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Ailmemts & Remedies

Repetitive strain injury(RSI)

Alternative Names:Repetitive stress injury, Repetitive motion injuries, Repetitive motion disorder (RMD), Cumulative trauma disorder (CT), Occupational overuse syndrome, Overuse syndrome, Regional musculoskeletal disorder

Definition:

Repetitive strain injury (RSI)  is an injury of the musculoskeletal and nervous systems that may be caused by repetitive tasks, forceful exertions, vibrations, mechanical compression (pressing against hard surfaces), or sustained or awkward positions.

The term “repetitive strain injury” is most commonly used to refer to patients in whom there is no discrete, objective, pathophysiology that corresponds with the pain complaints. It may also be used as an umbrella term incorporating other discrete diagnoses that have (intuitively but often without proof) been associated with activity-related arm pain such as carpal tunnel syndrome, cubital tunnel syndrome, thoracic outlet syndrome, DeQuervain’s syndrome, stenosing tenosynovitis/trigger finger/thumb, intersection syndrome, golfer’s elbow (medial epicondylosis), tennis elbow (lateral epicondylosis), and focal dystonia.

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Finally RSI is also used as an alternative or an umbrella term for other non-specific illnesses or general terms defined in part by unverifiable pathology such as reflex sympathetic dystrophy syndrome (RSDS), Blackberry thumb, disputed thoracic outlet syndrome, radial tunnel syndrome, “gamer’s thumb” (a slight swelling of the thumb caused by excessive use of a gamepad), “Rubik’s wrist” or “cuber’s thumb” (tendinitis, carpal tunnel syndrome, or other ailments associated with repetitive use of a Rubik’s Cube for speedcubing), “stylus finger” (swelling of the hand caused by repetitive use of mobile devices and mobile device testing.), “raver’s wrist”, caused by repeated rotation of the hands for many hours (for example while holding glow sticks during a rave).

Although tendinitis and tenosynovitis are discrete pathophysiological processes, one must be careful because they are also terms that doctors often use to refer to non-specific or medically unexplained pain, which they theorize may be caused by the aforementioned processes.

Doctors have also begun making a distinction between tendinitis and tendinosis in RSI injuries. There are significant differences in treatment between the two, for instance in the use of anti-inflammatory medicines, but they often present similar symptoms at first glance and so can easily be confused.

Types of RSIs that affect computer users may include non-specific arm pain or work related upper limb disorder (WRULD). Conditions such as RSI tend to be associated with both physical and psychosocial stressors.

Symptoms:

The following complaints are typical in patients who might receive a diagnosis of RSI:

*Short bursts of excruciating pain in the arm, back, shoulders, wrists, hands, or thumbs (typically diffuse – i.e. spread over many areas).

*The pain is worse with activity.

*Weakness, lack of endurance.

In contrast to carpal tunnel syndrome, the symptoms tend to be diffuse and non-anatomical, crossing the distribution of nerves, tendons, etc. They tend not to be characteristic of any discrete pathological condition.

1.The users experience constant pain in the hands, elbows, shoulders, neck, and the back. Other symptoms of Repetitive Stain Injury are cramps, tingling, and numbness in the hands. The hand movements of the user may become clumsy and the person may find it difficult even to fasten buttons.

2.Another variant of Repetitive Strain Injury is that, it may produce painful symptoms in the upper limbs, but the site may be difficult to locate.

3.The common diagnoses seen in Repetitive Strain Injury are Carpal Tunnel Syndrome, Tenosynovitis, Bursitis, White Limb, and Shoulder pain. A major cause is due to long unbroken periods of work. Ergonomics or the lack of it plays a very important role. Lack of information about the condition leads to neglect by the concerned individuals.

Frequency :A 2008 study showed that 68% of UK workers suffered from some sort of RSI, with the most common problem areas being the back, shoulders, wrists, and hands.

Physical examination and diagnostic testing; The physical examination discloses only tenderness and diminished performance on effort-based tests such as grip and pinch strength—no other objective abnormalities are present. Diagnostic tests (radiological, electrophysiological, etc.) are normal. In short, RSI is best understood as an apparently healthy arm that hurts. Whether there is currently undetectable damage remains to be established.

Causes:

RSI is believed by many to be caused due to lifestyle without ergonomic care,  E.g. While working in front of computers, driving, traveling etc. Simple reasons like ‘Using a blunt knife for everyday chopping of vegetables’, may cause RSI.

Repetitive Strain Injury occurs when the movable parts of the limbs are injured. Repetitive Strain Injury usually caused due to repetitive tasks, incorrect posture, stress and bad ergonomics. Repetitive Strain Injury generally causes numbness, tingling, weakness, stiffing, and swelling and even nerve damage. The chief complaint is the constant pain in the upper limbs, neck, shoulder and back.

