Is It Really Carpal Tunnel?

Carpal Tunnel Syndrome is a condition caused by compression of the median nerve at the carpal ligaments of the wrist. When the median nerve becomes entrapped common symptoms can include pain, numbness, or tingling in the thumb, index, and middle fingers.  Weakness can also be present which can make it difficult to perform certain tasks such as sewing or even writing.  Carpal Tunnel Syndrome is the most studied form of median nerve entrapment which has made it at times, a default of exclusion.  The fact is, the median nerve can be entrapped at many other locations along the arm, from the wrist all the way to the neck.  The neck, shoulder, elbow, forearm, and wrist are all included.  Other peripheral nerves affecting the upper extremity can also present with similar symptoms.  The superficial branch for of the radial nerve, for instance, can cause numbness in the thumb side of the hand.  In about 20% of the population there is a communicating branch between the ulnar and median nerve branch which can cause false positive symptoms.  This is know as Martin-Gruber Anastomosis.  These two examples illustrate the importance of a proper diagnosis.

The major causes of nerve entrapment are scar tissue or adhesions between the nerve and soft tissues and inflammation.  Both are usually brought on by repetitive stress and injury.  The process can be explained as either the space becomes too small (due to scar tissue) or the nerve becomes too big (inflammation).  In most cases, both are at fault and the goal of treatment is to combat both of these.  The restrictions caused by scarring must be released and anti-inflammatory measure must be taken.

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