carpals

Carpal tunnel syndrome is the name for a group of problems that includes numbness, tingling, weakness, or pain in your wrist or hand. It's a very common condition that happens when a nerve in your wrist becomes squeezed.

The carpal tunnel is a narrow opening between the bones in your wrist and the ligament that holds them together. A nerve, called the median nerve, runs from your lower arm through the carpal tunnel and into your hand. This nerve provides feeling to your thumb and first three fingers. It also helps you move your thumb.

Tendons also run from your lower arm, through the carpal tunnel, and into your hand. The tendons connect your finger bones to muscles in your arm, so you can bend your fingers.

If the tendons become swollen or irritated inside the carpal tunnel, they may press on the nerve. The squeezed nerve may not work well, which can lead to numbness, weakness, and other symptoms of carpal tunnel syndrome.

In certain cases, the cause of carpal tunnel syndrome is unknown. But it usually happens from a combination of things that affect the structures in your wrist, such as:

• Injury to your wrist that causes swelling, such as a sprain or broken bone
• Health conditions that can affect your nerves, joints, or other parts of your wrist, for example:
  • Diabetes.
  • Rheumatoid arthritis.
  • A cyst or tumor in your wrist.
  • Changes in certain hormones, which may cause swelling from extra fluid in your body. Examples include an underactive thyroid gland (hypothyroidism), pregnancy and menopause.
  • Problems with the way your wrist is formed.
• Doing the same wrist and hand movements over and over, such as:
  • Assembly line work.
  • Carpentry or using tools that vibrate.
  • Knitting, gardening, or sports, such as golf.

Researchers aren't sure whether long-term typing or computer use leads to carpal tunnel syndrome.

Carpal tunnel syndrome usually happens only in adults. You're more likely to develop it if you:

• Are a woman. Women are three times more likely to have carpal tunnel syndrome than men.
• Have a health condition that may affect structures in your wrist.
• Do activities with repeated hand motions.
• Have had a wrist injury.
• Have a close relative who has had carpal tunnel syndrome, such as a parent, brother or sister.

You may feel numbness, tingling or burning in your fingers, especially in your thumb, index, and middle fingers. Symptoms often affect both hands.

In the early stages, symptoms usually:

• Start slowly in your dominant hand (the one you write with)
• Happen at night if you sleep with your wrists bent

As symptoms get worse, you may notice:

• Tingling, pain, or weakness with certain activities, such as driving or holding a phone
• Difficulty grasping or holding small things
• Feeling like your fingers are swollen when they're not

Without treatment, you could lose feeling in some fingers and have permanent weakness in your thumb. But early diagnosis and treatment can help prevent lasting damage.

To find out if you have carpal tunnel syndrome, your health care provider will:

• Ask about your medical history
• Ask about your family health history
• Do a physical exam
• Order tests if needed, such as:
  • Lab tests to look for diseases that may damage nerves
  • X-rays to look for broken bones or arthritis
  • Tests to measure the electrical activity in your nerves and muscles
  • Ultrasound to check the nerve in the carpal tunnel

It's easier to treat carpal tunnel syndrome early on, so you should start treatment as soon as possible. Your provider will first treat any health conditions you have that may cause your symptoms. The next step would be treatments for carpal tunnel syndrome. They may include:

• Wrist splints (usually worn at night).
• Rest.
• Medicines to reduce swelling and pain:
• Over-the-counter pain relievers, such as aspirin, ibuprofen, and naproxen sodium.
• Prescriptionsteroids, either pills or an injection (shot) into your wrist.
• Other therapies (complementary and integrative medicine). Research shows that yoga may help with pain and weakness. Some people may find acupuncture and chiropractic care helpful, but research hasn't shown that these therapies can improve carpal tunnel syndrome. If you want to try other therapies, talk with your provider first.
• Surgery to make more space in the carpal tunnel. Surgery may be an option if your symptoms are severe and other treatments don't work. It involves cutting the wrist ligament to take pressure off the nerve. Recovery may take months. Carpal tunnel syndrome rarely comes back after surgery, but mild symptoms may last.

You may help prevent carpal tunnel syndrome if you protect your wrists:

• Use good posture to keep your wrists in a natural position.
• Keep your hands warm to keep your muscles flexible. Fingerless gloves may help.
• Take work breaks and vary your tasks.
• Stretch and exercise your hands and wrists.
• Organize your workspace and tools to reduce strain on your hands and wrists.