The main cause of this main are the repetitive activities, forceful activities of arms and hand and awkward postures. The other causes of Repetitive Strain Injuries are sitting in a fixed posture and poor workplace ergonomics.

Other typical habits that some sources believe lead to RSI

*Reading or doing tasks for extended periods of time while looking down.

*Sleeping on an inadequate bed/mattress or sitting in a bad armchair and/or in an uncomfortable position.

*Carrying heavy items.

*Holding one’s phone between neck and shoulder.

*Watching TV in incorrect position e.g. Too much to the left/right.

*Sleeping with head forward, while traveling.

*Prolonged use of the hands, wrists, back, neck, etc.

*Sitting in the same position for a long period of time.

Diagnosis:

Repetitive task and stress affects the body parts causes RSI. An instance of this is using a screwdriver, if you keep using the screwdriver without a break, you feel your wrist become restricted and you feel pain and you may also experience the loss of movement. This is the initial stage of RSI.

RSI, or should we say the group of syndromes that make up repetitive strain injury only affects the back, neck and arms. A lot of people without even realizing may suffer with RSI.

You may have had pains in your wrists or arms that you explained as being tired if you are working on an assembly line or you’re an avid musician who can’t put their guitar down. These pains are more than likely the initial RSI symptoms.

Judging the Symptom:

The problem in diagnosing repetitive strain injury is the fact that is can be hard to judge the symptoms, after all RSI is just a name given to a group of different conditions that are all related in some way to the affects we attribute to RSI.

Not only do we have this issue, we also have the problem that some of the symptoms related with repetitive strain injury are found in other, more dangerous conditions such as angina.

Even though RSI only affects the upper torso and limbs, the symptoms can in fact appear in the lower half of the body; this is due to the vertebral nerves that can be affected in some cases so the pains appear in the legs.

Carpal Tunnel Syndrome:

Carpal tunnel syndrome is the most common out of all the syndromes that make up the condition called RSI.

Carpal tunnel syndrome is a condition that affects the median nerve situated in the carpal canal in the wrist, when the same movement is carried out frequently it can cause the tendons also situated in the carpal canal to become inflamed and compress the nerve causing pain and tightness causing loss of movement.

The most famous out of all the syndromes that make up repetitive stress injury is carpal tunnel syndrome because it affects a lot of people who spend long periods on the computer without supporting their wrists appropriately.

Other Conditions:

There are some conditions that the every day layman may be aware of golfers elbow, which is called medial epicondylitis, or like tennis elbow, which is officially called lateral epicondylitis.

You should visit your doctor if you suffer with pains, aches, stiffness, numbness or tingling sensations in your back, arms, wrists or hands. While RSI is not life threatening it can affect you more than you think.

Eventually without visiting a medical professional the symptoms can become ever worse, or you may even find the RSI could be something more risky. Learn more about ergonomics at safecomputingtips.com.

Treatment :
Most common and simple measure of treatment, which is more common sense than anything is painkillers and anti inflammatory pills, these are available over the counter at any good pharmacy.When taking painkillers and anti inflammatory pills it is important that you rest the affected area, just because the pain is not there it doesn’t mean the condition has instantly been resolved.Another simple measure is speaking to your employer, you may find they have guidelines to work towards that may mean you can get some support in alleviating your condition. This means your work place may be assessed and improvements implemented.You can get a simple support bandage from your local pharmacy to help add strength to the affected area, if it is your wrist or arm. You may need to purchase a special keyboard and/or mouse or get speech recognition software in order to prevent further irritation to your injury.Speech recognition software is a great alternative for those who suffer due to computer work, speech recognition software works by the software writing what you say for you.Your medical professional might possibly prescribe that you wear an orthopedic hand brace. You don’t want to wear one of these if your doctor doesn’t. it because it could lead to further injury.Therapy:Your doctor may prescribe physical therapy, a physical therapists role is to develop and maximize the movement of the body, and this can also include the provision of aids to alleviate symptoms.

Another prescribed therapy your doctor may request is occupational therapy, it may sound like occupational therapy and physical therapy are very similar but there are differences.

Occupational therapy helps develop and maintain the skills required to carry out all the general functions needed to live a comfortable life.

Occupational therapy includes assessing what a persons requirements are and supporting them with offering recommendations on adapting to their living or working space and offering simple exercises to regain movement.

Alternative Treatment:

Deep body massages have been reported to work wonders for those suffering with repetitive strain injury as it works deep into the body’s soft tissues like the muscles and tendons where the pain comes from.

Soft tissue therapy is a type of therapy that works by decompressing the area surrounding the RSI. This will increase your circulation and aid in healing. They may also try biofeedback. This is generally used to reduce tension in the muscles in your shoulders and neck.

Some people have reported that slow martial arts like Tai Chi can have a dramatic affect on their condition because they work on specific movements and improve strength and flexibility.

