stay surgical procedure.
• Open Release Surgery: This surgery is a traditional procedure in which a 2 inch incision is cut in the wrist and then cut the carpal ligament which will enlarge the carpal tunnel. Unless there are other medical complications, this procedure is an outpatient surgery, which means that the patient will receive treatment but will not be hospitalized.
• Endoscopic Surgery: This surgery is done by making two incisions about ½ inch big, one in the wrist and the other in the palm. A camera attached to a tube is inserted into the incision observing the tissue on the screen and cutting the carpal ligament. This procedure allows for faster recovery and less postoperative discomfort. This surgery is very effective and minimizes scarring and the scarring tenderness. There is also a one-portal surgical procedure available.

Although these surgeries provide relief from carpal tunnel syndrome, the long term effects may take months to a full recovery. Patients may walk away from the surgeries from nerve damage, infection, or pain at the site of the scar. Sometimes, because the carpal ligament is cut, the wrist may lose strength. These procedures mentioned above should be followed up by physical therapy to restore the strength in the wrist. In some cases, patients may need to change jobs because of the needs of the wrist after the surgery.

VIIII. Preventions: There are ways in which to prevent carpal tunnel syndrome. If you feel the start of the symptoms, you should contact a doctor immediately. To prevent the start of carpal tunnel, exercises can be done at home. Warming up joints before using them in hands on work for an extensive period of time will help. Cushions will help when typing on a keyboard or moving a mouse, while wearing braces in sports related activities will support the wrist and prevent damage to the carpal tunnel.

X. Summary: Carpal Tunnel Syndrome is when the median nerve in the wrist gets pinched or compressed. This is caused by flexion of the wrist, most often during sleeping, serious injury and over usage. Although there are ways to prevent the disorder from appearing, sometimes minor injuries and leisure activities may cause symptoms to show and worsen. Typing, working with vibrating machinery, carpentry, and other stressful wrist activities can lead to carpal tunnel syndrome. To cure the disorder, there are non-surgical and surgical treatments that can be preformed. Sometimes these treatments may lead to some nerve damage, loss of sense of temperature, and pain, the overall outcome may in fact help treat the carpal tunnel syndrome.

XI. Resources:
• National Institute of Health – National Institute of Neurological Disorders and Stroke
• About.com: Orthopedics
• EMedicine from WebMD
• Internet
• Former Carpal Tunnel Patient

You May Also Find These Documents Helpful

Allegory Of American Pie By Don Mc Lean

Ask anyone what was the defining moment in the rock history of the 1960s was and all you will get is a one word answer: Woodstock. The three day rock festival that defined an era was only one of many music festivals of the '60s. But Woodstock has come to symbolize, "an era of peaceful, free- loving, drug- taking hippie youth, carefree before harsher realities hit..." (Layman 40). The Woodstock festival ended a century filled with many metamorphoses of rock'n'roll, from the era of pop music to the rebirth of folk music to the invention of acid rock. But some cynics say that rock'n'roll died with the death of Buddy Holly before the 60s even began. One such person is Don McLean. The poet behind the haunting epic song about the death of 'danceable' music, McLean wrote the ever popular song, "American Pie" (appendix 1). The most important song in rock'n'roll history, "American Pie", is the song about the demise of rock'n'roll after Buddy Holly's death and the heathenism of rock that resulted. Although McLean himself won't reveal any symbolism in his songs, "American Pie" is one of the most analyzed pieces of literature in modern society. Although not all of its secrets have been revealed, many "scholars" of the sixties will agree that the mystery of this song is one of the reasons it has become so successful- everyone wants to know the meanings of its allegories. Proof of "American Pie's" truth lies in the allegory of the song. Many People enjoy the song but have no idea what it means- Who is the Jester? What is the levee? When the deeper story is found, the importance of the song is unearthed. "American Pie" is not only a song, it is an epic poem about the course of rock'n'roll...