Your wrist connects your hand to your forearm. It is not one big joint; it has several small joints. This makes it flexible and allows you to move your hand in different ways. The wrist has two big forearm bones and eight small bones known as carpals. It also has tendons and ligaments, which are connective tissues. Tendons connect muscles to bones. Ligaments connect bones to each other.

Some of the more common types of wrist injuries and disorders are:

• Carpal tunnel syndrome, which happens when a nerve that runs from your forearm into your palm becomes squeezed at the wrist
• Ganglion cysts, which are noncancerous lumps or masses
• Gout, which is a form of arthritis caused by a buildup of uric acid in your joints
• Fractures (broken bones)
• Osteoarthritis, the most common type of arthritis. It is caused by wear and tear of the joints.
• Sprains and strains, which are injuries to ligaments and injuries to muscles or tendons
• Tendinitis, inflammation of a tendon, usually due to overuse

Certain things can put you at higher risk of having a wrist problem, including:

• Doing sports, which can put you at risk for injuries and puts stress on your wrist. For example, you may fall on your outstretched hand when you are skating or snowboarding. Your wrist could be injured while doing contact sports. And other sports such as gymnastics and basketball can strain your wrists.
• Doing repetitive wrist motions, such as typing on a keyboard, working on an assembly line, or using power tools.
• Having certain diseases. For example, rheumatoid arthritis can cause wrist pain.

The symptoms of a wrist problem can vary, depending on the problem. A common symptom is wrist pain. Some other possible symptoms include swelling, a decrease in wrist strength, and sudden numbness or tingling.

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms
• A physical exam, including checking your wrist strength and range of motion
• An x-ray or other imaging test
• Blood tests

Treatments for wrist pain depends on the type of injury or disorder. They may include:

• Resting your wrist
• Wearing a wrist brace or cast
• Pain relievers
• Cortisone shots
• Physical therapy
• Surgery

To try to prevent wrist problems, you can:

• Use wrist guards, when doing sports that put you at risk for wrist injuries
• In the workplace, perform stretching exercises and take frequent rest breaks. You should also pay attention to ergonomics to make sure that you are using the proper wrist position while working.
• Make sure that you get enough calcium and vitamin D to keep your bones strong

Amyloidosis occurs when abnormal proteins called amyloids build up and form deposits. The deposits can collect in organs such as the kidney and heart. This can cause the organs to become stiff and unable to work the way they should.

There are three main types of amyloidosis:

• Primary - with no known cause
• Secondary - caused by another disease, including some types of cancer
• Familial - passed down through genes

Symptoms can vary, depending upon which organs are affected. Treatment depends on the type of amyloidosis you have. The goal is to help with symptoms and limit the production of proteins. If another disease is the cause, it needs to be treated.

A biopsy is a procedure that removes cells or tissue from your body. A doctor called a pathologist looks at the cells or tissue under a microscope to check for damage or disease. The pathologist may also do other tests on it.

Biopsies can be done on all parts of the body. In most cases, a biopsy is the only test that can tell for sure if a suspicious area is cancer. But biopsies are performed for many other reasons too.

There are different types of biopsies. A needle biopsy removes tissue with a needle passed through your skin to the site of the problem. Other kinds of biopsies may require surgery.

Your bones help you move, give you shape and support your body. They are living tissues that rebuild constantly throughout your life. During childhood and your teens, your body adds new bone faster than it removes old bone. After about age 20, you can lose bone faster than you make bone. To have strong bones when you are young, and to prevent bone loss when you are older, you need to get enough calcium, vitamin D, and exercise. You should also avoid smoking and drinking too much alcohol.

Bone diseases can make bones easy to break. Different kinds of bone problems include:

• Low bone density and osteoporosis, which make your bones weak and more likely to break
• Osteogenesis imperfecta makes your bones brittle
• Paget's disease of bone makes them weak
• Bones can also develop cancer and infections
• Other bone diseases, which are caused by poor nutrition, genetics, or problems with the rate of bone growth or rebuilding

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Ergonomics looks at what kind of work you do, what tools you use and your whole job environment. The aim is to find the best fit between you and your job conditions. Examples of ergonomic changes to your work might include:

• Adjusting the position of your computer keyboard to prevent carpal tunnel syndrome
• Being sure that the height of your desk chair allows your feet to rest flat on floor
• Learning the right way to lift heavy objects to prevent back injuries
• Using handle coatings or special gloves to suppress vibrations from power tools
• Making sure that you have good posture in whatever you do, whether it is sitting in front of a computer, standing at a checkout, or walking around a warehouse

No matter what the job is, the goal is to make sure that you are safe, comfortable, and less prone to work-related injuries.