Surjury:

As a last resort, the medical professional might recommend to have surgery. one should keep in mind that it doesn’t always work and he or she  will be left without the use of one’s hand and arm for a long time. The above treatment methods have been proven to help heal even the worst types of RSI disorders when they are done correctly.

You may click to see the using of modern ergonomics in home office

Exercise:

Exercise decreases the risk of developing RSI.

*Doctors sometimes recommend that RSI sufferers engage in specific strengthening exercises, for example to improve posture.

*In light of the fact that a lifestyle that involves sitting at a computer for extended periods of time increases the probability that an individual will develop excessive kyphosis, theoretically the same exercises that are prescribed for thoracic outlet syndrome or kyphotic postural correction would benefit an RSI sufferer.

*Some sources[who?] recommend motoric exercises and ergo-aerobics to decrease chances of strain injury. Ergo-aerobics target touch typists and people who often use computer keyboard.

Resuming normal activities despite the pain:

Psychologists Tobias Lundgren and Joanne Dahl have asserted that, for the most difficult chronic RSI cases, the pain itself becomes less of a problem than the disruption to the patient’s life caused by

*avoidance of pain-causing activities

*the amount of time spent on treatment

They claim greater success from teaching patients psychological strategies for accepting the pain as an ongoing fact of life, enabling them to cautiously resume many day-to-day activities and focus on aspects of life other than RSI

Psychosocial factors:

Studies have related RSI and other upper extremity complaints with psychological and social factors. A large amount of psychological distress showed doubled risk of the reported pain, while job demands, poor support from colleagues, and work dissatisfaction also showed an increase in pain, even after short term exposure.

For example, the association of Carpal tunnel syndrome with arm use is commonly assumed but not well-established. Typing has long been thought to be the cause of carpal tunnel syndrome, but recent evidence suggests that, if anything, typing may be protective. Another study claimed that the primary risk factors for Carpal tunnel syndrome were “being a woman of menopausal age, obesity or lack of fitness, diabetes or having a family history of diabetes, osteoarthritis of the carpometacarpal joint of the thumb, smoking, and lifetime alcohol intake.
Prevention:
Risk of RSI can be reduced a lot by warming up and cooling down the muscles used, taking regular breaks throughout the day, having an appropriate workstation and seating position, and practising relaxation. If the job puts one  at risk of RSI he or she should seek out expert advice on prevention from your employer or professional body.

Repetitive Stress Injury symptoms when found, people should seek medical attention as early as possible. Measures that can be adopted to avoid Repetitive Stress Injury at an individual level include:
Position: The recommended position to sit in front of a computer is semi-reclined with the forearms resting in a cradle or on an extension of the keyboard support to prevent Repetitive Stress Injury.

There should be ample support for the back. The hands should be free and point in the direction of the forearms. The feet should rest on the ground or feet support. The distance of the monitor should be 18 inches or more and at a slightly lower level than the eye level. Using these measures Repetitive Stress Injury caused out of position can be avoided.

Hydration: The Repetitive Stress Injury can be prevented by drinking adequate fluids to keep the tendons and soft- tissues soft.

Shortcuts: Using keyboard shortcuts and less of mouse is the most effective preventive method to avoid Repetitive Stress Injury. Touch the ergonomic keyboard softly and do not pound at it. The wrist should rest on the table or wrist rest.

Telephone use: Don’t cradle the telephone between the face and shoulder while working, as this can lead to neck strain.

Messages: Don’t use the computer while conveying messages in person or through the intercom.

No games:One of the main Causes of Repetitive Stress Injury is Games. Games or surfing at work may increase stress on your hands. So games should be avoided.

Preventive Measures at the Organizational Level for Repetitive Stress injury :
Organizations that use computers in a big way can also adopt certain preventive measures for avoiding Repetitive Strain Injury to their employees. These include:

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1.You need to educate your employees on the importance of adopting a proper posture which is one of the main cause of Repetitive Stress Injury.
2.Ensure that all your employees are using quality ergonomic furniture that will save loss of working hours by guaranteeing full comfort of the employees.
3.Give periodic reminders through lectures and audio-visual presentations by medical professionals on the importance of taking good care of health while using computers and Repetitive Stress Injury.
4.Try to avoid computer as much as possible: use voicemail instead of sending e-mail. Go for a walk or watch a movie instead of playing video games. Its better go for a book instead of searching the Web. You are in the danger zone for Repetitve Stress Injury if you are using a computer for as little as two hours a day.
5.Adjust your workstation properly. Make sure your monitor is directly in front of you, with the top of the screen at eye level. Be sure your keyboard (Ergonomic Keyboard) and mouse (Ergonomic Mouse) are low enough to allow you to relax your shoulders.
6.Sit up straight. Make sure your chair supports your spine in an erect position as it is the one of the main causes of Repetitive Stress Injury.
7.Practice proper technique: never rest your wrists on the desk, wrist pad or armrests while you are typing or using a mouse or trackball.
8.Pace yourself. Take a 5-to-10 minute break every 20 minutes and limit your overall time at the computer.
9.Get regular cardiovascular exercise.
10.Do appropriate upper-body strengthening and stretching exercises.
11.Stretch frequently while at the computer.
12.Do not work at the computer or other hand-intensive activities if you are experiencing pain, fatigue or soreness.
13.Avoid using the mouse and trackball whenever possible. Use keystrokes instead for preventing Repetitive Stress Injury.
14.When symptoms of Repetitive Stress Injury are set in, consult an orthopedic surgeon. If you find of the symptoms of Repetitive Stress Injury mentioned above, do not make the diagnosis yourself. The diagnosis will be made from the history and clinical findings as there will be no changes in X-rays, since the soft tissues are involved.