Carl Orffs Philosophies In Music Education

While Carl Orff is a very seminal composer of the 20th century, his greatest success and influence has been in the field of Music Education. Born on July 10th in Munich, Germany in 1895, Orff refused to speak about his past almost as if he were ashamed of it. What we do know, however, is that Orff came from a Bavarian family who was very active in the German military. His father's regiment band would often play through some of the young Orff's first attempts at composing. Although Orff was adamant about the secrecy of his past, Moser's Musik Lexicon says that he studied in the Munich Academy of Music until 1914. Orff then served in the military in the first world war. After the war, he held various positions in the Mannheim and Darmstadt opera houses then returned home to Munich to further study music. In 1925, and for the rest of his life, Orff was the head of a department and co-founder of the Guenther School for gymnastics, music, and dance in Munich where he worked with musical beginners. This is where he developed his Music Education theories. In 1937, Orff's Carmina Burana premiered in Frankfurt, Germany. Needless to say, it was a great success. With the success of Carmina Burana, Orff orphaned all of his previous works except for Catulli Carmina and the En trata which were rewritten to be acceptable by Orff. One of Orff's most admired composers was Monteverdi. In fact, much of Orff's work was based on ancient material. Orff said: I am often asked why I nearly always select old material, fairy tales and legends for my stage works. I do not look upon them as old, but rather as valid material. The time element disappears, and only the spiritual power remains. My...

Johann Sebastian Bach Biography

Throughout the history of music, many great composers, theorists, and instrumentalists have left indelible marks and influences that people today look back on to admire and aspire to. No exception to this idiom is Johann Sebastian Bach, whose impact on music was unforgettable to say the least. People today look back to his writings and works to both learn and admire. He truly can be considered a music history great. Bach, who came from a family of over 53 musicians, was nothing short of a virtuosic instrumentalist as well as a masterful composer. Born in Eisenach, Germany, on March 21, 1685, he was the son of a masterful violinist, Johann Ambrosius Bach, who taught his son the basic skills for string playing. Along with this string playing, Bach began to play the organ which is the instrument he would later on be noted for in history. His instruction on the organ came from the player at Eisenach's most important church. He instructed the young boy rather rigorously until his skills surpassed anyone?s expectations for someone of such a young age. Bach suffered early trauma when his parents died in 1695. He went to go live with his older brother, Johann Christoph, who also was a professional organist at Ohrdruf. He continued his younger brother's education on that instrument, as well as introducing him to the harpsichord. The rigorous training on these instruments combined with Bach?s masterful skill paid off for him at an early age. After several years of studying with his older brother, he received a scholarship to study in Luneberg, Germany, which is located on the northern tip of the country. As a result, he left his brother?s tutelage and went to go and study there. The teenage years brought Bach to several parts of Germany where he...

Michelangelo

Michelangelo was pessimistic in his poetry and an optimist in his artwork. Michelangelo?s artwork consisted of paintings and sculptures that showed humanity in it?s natural state. Michelangelo?s poetry was pessimistic in his response to Strazzi even though he was complementing him. Michelangelo?s sculpture brought out his optimism. Michelangelo was optimistic in completing The Tomb of Pope Julius II and persevered through it?s many revisions trying to complete his vision. Sculpture was Michelangelo?s main goal and the love of his life. Since his art portrayed both optimism and pessimism, Michelangelo was in touch with his positive and negative sides, showing that he had a great and stable personality. Michelangelo?s artwork consisted of paintings and sculptures that showed humanity in it?s natural state. Michelangelo Buonarroti was called to Rome in 1505 by Pope Julius II to create for him a monumental tomb. We have no clear sense of what the tomb was to look like, since over the years it went through at least five conceptual revisions. The tomb was to have three levels; the bottom level was to have sculpted figures representing Victory and bond slaves. The second level was to have statues of Moses and Saint Paul as well as symbolic figures of the active and contemplative life- representative of the human striving for, and reception of, knowledge. The third level, it is assumed, was to have an effigy of the deceased pope. The tomb of Pope Julius II was never finished. What was finished of the tomb represents a twenty-year span of frustrating delays and revised schemes. Michelangelo had hardly begun work on the pope?s tomb when Julius commanded him to fresco the ceiling of the Sistine Chapel to complete the work done in the previous century under Sixtus IV. The overall organization consists of four large triangles at...

