CARPAL TUNNEL SYNDROME 2 Abstract This article discusses the definition of carpal tunnel syndrome, the anatomy of the arm,and treatment of carpal tunnel syndrome. The anatomy discussed is skeletal, muscular, and abrief mention of the brachial plexus and median nerves. It includes images from A&P revealed3.0. I also go over prevention and carpal tunnel release surgery.
CARPAL TUNNEL SYNDROME 3 Carpal Tunnel Syndrome What is Carpal Tunnel Syndrome?Carpal Tunnel Syndrome affects the median nerveof the brachial plexus as it runs through the carpal tunnel in the wrist. The inflammation of thenerve and pressure on it by the transverse carpal ligament can cause pain, weakness, ornumbness in the thumb and the first three fingers of the affected hand. Advanced cases of carpaltunnel syndrome can cause atrophy of the muscles of the thumb. The condition occurs withrepeated trauma to wrists from repetitive movements (flexion) of the wrist(A.D.A.M, 2011). Anatomy: The brachial plexuses are the anterior branches of the lower four cervicalnerves and the first thoracic nerve (Shier, Butler, & Lewis, 2010). This plexus is deep within theshoulders between the neck and armpits. The median nerve supplies the muscles of the forearms,and the skin of the hands with movement and sensation. Pictured below is the brachialplexus(APrevealed Version 3.0, 2011).
CARPAL TUNNEL SYNDROME 4 A picture of the median nerve below, notice how it supplies feeling to the thumb and firstthree fingers of the hand(APrevealed Version 3.0, 2011). The upper arm is attached at the pectoral girdle comprised of the scapula and clavicle thatarticulate with the Humerus to form the upper arm. The Humerus articulates distally with theradius and ulna, forming a hinge joint. The radius and ulna then articulate distally with eightcarpal bones, in two rows of four bones each. It is through these carpal bones that the carpaltunnel carries the median nerve through to innervate the muscles of the hand. Also travelingthrough this tunnel is the transverse carpal ligament, and all the associated blood vesselsincluding arteries and veins. The lowest row of the carpal bones articulate with the metacarpalbones of the hand, of which there are five. These metacarpals make up the palm of your hand.The metacarpals articulate distally with the phalanges, there are proximal, median, and distalphalanges for each finger except the thumb. In the thumb there are distal and proximal
CARPAL TUNNEL SYNDROME 5phalanges. It is important to note that the carpal tunnel is just that, a tunnel that runs through thecarpal bones of the wrist. This tunnel is very narrow, so any swelling of the tissue there putspressure on the median nerve (APrevealed Version 3.0, 2011). The muscles of the arm include the coracobrachialis, pectoralis major which flexthe arm. The Teres major and Latissimus dorsi muscles make up the extensor muscles thatextend the arm. The abductor muscles are the Supraspinatus and Deltoid muscles that abduct thearm and Subscapularis, Infraspinatus, and Teres minor muscles that rotate the arm. The muscles of the forearm include: Biceps brachii, brachialis, and brachioradialis thatare responsible for flexing the forearm. The Triceps brachii is responsible for extending theforearm. Finally the Supinator, pronator teres, and pronator quadratus muscles rotate the forearm. The muscles of the hand include the flexors: flexor carpi radialis, flexor carpi ulanaris,palmarislongus, and flexordigitorumsuperficialis. The extensors are comprised of: extensor carpi
CARPAL TUNNEL SYNDROME 6radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris, and extensor digitorium.The muscles of the hand move the wrist and the fingers and are most impacted by carpal tunnelsyndrome. Causes of Carpal Tunnel Syndrome: As mentioned earlier repetitive motions can causetrauma to the carpal tunnel inside the wrist. Repetitive flexing of the wrist can occur from typing,computer work, painting, massage work, using improperly sized hand tools, and bad posturewhen doing office work. Symptoms and Diagnosisof Carpal Tunnel Syndrome: Pain or numbness in the thumband first three fingers of the hand, particularly when bending or flexing the wrist. The pain ornumbness seems to worsen at night. With prolonged cases atrophy of the muscles in the thumbcan be seen. Your doctor will do a series of tests to determine if you have carpal tunnelsyndrome. He will flex your wrist for 60 seconds and then check for numbness or pain this isreferred to as Phalen’s sign. He or she may also tap on the median nerve in the forearm; if thisproduces pain then this is referred to as Tinel’s sign. Other diagnostic tests such as nerveconduction or electromyography may also be ordered to determine the extent of the damage tothe median nerve. X-rays may be done to rule out arthritis, or a fracture. Treatment Options: The patient will be given a splint to rest the wrist and preventfurther trauma for several weeks. This is to relieve the pressure on the median nerve. You mayalso be given anti-inflammatories such as ibuprofen, or Aleve. Your doctor may also give you acorticosteroid injection to ease pain. You may have to change the way you do work, to avoidfurther damage. You may need to change your work environment, with furniture or specializedtools to avoid straining your wrist and aggravating your symptoms. Proper posture when typingfor example can help greatly. You may also need to do physical therapy and take regular short
CARPAL TUNNEL SYNDROME 7breaks to stretch your wrists and fingers when doing prolonged repetitive tasks such as typing.As a final resort your doctor may suggest Carpal Tunnel release surgery. Carpal Tunnel Release: In carpal tunnel release surgery a small incision is made in thepalm of the hand near the wrist. This allows the surgeon to access the carpal tunnel and cut someof the traverse carpal ligament to relieve pressure on the median nerve. Sometimes other tissuemay be removed to make more room. The incision is then sutured closed and kept dry until it ishealed. During this time you may have to do finger exercises to increase circulation to the site(F.A. Davis Company [F.A. Davis], 2005, p. 349). Once pressure from the nerve is released, thenerve should stop hurting depending on how long it has been pressed upon. This should enablethe nerve to function normally as it once did, restoring feeling and movement; however ifdamagehas been prolonged, and then the damage may be permanent. With permanent damage the patientmay have pain or weakness in the affected hand permanently. Prevention: Always check your posture when sitting or working. Improper posture cancause additional strain on your joints including your wrists. Try to take regular breaks whendoing activities that cause you to bend and flex your wrists repeatedly, such as typing orgripping. Try stretching your arms, hands and fingers to improve blood flow. Use ergonomicoffice furniture and computer supplies to lessen strain. Make sure your furniture including yourkeyboard and monitor is adjusted for your height and comfort. Eat a nutritious diet, and getplenty of exercise to improve your flexibility, and strength. Finally make sure hand tools arebeing used properly and are sized for your hand to avoid stressing the wrist.
CARPAL TUNNEL SYNDROME 8 ReferencesA.D.A.M (2011).Carpal Tunnel Syndrome.In D. Zieve, & D. R. Eltz (Eds.), U.S. National Libarary of Medicine (Loc. para 1 - 11). Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001469/Anatomy & Physiology Revealed 3.0 (Version 3.0) [Computer software]. (2011). Retrieved from http://www.mhhe.com/sem/apr3/David, S., Jackie, B., & Lewis, R. (2010).Hole’s Human Anatomy & Physiology (12 ed.). New York, NY: McGraw-Hill.F.A. Davis Company. (2005). Carpal tunnel syndrome. In D. Venes, A. Bidderman, E. Adler, B. G. Fenton, & A. D. Enright (Eds.), Taber’s Cyclopedic Medical Dictionary (20, pp. 348 - 349). Philadelphia, PA: F.A. Davis Company.