Nerve conduction studies can confirm the diagnosis. In cases detected earlier, attention to ergonomics will restore normalcy.
In cases of Repetitive Stress Injury when diagnosed late, orthopedic treatment like injections and even minor surgery may be necessary.

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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Related articles

Resources:

English: Untreated Carpal Tunnel Syndrome
Image via Wikipedia

http://en.wikipedia.org/wiki/Repetitive_strain_injury
http://www.safecomputingtips.com/rsi-diagnosis.html
http://www.bbc.co.uk/health/physical_health/conditions/repetitivestrain1.shtml
http://www.rsiwarrior.com/ergonomics.html
http://www.hoverstop.com/eng/rsi.php

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Carpal Tunnel Syndrome

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Heavy computer use can lead to compression of the nerves in the carpal tunnel

Everyone worries about his or her health. Today, cancers and heart attacks are commonplace and randomly strike friends and relatives. Anyone who suddenly develops a tingling, shooting pain radiating down the left arm, severe enough to wake up the person in the night, cannot be blamed for thinking it is a heart attack!

But such symptoms are typical of carpal tunnel syndrome, a condition common during middle age.

The carpal tunnel is actually a narrow, rigid box-like area in the wrist which forms a passageway for the ligaments and nerves at the base of the hand. If the nerves are compressed as they pass through this canal, they respond to the pressure with pain, a tingling sensation and numbness. Sleeping with the wrist in a flexed position aggravates the problem and the sufferer often wakes up at night with a numbing pain in the arm that needs to be shaken for relief. If this occurs on the left side, it can be mistaken for a heart attack.

Eventually, as the compression progresses, the tingling decreases but is replaced by weakness of the fingers and obvious wasting of the thumb muscles. Grasping small objects, making a fist and distinguishing between hot and cold may be difficult.

Compression of the nerves in the carpal tunnel may occur as a result of :

A fracture or sprain of the wrist which disrupts the normal relationship between the various structures in that area

Repetitive stress injury as a result of continual movement of the wrist. People working as butchers, fishermen and tailors are particularly susceptible. Heavy computer use or typing for seven hours or more a day is also implicated

Diseases like diabetes and hypothyroidism (it may be the first symptom)

Fluid retention as a result of kidney or liver disease

Obesity and pregnancy

The symptoms are three times commoner in women than in men. This is because women have smaller carpal tunnels than men. However, the carpal tunnel syndrome is not seen in children even though their wrists are small as the structures are more pliable.

The diagnosis is made on the basis of the symptoms. The tingling sensation can be reproduced by tapping on the carpal tunnel area. The symptoms are aggravated if this is done with the wrist in a flexed position. If the diagnosis is uncertain then nerve conduction studies can be done.

Permanent damage to the entrapped median nerve can occur if the compression is not relieved sufficiently early.

Treatment involves the following :

Diagnosis and correction of any underlying metabolic disorders such as diabetes and hypothyroidism

Using a splint to maintain the wrist in a neutral position for two weeks

Using wrist supports while typing. Some computer keyboards are designed to prevent the carpal tunnel syndrome

Medications, especially the NSAID group (non-steroidal anti-inflammatory agents), can relieve pain and swelling. But they should be used only on a short-term basis

Vitamins, particularly pyridoxine (B6), can bring temporary relief.

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Injections — usually a combination of a steroid and local anaesthetic — can be given into the carpal tunnel

Surgery, open or laparoscopic, can be done to remove any compression from bands of bone or tissue. This is done if there is no improvement after six months of conservative treatment.

Physiotherapy provides sustained long-term relief without invasive procedures or medications. The exercises are simple and not time-consuming. Accrued benefit disappears within three days if the exercises are not continued.

Straighten the wrists and relax the fingers

Make tight fists with both hands

Bend the wrists down while keeping the fists. Hold for a count of five

Straighten the wrists and relax the fingers, again for a count of five

The exercise should be repeated 10 times. Finally, let your arms hang loosely at the sides and shake them for a few seconds. Many alternative treatments like acupuncture and massage have been tried. Studies, however, have not shown any proven benefits. Regular practice of yoga provides sustained and long-term relief.