Oscar Wilde

Oscar Fingal O'Flahertie Wills Wilde was born in Dublin Ireland on October 16, 1854. He is one of the most talented and most controversial writers of his time. He was well known for his wit, flamboyance, and creative genius and with his little dramatic training showing his natural talent for stage and theatre. He is termed a martyr by some and may be the first true self-publicist and was known for his style of dress and odd behavior. Wilde, 1882 His Father, William Wilde, was a highly accredited doctor and his mother, Jane Francesca Elgee, was a writer of revolutionary poems. Oscar had a brother William Charles Kingsbury along with his father's three illegitimate children, Henry, Emily, and Mary. His sister, Isola Emily Francesca died in 1867 at only ten years of age from a sudden fever, greatly affecting Oscar and his family. He kept a lock of her hair in an envelope and later wrote the poem 'Requiescat' in her memory. Oscar and his brother William both attended the Protora Royal School at Enniskillen. He had little in common with the other children. He disliked games and took more interest in flowers and sunsets. He was extremely passionate about anything that had to do with ancient Greece and with Classics. Wilde during school years In 1871, he was awarded a Royal School Scholarship to Trinity College in Dublin and received many awards and earned the highest honor the college offered to an undergraduate, the Foundation Scholarship. In 1874, he also won the College's Berkley Gold Medal for Greek and was awarded a Demyship to Magdalen College, Oxford. After graduating from Oxford, Oscar moved to London with his friend Frank Miles, a well-known portrait painter of the time. In 1878 his poem Ravenna was published, for which he won the...

The History Of Greek Theater

Theater and drama in Ancient Greece took form in about 5th century BCE, with the Sopocles, the great writer of tragedy. In his plays and those of the same genre, heroes and the ideals of life were depicted and glorified. It was believed that man should live for honor and fame, his action was courageous and glorious and his life would climax in a great and noble death. Originally, the hero's recognition was created by selfish behaviors and little thought of service to others. As the Greeks grew toward city-states and colonization, it became the destiny and ambition of the hero to gain honor by serving his city. The second major characteristic of the early Greek world was the supernatural. The two worlds were not separate, as the gods lived in the same world as the men, and they interfered in the men's lives as they chose to. It was the gods who sent suffering and evil to men. In the plays of Sophocles, the gods brought about the hero's downfall because of a tragic flaw in the character of the hero. In Greek tragedy, suffering brought knowledge of worldly matters and of the individual. Aristotle attempted to explain how an audience could observe tragic events and still have a pleasurable experience. Aristotle, by searching the works of writers of Greek tragedy, Aeschulus, Euripides and Sophocles (whose Oedipus Rex he considered the finest of all Greek tragedies), arrived at his definition of tragedy. This explanation has a profound influence for more than twenty centuries on those writing tragedies, most significantly Shakespeare. Aristotle's analysis of tragedy began with a description of the effect such a work had on the audience as a "catharsis" or purging of the emotions. He decided that catharsis was the purging of two specific emotions, pity and...

Scholarship Essay About Goals

Ever since I was a young kid I have always been interested with aircraft. I was so curious of how airplane's fly. I remember taking my toys apart to see how it works. As a kid I wanted to go to the airport to watch the airplanes land and fly and pondered how this happens. Other kids wanted to go to the amusement places. As I grew older I became more and more interested in aircraft and the technology behind it. I always involved myself with aviation early on. I read books and magazines on aviation, took museum tours, built model airplanes. When I was younger my father would take me to aircraft repair facilities where I would watch in great fascination. In my teens, went up to the military bases and befriended many soldiers involved with aircraft and asked them numerous questions. I got to meet many aeronautics engineers and borrowed their old textbooks and read them till the wee hours of the morning. As technology improved with information superhighway, I logged on the web. Stayed up for hours and hours searching through web pages and web pages of information about aircraft and technology. I started my elementary school in the Philippines, then we moved to U.S. and continued my high school education and graduated. Enrolled at the CCSF to pursue my college education and now I am in the 2nd year in CCSF taking aeronautics. My goal now is to obtain my AS degree from the City College of San Francisco (CCSF) so I can transfer to a University and get a Bachelors degree and to continue for my Masters degree in Aeronautics Engineering. I will strive hard to reach the peak level of my career which is a Professor and hopefully to be an aeronautic professor so...

