Carpal tunnel syndrome
CTS) is a condition that affects the hand and the wrist. It can result from injury to the wrist - dislocated or broken wrist bones or sprains. Carpal Tunnel Syndrome can also be caused by diabetes, rheumatoid arthritis or thyroid disease. Those who are at increased risk are computer users, violinists, golfers, meat packers, assembly line workers, hair stylists and mechanics since they perform the same hand movements repeatedly.
The median nerve controls some of the muscles that move the thumb. It also provides sensations of temperature, pain and touch from the hand to the brain as well as sweating of the hand. CTS results when the tunnel walls are compressed, thereby putting pressure on the nerve. Carpal tunnel syndrome is particularly associated with tasks that involve:
Repeated wrist movement
Awkward hand positions
Strong gripping
Stress on the palm
Use of vibrating tools
Lubrication is essential for the normal and smooth functioning of the tendons. With excessive or repetitive activity on the carpal tunnel, the lubrication system may malfunction. It may not produce enough fluid or it may produce a fluid with poor lubricating qualities. This failure creates friction between the tendon and its sheath causing inflammation and swelling of the tendon area.
The swelling squeezes the median nerve in the wrist or carpal tunnel. Repeated episodes of inflammation cause fibrous tissue to form. The fibrous tissue thickens the tendon sheath and hinders tendon movement. This makes moving of the wrist or the hand painful.
Symptoms of this condition usually start gradually - frequent burning, tingling, pins and needles or itching and numbness in the palm of the hand and the fingers especially the thumb and the index and middle fingers. In time, these symptoms can spread to the arm and shoulder. They tend to worsen at night or first thing in the morning since many people sleep with flexed wrists.
Carpal tunnel syndrome can affect one or both hands and the severity of the symptoms can vary. The hand muscles may become weakened, making it difficult to grip objects. It can also result in permanent loss of feeling. Fine finger movements, such as writing, may become increasingly difficult. In extreme cases patients might feel tingling during the day and the muscles at the base of the thumb may waste away. In some chronic cases people are unable to tell between hot and cold by touch.
Carpal tunnel exercises should be done by individuals who perform hand-intensive jobs. These exercises should be performed at the start of each workday and during a break. It reduces the amount of pressure on the median nerve in the carpal tunnel and prevents injury. A few important exercises for avoiding the carpal tunnel syndrome are discussed below:
- The most important thing to do is to get up from your desk and move around every 1/2 hour
- Extend and stretch both wrists and fingers acutely as if they are in a handstand position
- Straighten both wrists and relax fingers
- Make a tight fist with both hands and bend both wrists down.
- Take your arms out to the sides with the palms facing down. Extend your fingers and stretch through the elbows. On exhaling, rotate your shoulders back and bring the palms facing up.
Electromyography
Electromyography or EMG is a diagnostic test that understands the physiological of muscles thereby assessing their health. Electromyography involves inserting a needle electrode through the skin into the muscle. This electorde detects electrical activity in the muscles and nerves controlling the muscles. A patient is asked to flex or contract the muscles so that the response of the muscle to the nerve stimuli is observed. An electromyograph is used to detect and measure electric potential that is generated by the contracting muscles. Other indicators to the proper functioning of the muscles and their corresponding nerves are the size, duration and frequency of electric signals received from them. EMG is often conducted along with a nerve conduction velocity test.
The EMG test is used to diagnose any possible weakness or impaired muscle strength due to neurological problems. Some discorders that can lead to abnormal readings on EMG test are cervical spondylosis, myasthenia gravis, carpal tunnel syndrome, myopathy, Brachial plexopathy, Guillain Barre syndrome, sciatic nerve dysfunction and mononueritis multiplex. EMG test aids in differentiating between a muscle and nerve disorder. The muscle may feel tender after the EMG test with localised bruising.
Smiths fracture
In the US, about 17% of the emergency room visits are due to wrist injuries. Injury of the forearm bone near the wrist joint is known as Smith's fracture. Smith's fracture is a fracture of the distal radius occurring about 2.5 cm from the wrist joint. The fracture is the result from a backward fall onto the outstretched hand. It was the orthopedic surgeon Robert William Smith who described this fracture in his book 'A treatise on fractures in the vicinity of joints, and on certain forms of accidents and congenital dislocations' published in 1847. This fracture is named after him. Smith's fracture is often described as a garden-spade deformity.
Hands perform so many tasks that are fundamental and delicate. Therefore even a minor injury to the hand and wrist can have devastating consequences. Smith's fracture is unstable as the ulnar head can be displaced dorsally and therefore requires urgent attention. The hand and the wrist are so dependent on each other. Therefore when an injury occurs, it affects both the hand and wrist. Smith's fracture are classified as:
Type I: Most stable, extra articular transverse distal radial fracture with palmar and proximal displacement.
Type II: Barton type, palmar-lip fracture of the distal radius with dislocation of the carpus
Type III: Unstable, oblique juxta articular fracture of the distal radius and tilted palmar.
- A Smith's fracture is most commonly caused by people falling onto hard surface and breaking their fall with flexed wrists.
- Smith's fracture most commonly occurs in older post- menopausal women exhibiting osteoporosis.
- Smith's fracture occurs in adolescent boys and girls with joint surface displacement.
- Smith's fracture can be considered as a sports injury
Common complications from Smith's fracture:
- Ulnar nerve injury
- Carpal tunnel syndrome
- Post traumatic radio carpal osteoarthritis with limited range of motion
- Heterotopic ossification
- Reflex sympathetic dystrophy
- Tendon rupture
- Nonunion
- Radial shortening
Treatment for Smith's fracture depends much upon the severity of the fracture and other factors such as connective tissue injuries, musculoskeletal structure and neuroanatomy, and dislocations involved. If the fracture is an undisplaced fracture, then it can be treated simply with a 'cast' alone. Nevertheless, casting needs close watch so as to ensure that the fracture stays in proper position.
Bibliography / Reference
| 