Carpal Tunnel Syndrome
Carpal Tunnel Syndrome is caused by compression of the median nerve at the wrist. It is caused by thickening of the transverse carpal ligament, which overlies the nerve, or prior injury, and may occur through repetitive motion injury from certain occupations. The symptoms include pain, numbness, and tingling affecting the thumb, index, and middle fingers. The symptoms frequently worsen with flexion of the wrist. The symptoms also worsen at night, and sometimes the entire arm and hand may feel numb. Fluid retention during pregnancy may cause the onset of symptoms. More severe cases may involve atrophy of the thumb muscles and weakness.
Ulnar Neuropathy
Ulnar Neuropathy or Tardy Ulnar Palsy is caused by compression of the ulnar nerve at the elbow, or less commonly the wrist. The symptoms include pain and numbness in the 4th and 5th fingers of the hand. The syndrome may progress to involve atrophy of the entire hand except for the thumb.
Less common entrapment neuropathies include the radial nerve and its branches, the peroneal nerve at the knee, and certain nerves in the feet. Meralgia Paresthetica is caused by entrapment of the lateral femoral cutaneous nerve in the groin.
EMG/NCV studies can help determine the severity and location of the problem, and help rule out other problems such as cervical radiculopathy, sciatica, or peripheral neuropathy.
Treatment Options
Activity adjustment and anti-inflammatories can help with symptom control. Wrist braces worn especially at night, Vitamin B6 supplements, and certain exercises can help with carpal tunnel symptoms. Avoiding direct pressure, for example propping on the elbow, can help with ulnar neuropathy symptoms. Surgery is reserved for the more severe cases.
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