Carpal Tunnel Syndrome is a medical condition, where there is pressure on the median nerve within the carpal tunnel – a median nerve entrapment at the wrist. This gives rise to a number of symptoms that are the same as those triggered by several underlying conditions as well as those caused by problems in the musculoskeletal structure of the forearm and shoulder. The difficulty is identifying the real cause of the carpal tunnel symptoms.
WHAT IS CARPAL TUNNEL SYNDROME ?
According to the medical profession Carpal Tunnel Syndrome (CTS) is the name conventionally given to the medical condition where the median nerve is compressed at the point where the nerve passes through the wrist to the hand.
The carpal tunnel is a narrow passageway, on the palm (anterior) side of the wrist, made up of bones and connective tissue. There is a fibrous but rigid ligament over this. This is the Transverse Carpal Ligament, sometimes called the flexor retinaculum or anterior annular ligament. This arches over the carpal bones as a cover.
This is the carpal tunnel. The wrist itself is made up of two joints: the radial carpal joint and the midcarpal joint. Ten bones are involved. These are the distal radius and distal ulna, plus 8 other carpal (wrist) bones). These carpal (wrist) bones are arranged in 2 rows with 4 bones in each row. So, that’s the structure of your wrist.
The Carpal Tunnel itself serves as a pathway or channel to the palm for nine flexor tendons; these pass through the carpal tunnel along with the median nerve. The tendons and the median nerve are each about as wide as a pencil; the tunnel itself is a little over an inch wide. The tunnel is only just big enough to hold the nerve and the tendons. So it’s pretty tight in there.
Any problem with the nerves is described as a neuropathy. In the technical language of the American Academy of Orthopedic Surgeons, Carpal Tunnel Syndrome is therefore described as a compression neuropathy of the median nerve at the wrist. It is also described as a median nerve entrapment.
Lack of information, uncertainty and confusion:
Carpal Tunnel Syndrome has become a familiar topic with health professionals. It affects around 1 in 25 of the population so it is by no means unusual. Even so, it remains a puzzling condition.
Despite the large amount of published research on the subject, most of the research papers tend to be concerned with surgical techniques. There is little published research on causes.
Indeed, there is still a degree of uncertainty – and even controversy – amongst the medical community about the actual causes of carpal tunnel syndrome. Too little is known about the underlying predispositions and the factors that trigger the onset of the symptoms that we are all too familiar with.
This uncertainty is reflected in the description often used for Carpal Tunnel Syndrome: an idiopathic condition. This description is used to describe a medical condition, where the normal functioning of the body breaks down …. but no-one knows precisely why.
The result of all this is that there is only a superficial level of knowledge about this condition amongst healthcare professionals.
3 stages in the development of Carpal Tunnel Syndrome.
Stage 1: waking during the night with an annoying tingling in the fingers. There may also be numbness in the hand together with an ache in the muscles of the forearm. There is wrist pain and occasional bursts of pain in the forearm, when undertaking certain manual tasks.
Stage 2: the symptoms become present during the day after the wrist is in the same position for a long time or when the hand performs repetitive movements for a long period of time. Especially if there is any pressure on the wrist – or it is being used at an angle. At this stage there is a lack of feeling in the fingers, which leads on to a weakness in the grip: objects are not gripped properly enough and fall from the hand.
Stage 3: at this third stage, there is constant hand and wrist pain together with an ache in the forearm. Some wasting (atropy) may start to appear at the base of the thumb.
Some people will talk in general terms about pain or fatigue in other areas: writer’s cramp, shoulder pain, neck pain etc. In some instances, people find that symptoms only occur when carrying out rigorous activity: all of these could still be caused by Carpal Tunnel Syndrome.
Do I have Carpal Tunnel Syndrome …. or is it something else?
Problems of diagnosis:
The difficulty is that the symptoms described above can be caused by a number medical conditions. Some of these symptoms may be triggered by existing underlying conditions; others may reflect musculoskeletal problems in the forearm, shoulder or neck. Pressure on a nerve can occur anywhere along the nerve pathway; the brain has no way of telling where that pressure occurs.
The problems therefore start to arise when trying to distinguish between true Carpal Tunnel Syndrome and the various conditions that produce symptoms that mimic Carpal Tunnel Syndrome.
Lack of any real knowledge:
The whole situation is complicated by lack of any detailed knowledge amongst the medical profession and healthcare workers about this medical condition. A significant degree of confusion therefore exists amongst the healthcare profession about what the symptoms that are normally associated with Carpal Tunnel Syndrome actually indicate. It is all too easy to jump to the conclusion that it is Carpal Tunnel Syndrome.
Quite simply, the symptoms may not be associated with problems in the wrist (in the carpal tunnel) at all. They may be the result of problems elsewhere in the body – in the forearm, the shoulder and even in the neck.
There have been many occasions, when a patient’s condition has been described as Carpal Tunnel Syndrome, has been diagnosed as Carpal Tunnel Syndrome and the patient has shown all the signs of suffering from Carpal Tunnel Syndrome …. and yet the condition has had nothing to do with the carpal tunnel; the problems exist elswhere.
This uncertainty and controversy extends not only to the criteria used to diagnose the condition but also to the outcomes of various treatments and the appropriate strategies for intervention and prevention.