In India, there is usually no compensation for work-related incapacitating injuries. Workers have to maintain their health to remain efficient and productive. Occupational carpal tunnel syndrome can be prevented by —

Providing frequent breaks to workers

Teaching them corrective exercises and stretching

Designing furniture ergonomically for the workplace so that the hands are kept in a natural position.

Unfortunately, even among the educated, blue-collar workers, regular exercise and prevention of injures is not taken very seriously until it is too late.

Click to Learn more about Carpal Tunnel Syndrome…………..(1).………….(2)

Carpal Tunnel Syndrome Guide
Carpal Tunnel Syndrome Remedies – Natural Pain Relief – Alternative ……(2).…..(3)

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Source:The Telegraph (Kolkata, India)

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Carpal Tunnel Syndrome

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Definition:
Carpal tunnel syndrome (CTS) is a median entrapment neuropathy that causes paresthesia, pain, numbness, and other symptoms in the distribution of the median nerve due to its compression at the wrist in the carpal tunnel. The mechanism is not completely understood but can be considered compression of the median nerve traveling through the carpal tunnel.  It appears to be caused by a combination of genetic and environmental factors. Some of the predisposing factors include: diabetes, obesity, pregnancy, hypothyroidism, and heavy manual work or work with vibrating tools. There is, however, little clinical data to prove that lighter, repetitive tasks can cause carpal tunnel syndrome. Other disorders such as bursitis and tendinitis have been associated with repeated motions performed in the course of normal work or other activities. Though considered a condition of modern times, carpal tunnel syndrome has actually been recognized since the 1880s…...CLICK & SEE

The carpal tunnel is an anatomical compartment located at the base of the palm. Nine flexor tendons and the median nerve pass through the carpal tunnel that is surrounded on three sides by the carpal bones that form an arch. The median nerve provides feeling or sensation to the thumb, index finger, long finger, and half of the ring finger. At the level of the wrist, the median nerve supplies the muscles at the base of the thumb that allow it to abduct, or move away from the fingers, out of the plane of the palm. The carpal tunnel is located at the middle third of the base of the palm, bounded by the bony prominence of the scaphoid tubercle and trapezium at the base of the thumb, and the hamate hook that can be palpated along the axis of the ring finger. The proximal boundary is the distal wrist skin crease, and the distal boundary is approximated by a line known as Kaplan’s cardinal line. This line uses surface landmarks, and is drawn between the apex of the skin fold between the thumb and index finger to the palpated hamate hook. The median nerve can be compressed by a decrease in the size of the canal, an increase in the size of the contents (such as the swelling of lubrication tissue around the flexor tendons), or both. Simply flexing the wrist to 90 degrees will decrease the size of the canal.

Compression of the median nerve as it runs deep to the transverse carpal ligament (TCL) causes atrophy of the thenar eminence, weakness of the flexor pollicis brevis, opponens pollicis, abductor pollicis brevis, as well as sensory loss in the digits supplied by the median nerve. The superficial sensory branch of the median nerve, which provides sensation to the base of the palm, branches proximal to the TCL and travels superficial to it. Thus, this branch spared in carpal tunnel syndrome, and there is no loss of palmar sensatio.

Symptoms
Numbness or tingling in the thumb and the first three fingers.
Shooting pains in the wrist and forearm, which may radiate into the shoulder and neck.
Weakness in the hand; difficulty picking up and holding objects.
Feeling that the fingers are swollen when no swelling is visible.

The main symptom of CTS is intermittent numbness of the thumb, index, long and radial half of the ring finger. The numbness often occurs at night, with the hypothesis that the wrists are held flexed during sleep. Recent literature suggests that sleep positioning, such as sleeping on one’s side, might be an associated factor. It can be relieved by wearing a wrist splint that prevents flexion. Long-standing CTS leads to permanent nerve damage with constant numbness, atrophy of some of the muscles of the thenar eminence, and weakness of palmar abduction (see carpometacarpal joint §?Movements).

People with CTS experience numbness, tingling, or burning sensations in the thumb and fingers, in particular the index, middle fingers, and radial half of the ring fingers, which are innervated by the median nerve. Less-specific symptoms may include pain in the wrists or hands and loss of grip strength (both of which are more characteristic of painful conditions such as arthritis).

Some suggest that median nerve symptoms can arise from compression at the level of the thoracic outlet or the area where the median nerve passes between the two heads of the pronator teres in the forearm, but this is debatable. This line of thinking is an attempt to explain pain and other symptoms not characteristic of carpal tunnel syndrome. Carpal tunnel syndrome is a common diagnosis with an objective, reliable, verifiable pathophysiology, whereas thoracic outlet syndrome and pronator syndrome are defined by a lack of verifiable pathophysiology and are usually applied in the context of nonspecific upper extremity pain.

