Sarcasta.net - Carpal Tunnel Syndrome

NEW! 8-13-06

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Carpal Tunnel Syndrome (CTS)

CTS is a compression neuropathy, i.e. a pinching of the median nerve within the wrist. The carpal tunnel is a bony canal on the palm side of the wrist, allowing for passage of the median nerve to the hand. Pinching or compression of this nerve by the transverse carpal ligament [fig.1] sets into motion a progressively crippling disorder which eventually results in wrist pain, numbness and tingling in the hand, pain consisting of a "pins and needles" feeling at night, weakness in grip and a feeling of incoordination.

[fig.1] Compression of the nerve by the transverse carpal ligament.

This disabling syndrome used to occur more often in women than men, by a ratio of 3 to 1, usually between the ages of 30 and 50 years. However, young geek male programmers are popping up all over with the same wrist problems typically associated with middle-aged secretaries. Also, CTS is seen more frequently in people who tend to do forceful repetitive types of work, such as grocery store checkers, assembly line workers, meat packers, typist, accountants, writers, super-cool DJ skratchers, etc. Most patients generally visit their doctor with these complaints, and the diagnosis is confirmed after physical examination and appropriate nerve testing.

The transverse carpal ligament can be irratated by repetetive motion (such as typing), continued stress by vibration (such as from a lawnmower or continued use of a"marital aid") and hormonal changes during pregnancy (such as the craving for New York Triple Fudge ice cream). When the ligament becomes irritated, it starts to twich from side to side. This motion, commonly referred to as "fish out of water" is the beginning of nerve compression. The median nerve is the only nerve that passes through the carpal tunnel, providing the sensation of feeling to the thumb, index and middle fingers and half of the ring finger. It also controls the working of some of the thumb muscles that permit you to pinch. When compressed by the movements of the transverse carpal ligament, the nerve loses its ability to transmit data to the hand.

Treatment for CTS depends upon the stage of the disease. Much as a shark must keep swimming or it will die, the pain from carpal tunnel syndrome can be significantly reduced if the transverse carpal ligament is kept still by putting the wrist in a splint. Although anecdotal evidence indicating the use of a splint is plentiful, the splints tend to be unattractive and make the wearer look like an even bigger geek than they were before. However, medical testing has proven that some geeks benefit from the increased attention they receive when wearing a splint.

[fig.2] A Gyotaku of the transverse carpal ligament.

In moderate stages of the disorder, especially if the numbness and pain continues in the wrist and hand, a morphine injection into the wrist can be extremely beneficial. This injection delivers a powerful sedative directly to the transverse carpal ligament, thereby inducing stupor and a cessation of the "fish out of water" movement.

Surgical intervention in CTS is only indicated in those patients in whom non-operative treatment has failed to eliminate their symptoms. In patients with advanced disease, and especially in those who have profound weakness or muscle atrophy, surgical intervention should be done early. Surgeons will divide the transverse carpal ligament into "head" and "tail" sections, thereby eliminating any chance of the ligament thrashing around. In rare cases, the ligament is removed entrely, providing medical researchers the opportunity to document their "catch" by using an old Japanese technique called Gyotaku, or "fish print" [fig.2].