Circus Circus Enterprises Case Studies

Executive Summary: Circus Circus Enterprises is a leader and will continue to be in the gaming industry. In recent years, they have seen a decline in profit and revenue; management tends to blame the decrease on continuing disruptions from remodeling, expansion, and increased competition. Consequently, Circus has reported decreases in its net income for 1997 and 1998 and management believes this trend will continue as competition heightens. Currently the company is involved in several joint ventures, its brand of casino entertainment has traditionally catered to the low rollers and family vacationers through its theme park. Circus should continue to expand its existing operations into new market segments. This shift will allow them to attract the up scale gambler. Overview Circus Circus Enterprises, Inc founded in 1974 is in the business of entertainment, with its core strength in casino gambling. The company?s asset base, operating cash flow, profit margin, multiple markets and customers, rank it as one of the gaming industry leaders. Partners William G. Bennett an aggressive cost cutter and William N. Pennington purchased Circus Circus in 1974 as a small and unprofitable casino. It went public in 1983, from 1993 to 1997; the average return on capital invested was 16.5%. Circus Circus operates several properties in Las Vegas, Reno, Laughlin, and one in Mississippi, as well as 50% ownership in three other casinos and a theme park. On January 31,1998 Circus reported net income of 89.9 million and revenues of 1.35 billion, this is a down from 100 million on 1.3 billion in 1997. Management sees this decline in revenue due to the rapid and extensive expansion and the increased competition that Circus is facing. Well established in the casino gaming industry the corporation has its focus in the entertainment business and has particularly a popular theme resort concept....

Effect Of Civil War On American Economy

The Economies of the North and South, 1861-1865 In 1861, a great war in American history began. It was a civil war between the north and south that was by no means civil. This war would have great repercussions upon the economy of this country and the states within it. The American Civil War began with secession, creating a divided union of sorts, and sparked an incredibly cataclysmic four years. Although the actual war began with secession, this was not the only driving force. The economy of the Southern states, the Confederacy, greatly if not entirely depended on the institution of slavery. The Confederacy was heavily reliant on agriculture, and they used the profits made from the sale of such raw materials to purchase finished goods to use and enjoy. Their major export was cotton, which thrived on the warm river deltas and could easily be shipped to major ocean ports from towns on the Mississippi and numerous river cities. Slavery was a key part of this, as slaves were the ones who harvested and planted the cotton. Being such an enormous unpaid work force, the profits made were extraordinarily high and the price for the unfinished goods drastically low in comparison; especially since he invention of the cotton gin in 1793 which made the work all that much easier and quicker. In contrast, the economical structure of the Northern states, the Union, was vastly dependent on industry. Slavery did not exist in most of the Union, as there was no demand for it due to the type of industrial development taking place. As the Union had a paid work force, the profits made were lower and the cost of the finished manufactured item higher. In turn, the Union used the profits and purchased raw materials to use. This cycle...

Evaluation Of The Effectiveness Of Trade Embargoes

Although I am a strong critic of the use and effectiveness of economic sanctions, such as trade embargoes, for the sake of this assignment, I will present both their theoretical advantages and their disadvantages based upon my research. Trade embargoes and blockades have traditionally been used to entice nations to alter their behavior or to punish them for certain behavior. The intentions behind these policies are generally noble, at least on the surface. However, these policies can have side effects. For example, FDR's blockade of raw materials against the Japanese in Manchuria in the 1930s arguably led to the bombing of Pearl Harbor, which resulted in U.S. involvement in World War II. The decades-long embargo against Cuba not only did not lead to the topple of the communist regime there, but may have strengthened Castro's hold on the island and has created animosity toward the United States in Latin America and much suffering by the people of Cuba. Various studies have concluded that embargoes and other economic sanctions generally have not been effective from a utilitarian or policy perspective, yet these policies continue. Evaluation of the effectiveness of Trade Embargoes Strengths Trade embargoes and other sanctions can give the sender government the appearance of taking strong measures in response to a given situation without resorting to violence. Sanctions can be imposed in conjunction with other measures to achieve conflict prevention and mitigation goals. Sanctions may be ineffective: goals may be too elusive, the means too gentle, or cooperation from other countries insufficient. It is usually difficult to determine whether embargoes were an effective deterrent against future misdeeds: embargoes may contribute to a successful outcome, but can rarely achieve ambitious objectives alone. Some regimes are highly resistant to external pressures to reform. At the same time, trade sanctions may narrow the...