Numbness and paresthesias in the median nerve distribution are the hallmark neuropathic symptoms (NS) of carpal tunnel entrapment syndrome. Weakness and atrophy of the thenar muscles may occur if the condition remains untreated

Pain in carpal tunnel syndrome is primarily numbness that is so intense that it wakes one from sleep. Pain in electrophysiologically verified CTS is associated with misinterpretation of nociception and depression.
Causes:
Most cases of CTS are of unknown causes, or idiopathic. Carpal tunnel syndrome can be associated with any condition that causes pressure on the median nerve at the wrist. Some common conditions that can lead to CTS include obesity, oral contraceptives, hypothyroidism, arthritis, diabetes, prediabetes (impaired glucose tolerance), and trauma. Carpal tunnel is also a feature of a form of Charcot-Marie-Tooth syndrome type 1 called hereditary neuropathy with liability to pressure palsies.

Other causes of this condition include intrinsic factors that exert pressure within the tunnel, and extrinsic factors (pressure exerted from outside the tunnel), which include benign tumors such as lipomas, ganglion, and vascular malformation. Carpal tunnel syndrome often is a symptom of transthyretin amyloidosis-associated polyneuropathy and prior carpal tunnel syndrome surgery is very common in individuals who later present with transthyretin amyloid-associated cardiomyopathy, suggesting that transthyretin amyloid deposition may cause carpal tunnel syndrome.

The median nerve can usually move up to 9.6 mm to allow the wrist to flex, and to a lesser extent during extension. Long-term compression of the median nerve can inhibit nerve gliding, which may lead to injury and scarring. When scarring occurs, the nerve will adhere to the tissue around it and become locked into a fixed position, so that less movement is apparent.

Normal pressure of the carpal tunnel has been defined as a range of 2–10 mm, and wrist flexion increases this pressure 8-fold, while extension increases it 10-fold. Repetitive flexion and extension in the wrist significantly increase the fluid pressure in the tunnel through thickening of the synovial tissue that lines the tendons within the carpal tunnel.

Work related:...click & see
The international debate regarding the relationship between CTS and repetitive motion in work is ongoing. The Occupational Safety and Health Administration (OSHA) has adopted rules and regulations regarding cumulative trauma disorders. Occupational risk factors of repetitive tasks, force, posture, and vibration have been cited. The relationship between work and CTS is controversial; in many locations, workers diagnosed with carpal tunnel syndrome are entitled to time off and compensation.

Some speculate that carpal tunnel syndrome is provoked by repetitive movement and manipulating activities and that the exposure can be cumulative. It has also been stated that symptoms are commonly exacerbated by forceful and repetitive use of the hand and wrists in industrial occupations, but it is unclear as to whether this refers to pain (which may not be due to carpal tunnel syndrome) or the more typical numbness symptoms.

A review of available scientific data by the National Institute for Occupational Safety and Health (NIOSH) indicated that job tasks that involve highly repetitive manual acts or specific wrist postures were associated with incidents of CTS, but causation was not established, and the distinction from work-related arm pains that are not carpal tunnel syndrome was not clear. It has been proposed that repetitive use of the arm can affect the biomechanics of the upper limb or cause damage to tissues. It has also been proposed that postural and spinal assessment along with ergonomic assessments should be included in the overall determination of the condition. Addressing these factors has been found to improve comfort in some studies. A 2010 survey by NIOSH showed that 2/3 of the 5 million carpal tunnel cases in the US that year were related to work. Women have more work-related carpal tunnel syndrome than men.

Speculation that CTS is work-related is based on claims such as CTS being found mostly in the working adult population, though evidence is lacking for this. For instance, in one recent representative series of a consecutive experience, most patients were older and not working. Based on the claimed increased incidence in the workplace, arm use is implicated, but the weight of evidence suggests that this is an inherent, genetic, slowly but inevitably progressive idiopathic peripheral mononeuropathy.

Other Associated conditions:
A variety of patient factors can lead to CTS, including heredity, size of the carpal tunnel, associated local and systematic diseases, and certain habits. Non-traumatic causes generally happen over a period of time, and are not triggered by one certain event. Many of these factors are manifestations of physiologic aging.
Examples include:

