Carpal Tunnel Syndrome Do you often feel numbness or tingling in your hand, especially at night? Maybe you experience clumsiness in handling objects. Or sometimes you feel a pain that goes up your arm to your shoulder. If so, you may have symptoms of carpal tunnel syndrome.
The carpal tunnel is a narrow tunnel formed by the bones and other tissues of the wrist through which the nerves, ligaments and tendons extend to the hand. Carpal tunnel syndrome is a disorder that results in numbness of the fingers, disturbing sleep and can be related to neck pain and many medical conditions. It is most common in middle-aged females. Although symptoms can be aggravated by repetitive hand use, there is no evidence that carpal tunnel syndrome is caused by repetitive motion such as typing.
If carpal tunnel syndrome is suspected, an orthopaedic specialist can examine the wrist for movement restrictions and pain. A nerve conduction velocity test or electromyography also will be conducted.
To relieve symptoms, a doctor may prescribe conservative treatment, such as wearing a wrist brace or splint, resting the injured hand, modifying the work environment, and taking an anti-inflammatory medication or aspirin to reduce the swelling. If these do not alleviate the problem, surgical options are considered.
Brachial Plexus Injuries
The brachial plexus is the collection of nerves near the shoulder that control muscles in the shoulders, arm or hand. Adult traumatic brachial plexus injuries most often occur with forceful traction on the arm or shoulder – particularly in motor vehicle or sports accidents.
The injury can cause paralysis and numbness of the arm, shoulder, elbow and hand. The weakness may resolve in less severe cases, but surgery may be required. Methods include:
Neurolysis to free the nerve from scar
Nerve graft to replace scarred nerve segments
Nerve transfer to resupply a paralyzed muscle or tendon transfers to substitute for paralyzed muscles
Brachial plexus palsy is another injury that typically occurs on a baby during childbirth. The condition can be caused by excessive traction on the shoulders during a delivery (head first) or on the raised arms during a breech delivery (feet first). Most children or infants are treated non-operatively.
Ulnar Nerve Compression The ulnar nerve starts at the side of the neck and joins three main nerves that travel down the arm to the hand. As it crosses the wrist, the ulnar nerve and artery run through the tunnel known as Guyon's canal. After passing through the canal, the ulnar nerve branches out to supply feeling to the little finger and half the ring finger, as well as the small muscles of the hand.
Cubital tunnel syndrome, which is compression at the elbow, is the most common nerve compression affecting the ulnar nerve. The condition results in numbness in the ring and little fingers. This syndrome is often confused with carpal tunnel syndrome. The condition also causes weakness and atrophy of the intrinsic hand muscles, and can be confused with compression of the ulnar nerve fibers at the neck level.
Treatment is avoidance of pressure on the nerve at the elbow and avoidance of extreme elbow flexing. If there is denervation, surgery to relieve the compression may be necessary.
