Carpal Tunnel Syndrome

Carpal tunnel syndrome refers to a condition resulting from a pressed or impinged median nerve, an anatomical structure that is located from the forearm to the hand. As a result, the individual may experience pain, weakness and loss of sensation along the area supplied by the median nerve. ^[1]

Epidemiology

One to three cases per 1000 people are recorded annually in the US. There is female predilection with female to male ratio of 3-10:1. Affected individuals have ages that range from 45 up to 60 years old. ^[2]

Causes

Conditions that apply pressure to the nerve can be a factor to develop the disease. Among these are obesity, pregnancy, trauma, tumor, hyperactivity of the pituitary gland, diabetes mellitus, rheumatoid arthritis, hypothyroidsm and menopause. ^{[3] [4]}
Females are more affected and the condition is more frequent among workers doing assembly job such as those involved in crafting and manufacturing. ^[4]

Signs and Symptoms

Symptoms often develop in a gradual manner. Patients report tingling sensation, itchiness, pain, numbness, weakness and temperature changes in the hands. The manifestations are more observed at night. There can be diminished strength in gripping objects and loss of precision due to changes in sensation leading to clumsiness in performing motor activities. Atrophy or wasting of the muscles in the hand area may also be apparent. ^{[2] [4] [5]}

Diagnosis

History is important. During the physical examination, the physician conducts specific tests to diagnose carpal tunnel syndrome like Tinel’s and Phalen’s test. ^[1] Ancillary tests include imaging studies such as MRI and ultrasound. ^{[2] [3]}

Treatment

Initial treatments are rest and immobilization using a splint along with the determination and addressing of the underlying cause. ^[3] Analgesics may be given for pain and diuretics may be prescribed for swelling. Corticosteroids and vitamin B6 or pyridoxine may also be given to help alleviate symptoms. Patients whose CTS are caused by increased BMI may benefit from exercise and weight loss programs. A surgical intervention termed carpal tunnel release may be suggested for those who have symptoms for about half a year or those who cannot be managed conservatively. This can be done thru an open release surgery or thru endoscopic surgery. ^{[2] [4]}

References:

1. http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm
2. http://emedicine.medscape.com/article/327330-overview#a0199
3. http://www.medicinenet.com/carpal_tunnel_syndrome/article.htm
4. http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm
5. http://www.mayoclinic.com/health/carpal-tunnel-syndrome/DS00326

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Bromelain (Sulphydryl Proteolytic Enzyme, Ananas Comosus):

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present.

Recommendation: no recommendation (Available evidence shows mixed results to claims that Bromelain helps to treat carpal tunnel syndrome)

Grade of Evidence: low quality of evidence

Acupuncture:

Recommendation: weakly in favor (available evidence suggests that acupuncture may help to relieve the symproms of Carpal Tunnel Syndrome)

Grade of Evidence: very low quality of evidence

* www.gradeworkinggroup.org