No matter how old you are or what you do for a living, you are always using your hands. When there is something wrong with them, you may not be able to do your regular activities.

Hand problems include :

• Carpal tunnel syndrome - compression of a nerve as it goes through the wrist, often making your fingers feel numb
• Injuries that result in fractures (broken bones), ruptured ligaments and dislocations
• Osteoarthritis - wear-and-tear arthritis, which can also cause deformity
• Tendinitis - irritation of the tendons
• Disorders and injuries of your fingers and thumb

Raynaud phenomenon is a condition that affects your blood vessels (the tubes that your blood flows through). It causes your blood vessels to narrow, which decreases blood flow. This is called a Raynaud episode or "attack." The attacks usually affect your fingers and toes, causing them to become cold and numb. They may also change color, usually to white or blue. These attacks happen in response to cold temperatures or stress.

Raynaud phenomenon may also be called Raynaud disease or Raynaud syndrome.

There are two types of Raynaud phenomenon:

• Primary Raynaud phenomenon is the more common type. Its cause is unknown.
• Secondary Raynaud phenomenon is usually caused by another disease or problem, such as lupus or scleroderma. Other causes may be exposure to cold or certain chemicals. The type can be more serious than the primary type.

Researchers don't know exactly why some people develop Raynaud phenomenon. But they do understand how the attacks happen. When you are exposed to cold, your body tries to slow the loss of heat and maintain its temperature. To do this, the blood vessels in the top layer of your skin constrict (narrow). This moves blood from those vessels near the surface to vessels deeper in the body. But when you have Raynaud phenomenon, the blood vessels in your hands and feet react to cold or stress by narrowing quickly. They also stay narrowed for a long time.

Anyone can develop Raynaud phenomenon, but some people are more likely to develop it:

• Primary Raynaud phenomenon has been linked to:
  • Your sex. Women get it more often than men.
  • Your age. It usually develops in people younger than age 30. It often starts in the teenage years.
  • A family history of Raynaud phenomenon. You are more likely to develop Raynaud phenomenon if you have a family member who has it.
• Secondary Raynaud phenomenon has been linked to:
  • Certain diseases. These include lupus, scleroderma, rheumatoid arthritis (RA), carpal tunnel syndrome, and connective tissue disorders.
  • Certain medicines. Medicines that treat high blood pressure, migraines, and attention deficit hyperactivity disorder (ADHD) may cause similar symptoms to Raynaud phenomenon or make your symptoms worse.
  • Work-related exposures, such as repeated use of vibrating machinery (such as a jackhammer), or exposure to cold or certain chemicals.

Raynaud attacks most often happen when you get cold, for example when you grab something cold from the freezer or go into an air-conditioned building on a warm day. Attacks usually affect your fingers and toes. But sometimes they can affect other parts of your body, such as your ears, nose, lips, or nipples.

An attack causes the skin to become cold and numb. Your skin may also turn white or blue due to a lack of oxygen. As the blood flow returns, your skin may tingle, throb, or turn red. An attack may last a few minutes or a few hours. If you have darker skin, you may not be able to easily see the skin color changes.

For many people, especially those with the primary type, the symptoms are mild. People with the secondary type often have more severe symptoms. They may develop skin ulcers (open sores caused by poor blood flow) or skin infections.

There is no specific test to diagnose Raynaud phenomenon. To find out if you have it, your health care provider:

• Will take your medical history and ask about your symptoms.
• Will do a physical exam.
• May order blood and other lab tests to check for other conditions which could be causing your symptoms and/or to help decide which type of Raynaud phenomenon you have.

Most people with Raynaud phenomenon can keep their symptoms under control by avoiding getting cold. But if this is not enough, medicines and, in some cases, surgical procedures can help.

Secondary Raynaud phenomenon is more likely to be serious and to need more treatments. It's also important to treat the condition or problem that is causing your Raynaud phenomenon.

You may need to see a specialist such as a rheumatologist, a doctor who treats diseases of the joints, muscles, and bones.

