CARPAL TUNNEL SYNDROME RELIEF COMES IN SEVERAL FORMS
I have carpal tunnel syndrome that used to bother me only at night. Wearing a splint helped, but, now, my symptoms are noticeable throughout the day, as well. Is surgery inevitable?
Carpal tunnel syndrome is caused by pressure on the median nerve that's in the front of your wrist. Treatment for carpal tunnel syndrome usually starts with splinting, self-care measures and, if needed, a corticosteroid injection. If that provides only temporary relief, then surgery may be recommended.
The carpal tunnel is a small passageway on the palm side of your wrist. Nine tendons and the median nerve travel through the carpal tunnel. Those tendons are like ropes that control the movement of your fingers. The median nerve serves as a pathway for the sensations you feel in your palm, thumb, index finger, middle finger and outer border of your ring finger. It also sends the nerve signals that move muscles around the base of your thumb.
Carpal tunnel syndrome happens when the space in the carpal tunnel becomes smaller or the tendons in the tunnel thicken, placing pressure on the median nerve. In its early stages, symptoms may include tingling or numbness in your thumb, index finger, middle finger and outer border of your ring finger.
A wrist splint typically is the first step in treatment. A splint can be particularly helpful for people whose symptoms bother them at night. Wearing a splint at night can keep the wrist from bending while you sleep. That can relieve the nerve pressure and eliminate nighttime discomfort.
When symptoms persist during waking hours, wearing a splint during the day can be useful. You also may be able to ease daytime symptoms by taking frequent breaks from repetitive activities. Throughout the day, rotate your wrists and stretch your palms and fingers. Taking a pain reliever, such as ibuprofen, naproxen or aspirin, may help lessen the inflammation.
If those steps aren't enough, then a corticosteroid injection into the carpal tunnel may reduce tingling and numbness. Corticosteroids lower inflammation and swelling within the carpal tunnel, which can relieve pressure on the median nerve.
For those with severe symptoms or whose symptoms come back after an injection, surgery may be appropriate. The goal of surgery is to relieve pressure on the median nerve by cutting the transverse carpal ligament.
Traditionally, surgery for carpal tunnel syndrome has been performed as an open surgery in which a surgeon makes a small incision in the palm of the hand over the carpal tunnel and then releases the ligament. Alternatively, this procedure can be performed via endoscopic surgery. With that approach, the surgeon uses a telescopelike device with a small camera attached to it to see inside the carpal tunnel. The surgeon cuts the ligament through small incisions in the hand or wrist.
Ultrasound-guided carpal tunnel release is another alternative treatment in which a surgeon or qualified physician uses ultrasound images to guide an instrument into the carpal tunnel through a small incision in the forearm, and then cut the ligament. As techniques for ultrasound carpal tunnel release evolve, the procedures may be able to be performed in a doctor's office under local anesthesia.
Effectively treating carpal tunnel syndrome as promptly as possible is important. The longer the median nerve remains compressed, the more damaged it can become. If the nerve is compressed for too long, it may not recover. Eventually, that could lead to permanent weakness and lack of coordination in your fingers and thumb.
Jay Smith, M.D., Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minn.
THE ORIGIN OF MULTIPLE SCLEROSIS
What causes multiple sclerosis in people who don't have it in their family?
The exact cause of MS isn't known, but it's clear that a variety of factors can increase a person's risk of developing this disease. Along with genetics, those risk factors include age, sex, a medical history of certain infections or diseases, race and the climate where you live.
MS is a potentially disabling disease of the central nervous system, which includes the optic nerves; the white matter of the brain and back of the brain, called the cerebellum; the brainstem, which is the lowest part of the brain; and the spinal cord. The nerves that travel from the spinal cord out to the muscles are the peripheral nervous system. MS does not affect those nerves.
MS is an autoimmune disease, where the body's immune system mistakenly attacks and damages the protective sheath called myelin that covers and protects the central nervous system's nerve fibers. That damage leads to communication problems between the brain and the rest of the body. Eventually, the disease can cause the nerves to deteriorate and become permanently disabled.
Signs and symptoms of MS vary widely and depend on the amount of nerve damage and which nerves are affected. Some people with severe MS may lose the ability to walk independently, or to walk at all, while others may experience long periods of remission without any new symptoms.
According to the Multiple Sclerosis Association of America, more than 400,000 Americans are living with MS. About 20 percent of them have a parent, child or sibling who also is affected by the disease.
For the other 80 percent who do not have a family history of MS, a number of factors seem to play a role in increasing their susceptibility to the disease. For example, although it can happen at any age, MS most commonly affects people between 15 and 60. Women are at least two to three times as likely as men to develop MS. Caucasians, particularly those of Northern European descent, are at high risk of MS. People of Native American, African or Asian descent have low risk.
Medical history plays a role, too. A variety of viruses have been linked to MS. In particular, people who have been infected during late adolescence or young adulthood with the Epstein-Barr virus that causes mononucleosis (often called the kissing disease) are at increased risk for MS. If you have thyroid disease or inflammatory bowel disease, that also can raise your risk slightly.
MS is much more common in people who live in temperate climates, such as in Canada, the northern portion of the United States, Europe, New Zealand and southeastern Australia. Researchers suspect this may be due, in part, to the fact that people in these areas have lower levels of vitamin D in their blood, and that raises the risk for MS.
Vitamin D is taken in through diet but also in large measure through exposure to sunshine. Those who live in temperate regions have less sun exposure than people who live in locations closer to the equator, where sunshine is more plentiful year-round.
If you have family members affected by MS, or if you are concerned about your risk for the disease based on other factors, talk to your health care provider. He or she can review your possible MS risk with you and discuss any evaluation or screening that might be appropriate.
B. Mark Keegan, M.D., Neurology, Mayo Clinic, Rochester, Minn.
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