CARPAL TUNNEL SYNDROME
The carpal tunnel is a narrow, fibrous passage in the wrist that protects the median nerve, which runs down the length of arm and through the wrist into the hand. It controls some hand movement, and sensation in the thumb, index and middle fingers, and half of the ring finger. Irritation or compression of the median nerve within the carpal tunnel can cause tingling and numbness in the fingers, a condition known as carpal tunnel syndrome (CTS).
Symptoms of Carpal Tunnel Syndrome
CTS develops gradually, usually beginning as an ache in the wrist that extends up the forearm or down into the hand. As CTS worsens, there may be tingling or numbness in the fingers, or pain radiating through the entire arm. Some people also experience weakness in the hand and arm, and have difficulty grasping small objects. These symptoms are usually most severe when a person first wakes up.
Although most people associate carpal tunnel syndrome with pain and tingling in the fingers, it should be noted that the "pinky" finger is not affected. Anyone experiencing symptoms in the pinky may be suffering from another condition.
Risk Factors for Carpal Tunnel Syndrome
In most cases, the causes of CTS remain unknown. In some instances, CTS is the result of genetic predisposition, with some people having atypically small carpal tunnels, making the median nerve more susceptible to irritation. Whether CTS is caused by repetitive motions such as using a computer mouse has not been proven conclusively. Risk factors for CTS include the following:
- Inflammatory conditions (such as arthritis)
- Fluid retention
- Thyroid disorders
- Kidney failure
- Use of oral contraceptives
Symptoms can be triggered by any pressure placed on the median nerve.
Diagnosis of Carpal Tunnel Syndrome
Carpal tunnel is usually diagnosed through a complete medical history and physical examination. Diagnostic tests such as an electromyogram, which records the electrical activity of nerves and muscles, may be performed.
Treatment of Carpal Tunnel Syndrome
Often, CTS can be effectively treated by avoiding or modifying the activity that is causing symptoms. Additional treatments may include the following:
- Resting the hands
- Applying cold packs
- Taking anti-inflammatory medication
- Getting corticosteroid injections
- Wearing splints
- Getting physical therapy
More severe cases of CTS, such as those that interfere with normal daily activities or are caused by nerve damage, may be treated surgically by cutting the ligament that is pressing on the median nerve. Either endoscopy or open surgery can be used. Postsurgery, activities known to have caused CTS should be stopped, or performed differently.
Cervical radiculopathy refers to pain that radiates into the shoulder and arm as a result of injury to a nerve root in the cervical spine (neck). An injured nerve can send pain signals throughout the area into which it extends. Sometimes known as a "pinched nerve," cervical radiculopathy can be the result of a herniated disc, a bone spur, an injury to the spine, or osteoarthritis.
Causes of Cervical Radiculopathy
Cervical radiculopathy often results from pressure placed on spinal nerves by either a herniated disc or bone spur. A herniated disc can develop when too much force is exerted on an otherwise healthy intervertebral disc; bone spurs develop when cartilage deteriorates and bones begin rubbing against each other. Bone spurs can cause a narrowing of the spinal canal, which can place pressure on a nearby nerve.
Additional causes of cervical radiculopathy include the following:
- Degenerative diseases such as arthritis
- Conditions that cause changes in bones
- Traumatic injury
Although aging can cause disc changes that result in cervical radiculopathy, not everyone with aged, worn discs is affected.
Symptoms of Cervical Radiculopathy
Cervical radiculopathy can result in pain that radiates down one or both arms, or into the shoulders. Certain movements, such as extending the neck or turning the head, pull on the affected area, and can worsen the pain. Additional symptoms of cervical radiculopathy include the following:
- Muscle weakness in the arm, neck, chest, upper back or shoulders
- Tingling sensations down to the hands
A lack of coordination, particularly in the hands, can also be a symptom of cervical radiculopathy.
Diagnosis of Cervical Radiculopathy
In order to diagnose cervical radiculopathy, a complete medical history is taken and a physical examination conducted. The exam typically includes an evaluation of the patient's strength, reflexes and sensation of feeling.
To ensure the most accurate diagnosis, several diagnostic tests may also be performed. These tests may include X-rays to view spinal alignment and discs; a CT scan to obtain detailed views of the spinal bones; and an electromyogram to examine electrical activity along the nerve.
MRI scans are the most commonly performed tests used to evaluate spinal conditions, because they offer clear visualization of the abnormal areas of soft tissue around the spine. In many cases, MRI scans are the only test needed to determine the cause of neck pain. Unlike other imaging tests, MRI scans use magnetic fields and radio waves to view the structures of the neck. MRI scans also enable a thorough examination of the nerves and discs without using any dyes or needles.
Treatment of Cervical Radiculopathy
Cervical radiculopathy is generally first treated with conservative measures. Treatment plans may include a combination of medications, including anti-inflammatory drugs and oral corticosteroids, to help reduce pain and swelling. Steroid injections in the spine can be very effective for decreasing swelling, allowing for healing to take place. In severe cases, stronger prescription pain medications may be necessary.
Physical therapy can help strengthen the muscles in the problem area, maximize flexibility with stretching exercises and take some pressure off the injured nerve roots. Cervical radiculopathy patients may also need to wear a soft collar around the neck to limit the range of motion in the neck and rest the muscles.
If conservative measures fail to provide a patient with relief, or symptoms are worsening, surgery is often required. There are several types of procedures used to correct cervical radiculopathy. Anterior cervical discectomy and fusion (ACDF) is the most common surgery to treat cervical radiculopathy; it restores alignment of the spine and reduces compression on the nerves. Posterior cervical laminoforaminotomy is another procedure used to alleviate symptoms; it removes portions of the spinal bones that are compressing the nerve roots. Artificial disc replacement (ADR) is performed to remove the worn disc, relieve pressure on the nerves and restore height between the vertebrae.