*Rheumatoid arthritis and other diseases that cause inflammation of the flexor tendons.
*With hypothyroidism, generalized myxedema causes deposition of mucopolysaccharides within both the perineurium of the median nerve, as well as the tendons passing through the carpal tunnel.
*During pregnancy women experience CTS due to hormonal changes (high progesterone levels) and water retention (which swells the synovium), which are common during pregnancy.
*Previous injuries including fractures of the wrist.
*Medical disorders that lead to fluid retention or are associated with inflammation such as: inflammatory arthritis, Colles’ fracture, amyloidosis, hypothyroidism, diabetes mellitus, acromegaly, and use of corticosteroids and estrogens.
*Carpal tunnel syndrome is also associated with repetitive activities of the hand and wrist, in particular with a combination of forceful and repetitive activities
*Acromegaly causes excessive growth hormones. This causes the soft tissues and bones around the carpel tunnel to grow and compress the median nerve.
*Tumors (usually benign), such as a ganglion or a lipoma, can protrude into the carpal tunnel, reducing the amount of space. This is exceedingly rare (less than 1%).
*Obesity also increases the risk of CTS: individuals classified as obese (BMI > 29) are 2.5 times more likely than slender individuals (BMI < 20) to be diagnosed with CTS.
*Double-crush syndrome is a debated hypothesis that compression or irritation of nerve branches contributing to the median nerve in the neck, or anywhere above the wrist, increases sensitivity of the nerve to compression in the wrist. There is little evidence, however, that this syndrome really exists.
*Heterozygous mutations in the gene SH3TC2, associated with Charcot-Marie-Tooth, confer susceptibility to neuropathy, including the carpal tunnel syndrome

Diagnosis:
There is no consensus reference standard for the diagnosis of carpal tunnel syndrome. A combination of described symptoms, clinical findings, and electrophysiological testing is used by a majority of hand surgeons. Numbness in the distribution of the median nerve, nocturnal symptoms, thenar muscle weakness/atrophy, positive Tinel’s sign at the carpal tunnel, and abnormal sensory testing such as two-point discrimination have been standardized as clinical diagnostic criteria by consensus panels of experts. A predominance of pain rather than numbness is unlikely to be caused by carpal tunnel syndrome no matter what the result of electrophysiological testing.

Electrodiagnostic testing (electromyography and nerve conduction velocity) can objectively verify the median nerve dysfunction. Normal nerve conduction studies, however, do not exclude the diagnosis of CTS: waiting for nerve tests to become positive may well prejudice the eventual duration and completeness of recovery, particularly of the thenar motor branch is involved.

Clinical assessment by history taking and physical examination can support a diagnosis of CTS.

Phalen’s maneuver is performed by flexing the wrist gently as far as possible, then holding this position and awaiting symptoms.  A positive test is one that results in numbness in the median nerve distribution when holding the wrist in acute flexion position within 60 seconds. The quicker the numbness starts, the more advanced the condition. Phalen’s sign is defined as pain and/or paresthesias in the median-innervated fingers with one minute of wrist flexion. Only this test has been shown to correlate with CTS severity when studied prospectively.

Tinel’s sign, a classic — though less sensitive – test is a way to detect irritated nerves. Tinel’s is performed by lightly tapping the skin over the flexor retinaculum to elicit a sensation of tingling or “pins and needles” in the nerve distribution. Tinel’s sign (pain and/or paresthesias of the median-innervated fingers with percussion over the median nerve) is less sensitive, but slightly more specific than Phalen’s sign.

Durkan test, carpal compression test, or applying firm pressure to the palm over the nerve for up to 30 seconds to elicit symptoms has also been proposed.
Hand elevation test The hand elevation test has higher sensitivity and specificity than Tinel’s test, Phalen’s test, and carpal compression test. Chi-square statistical analysis confirms the hand elevation test is not ineffective compared with Tinel’s test, Phalen’s test, and carpal compression test.

As a note, a patient with true carpal tunnel syndrome (entrapment of the median nerve within the carpal tunnel) will not have any sensory loss over the thenar eminence (bulge of muscles in the palm of hand and at the base of the thumb). This is because the palmar branch of the median nerve, which innervates that area of the palm, branches off of the median nerve and passes over the carpal tunnel. This feature of the median nerve can help separate carpal tunnel syndrome from thoracic outlet syndrome, or pronator teres syndrome.

Other conditions may also be misdiagnosed as carpal tunnel syndrome. Thus, if history and physical examination suggest CTS, patients will sometimes be tested electrodiagnostically with nerve conduction studies and electromyography. The goal of electrodiagnostic testing is to compare the speed of conduction in the median nerve with conduction in other nerves supplying the hand. When the median nerve is compressed, as in CTS, it will conduct more slowly than normal and more slowly than other nerves. There are many electrodiagnostic tests used to make a diagnosis of CTS, but the most sensitive, specific, and reliable test is the Combined Sensory Index (also known as Robinson index). Electrodiagnosis rests upon demonstrating impaired median nerve conduction across the carpal tunnel in context of normal conduction elsewhere. Compression results in damage to the myelin sheath and manifests as delayed latencies and slowed conduction velocities However, normal electrodiagnostic studies do not preclude the presence of carpal tunnel syndrome, as a threshold of nerve injury must be reached before study results become abnormal and cut-off values for abnormality are variable. Carpal tunnel syndrome with normal electrodiagnostic tests is very, very mild at worst.

The role of MRI or ultrasound imaging in the diagnosis of carpal tunnel syndrome is not very clear.