Raynaud phenomenon cannot be prevented, but you can help prevent attacks and manage your symptoms by:

• Placing your hands or feet in a warm place when you have an attack. This could mean putting them under warm (not hot) water or under a heating pad.
• Keeping your body, especially your hands and feet, warm in cold weather.
• Avoiding triggers, such as certain medicines and stress.
• Quitting smoking (or not starting smoking).
• Managing stress.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Occupational health problems occur at work or because of the kind of work you do. These problems can include:

• Cuts, fractures (broken bones), and sprains and strains
• Loss of limbs
• Repetitive motion disorders
• Hearing problems caused by exposure to noise
• Vision problems
• Illness caused by breathing, touching, or swallowing unsafe substances
• Illness caused by exposure to radiation
• Exposure to germs in health care settings

Good job safety and prevention practices can reduce your risk of these problems. Try to stay fit, reduce stress, set up your work area properly, and use the right equipment and gear.

Nerves are like wires that carry messages back and forth between your brain and your body. Your peripheral nerves branch off from your brain and spinal cord and connect to all parts of your body, including your muscles and organs. Peripheral nerves carry messages from your brain that control your movement, breathing, heartbeat, digestion, and more. They also carry messages from your body to your brain, so you can feel things, such as pain, heat, and cold.

Peripheral nerve disorders happen when one or more peripheral nerves are damaged. Damaged nerves may not carry messages correctly, or they may not work at all. As a result, you may have pain, trouble walking, or a variety of other problems, depending on which nerves are involved.

Peripheral nerve disorders are very common. There are more than 100 different types.

Many things can damage nerves and lead to peripheral nerve disorders:

• Diabetes is the most common cause of peripheral nerve disorders. Most people with diabetes will develop diabetic nerve problems.
• Physical injury (trauma) that stretches, crushes, squeezes, cuts, or puts pressure on one or more nerves. Some examples of peripheral nerve disorders from physical injury include complex regional pain syndrome and brachial plexus injuries.
• Health conditions, including:
  • Certain cancers and their treatment (chemotherapy and radiation therapy).
  • Infections, such as HIV and Lyme disease.
  • Problems with blood or blood vessels.
  • Autoimmune diseases, such as rheumatoid arthritis and lupus.
  • Kidney or liver disease.
• Certain medicines.
• Contact with certain toxic substances, such as lead or mercury.
• Alcohol use disorder (AUD) and smoking.
• Vitamin imbalances, especially a lack of vitamin B12.
• Your genes, including changes in your genes or conditions that you inherit from your parents, such as Charcot-Marie-Tooth disease.

In certain cases, the cause of peripheral nerve disorder is not known.

The symptoms of peripheral nerve disorders depend on which nerves are affected, what is causing the damage, and how serious it is:

• Weak or aching muscles
• Problems with balance, walking, or using your arms and hands
• Cramps or twitching muscles
• Muscle shrinking

• Tingling, numbness, or pain often in the hands and feet
• Not being able to feel heat, cold, or pain, such as a cut on your foot
• Pain from even light touch

• A heartbeat that's too fast or too slow
• Trouble swallowing
• Sweating too much or too little
• Vomiting, diarrhea, or constipation
• Problems with urination or sexual function

Symptoms may range from mild to very strong. They may develop quickly over days or slowly over months and years. But they are rarely life-threatening.

To find out if you have a peripheral nerve disorder, your provider will:

• Ask about your medical history
• Ask about your family health history
• Do a physical exam
• Order tests, which may include:
  • Blood tests
  • Genetic tests
  • Nerve tests that measure:
    • Electrical activity in your nerves and muscles
    • How well your autonomic nerves are working
  • A biopsy of nerve or skin tissue
  • CT or MRI scan to see what may be pressing on your nerves

It's important to treat any conditions that are causing nerve damage. In certain cases, that will allow your nerves to heal over time.

Treatment for symptoms depends on the type of peripheral nerve disorder you have, where it is, and how severe. Treatment options include:

• Braces or splints
• Over-the-counter patches and skin creams
• Prescription medicines
• Non-drug pain management, such as electrical stimulation or relaxation therapy
• Surgery to relieve pressure on a nerve

You can help prevent peripheral nerve disorders by:

• Managing health conditions that may cause nerve damage, especially diabetes
• Preventing falls and accidents
• Avoiding toxic substances
• Being careful to avoid repeated motions and body positions that press on your nerves
• Eating a balanced diet, exercising, limiting alcohol, and not smoking

NIH: National Institute of Neurological Disorders and Stroke