CARPAL TUNNEL REVISTED 
Many patients complain of numbness and tingling in one or both hands. When we examine the patient in the clinic it can be tricky to identify the true cause of the problem. Patients may also complain of weakness or “dropping things”. I recently reviewed several studies that shed some light on these problems. The first study showed dropping things and weakness for grip is more commonly associated with neck cervical compression or elbow ulnar nerve compression than with Carpal Tunnel. Another study showed there is a high incidence of anatomical variation such as muscles extending into the Carpal Tunnel at the wrist as a source of these problems. In one study 76% of those with Carpal Tunnel had these anatomical abnormalities. See Illustration A for a view of the carpal tunnel. A number of underlying medical diseases have been associated with Carpal Tunnel as well. A recent study showed that 8% of the cases of Carpal Tunnel were attributed to Rheumatoid Arthritis. In the same study 10% found diabetes to be the underlying cause of the Carpal Tunnel. Hypothyroidism (under active thyroid) was found to be responsible for 18% of the Carpal Tunnel cases in the same study. Another large study found that 73% of patients that had Carpal Tunnel symptoms had hypothyroidism. (under active thyroid) They concluded that Carpal Tunnel symptoms are common in patients with hypothyroidism even when they are properly treated with thyroid medication. When it comes to diagnosing Carpal Tunnel versus other nerve problems a few things are key: #1) A good history that includes any underlying diseases that may be contributing or causing the problem. #2) Listen to the patients complaints. One study showed a high association between the patient’s subjective complaints of tingling, loss of sensation and weakness and actual occurrence of the problem. The data showed the patient’s point of view is valid and reliable! Yet how often patients are dismissed as whiners when a nerve test comes back normal even when they continue to complain of pain and numbness! #3). Consider an alternative testing such as the painless Pressure Specified Sensory Device (PSSD) to diagnose the problem. It has greater sensitivity than a standard nerve test. In conclusion, remember that an under active thyroid (Hypothyroidism) can cause Carpal Tunnel and its symptoms. Dropping things is usually more a sign of neck or elbow nerve compression than Carpal Tunnel. Muscle abnormalities at the wrist can contribute to Carpal Tunnel syndrome. When it comes to diagnosing Carpal Tunnel versus other nerve problems a few things are key: #1) A good history that includes any underlying diseases that may be contributing or causing the problem. #2) Listen to the patients complaints. One study showed a high association between the patient’s subjective complaints of tingling, loss of sensation and weakness and actual occurrence of the problem. The data showed the patient’s point of view is valid and reliable! Yet how often patients are dismissed as whiners when a nerve test comes back normal even when they continue to complain of pain and numbness! See Illustration B for sensory loss in carpal tunnel. #3). Consider an alternative testing such as the painless Pressure Specified Sensory Device (PSSD) to diagnose the problem. It has greater sensitivity than a standard nerve test. In conclusion, remember that an under active thyroid (Hypothyroidism) can cause Carpal Tunnel and its symptoms. Dropping things is usually more a sign of neck or elbow nerve compression than Carpal Tunnel. Muscle abnormalities at the wrist can contribute to Carpal Tunnel syndrome. If you have pain in your hands and arms, numbness or tingling, weakness of pinch or grip, these can be warning signs of a nerve problem. Give us a call for testing which is sensitive and painless and can pinpoint your problem before permanent damage can occur. You only get one pair of hands for a lifetime, you owe it to yourself and your family to take care of them. Call us today if you have a problem. We will be happy to answer any questions. Call us today!! You will be glad you did!! |
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