Differential diagnosis:
Carpal tunnel syndrome is sometimes applied as a label to anyone with pain, numbness, swelling, and/or burning in the radial side of the hands and/or wrists. When pain is the primary symptom, carpal tunnel syndrome is unlikely to be the source of the symptoms. As a whole, the medical community is not currently embracing or accepting trigger point theories due to lack of scientific evidence supporting their effectiveness.

Treatment:
Conservative treatments include use of night splints and corticosteroid injection. The only scientifically established disease modifying treatment is surgery to cut the transverse carpal ligament.
Generally accepted treatments include: physiotherapy, steroids either orally or injected locally, splinting, and surgical release of the transverse carpal ligament. There is no or insufficient evidence for ultrasound, yoga, lasers, B6, and exercise therapy.

The American Academy of Orthopedic Surgeons recommends proceeding conservatively with a course of nonsurgical therapies tried before release surgery is considered. Early surgery with carpal tunnel release is indicated where there is evidence of median nerve denervation or a person elects to proceed directly to surgical treatment. The treatment should be switched when the current treatment fails to resolve the symptoms within 2 to 7 weeks. However, these recommendations have sufficient evidence for carpal tunnel syndrome when found in association with the following conditions: diabetes mellitus, coexistent cervical radiculopathy, hypothyroidism, polyneuropathy, pregnancy, rheumatoid arthritis, and carpal tunnel syndrome in the workplace.

How Supplements Can Help
Several studies have suggested that a vitamin B6 deficiency can make you susceptible to the numbness and pain of carpal tunnel syndrome. This vitamin is important in maintaining healthy nerve tissue, relieving inflammation, and improving circulation. It also may increase the brain’s production of the nerve chemical GABA (gamma-aminobutyric acid), which helps control pain sensations. If you don’t notice any improvement after taking vitamin B6 for three weeks, switch to pyridoxal-5-phosphate (P-5-P), a form of the vitamin that the body eventually produces as it breaks down vitamin B6. Some people find this form works better for them.
Taking vitamin C supplements may leave you vulnerable to carpal tunnel-unless you also get enough vitamin B6. One study involving 441 participants found that those deficient in B6 who took vitamin C daily were more likely to develop carpal tunnel syndrome than those who were B6 deficient but did not use vitamin C supplements.

In addition to B6, bromelain, a powerful anti-inflammatory enzyme found in pineapple, is very effective in treating the inflammation and any resulting pain. The combination of bromelain and vitamin B6 works better than either supplement alone. Turmeric, a member of the ginger family, is another useful herb. When turmeric is taken with bromelain, they enhance each other’s anti-inflammatory properties and together may help relieve the pain of carpal tunnel syndrome. Though turmeric is safe to use over the long term, cut the dose in half once your symptoms subside. (This herb can be expensive.)

What Else can be done:
Take frequent breaks when performing any repetitive hand activity, such as typing, knitting, or playing an instrument. Stop at least once an hour to flex your fingers and shake your hands.
Apply ice to your wrists when pain strikes. Use a flexible ice pack — or even a bag of frozen peas — and put it on for 10 minutes every hour to ease the pain and reduce the inlammation.
Elevate your wrists with a pillow when you lie down.
Salt promotes water retention, which can contribute to swelling and may aggravate the symptoms of carpal tunnel syndrome. Try reducing the amount of salt in your diet and see if it helps.

Supplement Recommendations
Vitamin B6
Bromelain
Turmeric

Vitamin B6
Dosage: 50 mg 3 times a day until symptoms subside.
Comments: 200 mg daily over long term can cause nerve damage.

Bromelain

Dosage: 1,000 mg twice a day during acute phase. Reduce to 500 mg twice a day when symptoms subside. Take between meals.
Comments: Provides 8,000 GDU or 12,000 MCU in acute phase.

Turmeric

Dosage: 400 mg 3 times a day.
Comments: Standardized to contain 95% curcumin. Should be used with bromelain.

Prognosis:
Most people relieved of their carpal tunnel symptoms with conservative or surgical management find minimal residual or “nerve damage”. Long-term chronic carpal tunnel syndrome (typically seen in the elderly) can result in permanent “nerve damage”, i.e. irreversible numbness, muscle wasting, and weakness. Those that undergo a carpal tunnel release are nearly twice as likely as those not having surgery to develop trigger thumb in the months following the procedure.

While outcomes are generally good, certain factors can contribute to poorer results that have little to do with nerves, anatomy, or surgery type. One study showed that mental status parameters or alcohol use yields much poorer overall results of treatment.

Recurrence of carpal tunnel syndrome after successful surgery is rare. If a person has hand pain after surgery, it is most likely not caused by carpal tunnel syndrome. It may be the case that the illness of a person with hand pain after carpal tunnel release was diagnosed incorrectly, such that the carpal tunnel release has had no positive effect upon the patient’s symptoms

Resources
Your Guide to Vitamins, Minerals, and Herbs
http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome