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$Unique_ID{BRK03570}
$Pretitle{}
$Title{Carpal Tunnel Syndrome}
$Subject{Carpal Tunnel Syndrome CTS Thenar Amyotrophy of Carpal Origin Median
Neuritis Median Neuropathy Constrictive Median Neuropathy Thoracic Outlet
Syndrome Cervical Degenerative Disc Disease Pronator quadratus syndrome
Anterior Interosseous Nerve Syndrome Peripheral Neuropathy Ulnar Nerve Palsy
Radial Nerve Palsy Peripheral Neuropathy}
$Volume{}
$Log{}
Copyright (C) 1987, 1990 National Organization for Rare Disorders, Inc.
391:
Carpal Tunnel Syndrome
** IMPORTANT **
It is possible the main title of the article (Carpal Tunnel Syndrome) is
not the name you expected. Please check the SYNONYMS listing on the next
page to find alternate names, disorder subdivisions, and related disorders
covered by this article.
Synonyms
CTS
Thenar Amyotrophy of Carpal Origin
Median Neuritis
Median Neuropathy
Constrictive Median Neuropathy
Information on the following diseases can be found in the Related
Disorders section of this report:
Thoracic Outlet Syndrome
Cervical Degenerative Disc Disease
Pronator quadratus syndrome
Anterior Interosseous Nerve Syndrome
Peripheral Neuropathy
Ulnar Nerve Palsy
Radial Nerve Palsy
Peripheral Neuropathy
General Discussion
** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only. It should not be used for diagnostic or treatment
purposes. If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.
Carpal Tunnel Syndrome (CTS) is a condition caused by compression of
peripheral nerves affecting one or both hands. It is characterized by a
sensation of numbness, tingling, burning and/or pain in the hand and wrist.
Persons affected by this disorder may be awakened at night with the feeling
that the hand has "gone to sleep". Strain or injury involving the hand and
wrist, or various other disorders may cause CTS. The disorder can appear as
a symptom of various other diseases or may occur as a single primary
condition. With timely treatment, the prognosis in most cases is favorable.
Symptoms
Major symptoms of Carpal Tunnel Syndrome (CTS) include a sensation of
numbness, tingling, burning and/or slight pain in the hand and wrist. This
sensation can be temporary at first, later becoming chronic. It can cause
patients to awaken during the night. Left untreated, muscle atrophy in the
hand may develop. All of the fingers may not be affected. Weakness or
clumsiness in gripping objects may occur if the thumb is involved. Symptoms
may become worse with activities that require wrist flexion or prolonged
gripping such as driving for long periods of time.
Causes
A rare genetic type of Carpal Tunnel Syndrome (CTS) was found to be inherited
through male to male transmission according to a 1979 study. Symptoms of
this form of CTS may be linked to a deficiency of Vitamin B-6, but it is very
rare.
The non-hereditary type of Carpal Tunnel Syndrome is very prevalent and
its causes are varied. Any stress or injury that narrows the carpal canal in
the wrist can put pressure on the median nerve leading to the hand. Wrist
fractures or dislocations can cause bone spurs or thickenings. Occupational
requirements of prolonged gripping or wrist flexion can increase the risk of
CTS (e.g., carpenter, typist, meat cutter, etc.).
Sports-related causes of median nerve compression may involve a wide
range of symptoms including wrist tendon inflammation, narrowing (stenosis)
of the carpal canal and incomplete or partial wrist dislocation with possible
displacement of blood vessels. Additionally, inborn muscle, bone, nerve or
blood vessel abnormalities may combine with overexertion or injury to cause
CTS. Tumors of the wrist are extremely rare but may cause Carpal Tunnel
Syndrome (CTS).
CTS has been described as a symptom of Amyloid Neuropathy, the
Mucopolysaccharidoses (MPS Disorders), and the Mucolipidoses (ML Disorders).
(For more information on these disorders, choose "Amyloidosis," MPS Disorders
and ML Disorders as your search terms in the Rare Disease Database).
Inflammatory disorders such as Rheumatoid Arthritis or Gout (a hereditary
form of arthritis usually affecting a single joint) can cause swelling in the
wrist thus putting pressure on the median nerve. Acromegaly (characterized
by enlargement of bones in the extremities) may cause CTS if the wrist is
affected. Other disorders that can cause the syndrome include myxedema
(swelling with dry, waxy skin) or Diabetes. Pregnancy may also trigger the
onset of some cases of this disorder.
For more information on the above disorders, see the Arthritis section of
the Prevalent Health Conditions/Concerns area of NORD Services, and choose
"acromegaly" and "diabetes" as your search terms in the Rare Disease
Database.)
