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Monday, June 6, 2011

Painful Hand of Carpal Tunnel Syndrome

Posted by Prahallad Panda on 6:46 AM Comments

Objects drop from hand, inability to clinch a fist firmly, painful hand, and reduced muscle mass mainly in the outer side of palm; could be from carpal tunnel syndrome.
There are 8 bones in the wrist, arranged in a semicircular manner in two rows. Various ligaments attach the edges together to form several tunnels. The tendons, blood vessels and nerves pass to the palm through these tunnels. Median nerve   responsible for gross movement of hand passes through the largest tunnel and ulnar nerve passes in a separate tunnel.
Image Source,Photobucket Uploader Firefox ExtensionSometimes median nerve and at times ulnar get compressed in this tunnel giving rise to painful neuralgia, weakness in the muscles supplied by them; muscle wasting in the same groups; consequently weakening the grip of hand.
There may be  loss of sensation to varied extent in the thumb, index, middle finger and half of ring finger; and sensory blunting to pin-prick; if median nerve is compressed. If ulnar nerve is involved, though rarely; the rest of ring finger and little finger are affected. Female patients outnumber males in this disease.

Many diseases may cause this syndrome; important are;
  • occupation involving long term work with vibrating instruments like drillers;
  • fracture of radial bone with bad healing,
  • myxedema of hypothyroid,
  • pressure on wrist from mouse of comuter and 
  • spontaneous compression from fascia of the tunnel. 
  • It is also common in pregnancy.
Various clinical tests have been described. Electro-physiological study for nerve conduction, ultrasonogram and magnetic resonance imaging are helpful to figure out site of compression. Thyroid profile may be done, if hypothyroidism is suspected.
A conservative treatment involving local steroid injection, use of brace and treatment of hypothyroid if present; relieve the symptoms in a number of cases. If not, decompression surgery has to be conducted, which relieves the symptoms.
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