Affected Population
Carpal Tunnel Syndrome (CTS) occurs five times more frequently in females
(usually between forty and sixty years of age) than males. A hereditary form
of CTS occurs mostly in males and usually begins during the second decade of
life. However, children can also get CTS.
Related Disorders
Peripheral Neuropathy is a term encompassing disorders with sensory, motor,
reflex and blood vessel (vasomotor) disorders including Carpal Tunnel
Syndrome. (For more information on this disorder, choose Peripheral
Neuropathy as your search term in the Rare Disease Database).
The following disorders have similar symptoms to Carpal Tunnel Syndrome
(CTS). Comparisons may be useful for a differential diagnosis:
Ulnar Nerve Palsy is characterized by compression and entrapment of a
nerve in the elbow caused by injury. Pain, prickling and burning sensations
or numbness in the fourth and fifth fingers, plus weakness and wasting of the
thumb and surrounding muscles are symptoms of this disorder. Severe chronic
ulnar palsy may produce a "claw-hand" deformity.
Radial Nerve Palsy, also known as "Saturday night palsy", is a nerve
compression and entrapment disturbance caused by pressure on the nerve by the
upper arm bone (humerus). This can occur when the arm is draped over the
back of a chair for long periods of time such as deep sleep. Symptoms may
include weakness of the wrist and hand and numbness particularly of the first
two fingers.
Anterior Interosseous Nerve Syndrome is characterized by pain in the
forearm with weakness and loss of dexterity in the hand. The disorder can be
caused by injuries or strenuous exercise. Pain is a major symptom, numbness
usually does not occur. Some muscle changes may develop in time.
Pronator quadratus syndrome is another median nerve compression syndrome
that must be differentiated from Carpal Tunnel Syndrome. Pain in the forearm
and palm characterizes this syndrome. Strenuous exercise often increases the
pain. A tingling sensation may be felt when pressure is applied to the
affected area. This disorder occurs less frequently than Carpal Tunnel
Syndrome (CTS).
Cervical Degenerative Disc Disease is characterized by a "slipped disc"
(acute herniated cervical discs). This disorder may also cause pain and
numbness in the hand. With neck area (cervical) discs, the onset of symptoms
are usually abrupt. Nerve root compression can cause gradual loss of
reflexes. X-rays can be useful to identify the spinal disc involvement.
Thoracic Outlet Syndrome can also cause pain and numbness in the hand and
arm. This compression syndrome can occur in conjunction with compression of
the brachial plexus nerves as they pass over the first rib and between the
muscles in the shoulder region. Symptoms of this disorder affect the side of
the forearm closest to the body and the side of the hand opposite the thumb
(ulnar).
Therapies: Standard
Treatment for Carpal Tunnel Syndrome (CTS) varies according to severity and
persistence of symptoms. Mild symptoms with no muscle atrophy may be treated
using steroidal and nonsteroidal medications. Splinting to immobilize the
wrist is recommended. Corticosteroid drugs also may be injected into the
carpal tunnel. However, great care must be taken not to inject the steroid
into the nerve.
If symptoms are severe, if conservative measures fail, or if there is
significant muscle weakness, surgical decompression of the carpal canal can
be performed. If pressure on the median nerve has persisted for a prolonged
period of time, recovery may be incomplete. In Carpal Tunnel Syndrome (CTS),
an electromyogram (EMG) to test nerve conduction velocities should be
performed before surgery. This test can increase success rates by ruling out
other nerve compression conditions.
Therapies: Investigational
This disease entry is based upon medical information available through April
1990. Since NORD's resources are limited, it is not possible to keep every
entry in the Rare Disease Database completely current and accurate. Please
check with the agencies listed in the Resources section for the most current
information about this disorder.
Resources
For more information on Carpal Tunnel Syndrome, please contact:
National Organization for Rare Disorders (NORD)
P.O. Box 8923
New Fairfield, CT 06812-1783
(203) 746-6518
American Carpal Tunnel Syndrome Association
P.O. Box 514
Santa Rosa, CA 95402-0514
(517) 792-1337
NIH/National Institute of Neurological Disorders & Stroke (NINDS)
9000 Rockville Pike
Bethesda, MD 20892
(301) 496-5751
(800) 352-9424
References
CARPAL TUNNEL SYNDROME: D.M. Ditmars, et al.; Hand Clin (August 1986, issue
2(3)). Pp. 525-532.
SPORTS-RELATED EXTRAARTICULAR WRIST SYNDROMES: M.B. Wood, et al.; Clin
Orthop (January 1986, issue 202). Pp. 93-102.
ACUTE CARPAL TUNNEL SYNDROME. COMPLICATIONS OF DELAYED DECOMPRESSION:
D.J. Ford, et al.; J Bone Joint Surg [Br] (November 1986, issue 68(5)). Pp.
758-759.