Talk:Carpal tunnel syndrome

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edit·history·watch·refresh Stock post message.svg To-do list for Carpal tunnel syndrome:
  1. Improve opening definition/intro section. As muddled as the CTS definition can be, the opening must be clear, concise, and correct.
  2. SPAM patrol (continuing).
  3. Causes section "...a 2083 study..." Typo or spam.
  4. Causes section needs organization, sub-sections, and more references.
  5. Treatment and Prevention section needs better organization, references, and VooDoo treatment cleansing.
  6. Make a section to clarify the relationship of CTS to office/computer work & clear up any misconceptions.
  7. Integrate in-line, non-standard references and port to new Cite.php format. Done - 1/25/2007
  8. Anatomical images are needed—throughout the entry.
  9. References. References. References.
(Eventually we should get to the point that ~90% of all sentences have refs—with the remainder falling in the "connecting sentences" category.)
  1. References section Reference 39 quotes Parvo virus B18 instead of B19. Typographical error.
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Contents

Editing Non-traumatic part of the Causes section[edit]

Icarus3 wanted to delete the following bullet points from the Non-traumatic part of the Causes section, because "the controversy over whether or not such things cause CTS is covered in more depth in earlier section or article":

  • Common activities that have been identified as contributing to repetitive stress induced carpal tunnel syndrome include:
    • Use of power tools
    • Construction work such as handling many bricks, stone and/or lumber
    • Computer keyboarding, typing and using a mouse
    • Playing video games or computer games
    • Playing a musical instrument
    • Cycling, due to pressure and vibration on hands
    • Any activity where hand use is vigorous and routine could contribute (surgeons, dentists). Still, these activities are often merely associated with, but do not actually cause, carpal tunnel syndrome.

I disagree, because the following words do not have any other instances in the entire article: 'power', 'construction', 'bricks', 'typing', 'games' or 'cycling'.

I have reversed Icarus3's change, but would welcome discussion on how to integrate these points in a better way. From my own point of view, the above points were enlightening when I was first investigating Carpal tunnel syndrome, and I think there's a great benefit in having them listed together. Perhaps it's worthwhile putting some disclaimer againt them to indicate that there is some disagreement between experts, with a reference to the relevant section. --Matthew 1130 02:50, 24 December 2006 (UTC)


I think that chronic masturbation should be listed as a non stressful cause.

I think you obviously have no knowledge of this subject if you believe that

AID appeal[edit]

Let's shine some light down the dark hole this article has been hiding in. Please go to the AID page and vote to have this article spotlighted for a thourough cleaning-up! --DanielCD 00:40, 17 February 2006 (UTC)

Opening comments[edit]

Hi, I was trying to get the RSI article a little bit better, but I found out, that it is probably the same as Carpal tunnel syndrome. Thanks for comments, Fantasy 13:29 16 May 2003 (UTC)

AFAIK, CTS and RSI are not the same. But CTS can be considered a type of RSI - Tarquin 15:24 16 May 2003 (UTC)
Carpal tunnel syndrome, (though it usually is), doesn't have to be caused by repetition. I'll rearrange the article to fit in the other causes a bit better tomorrow Tristanb 12:00 27 May 2003 (UTC)
Great, thanks! I look forward to it! Fantasy 14:07 27 May 2003 (UTC)
Hopefully you weren't looking too forward to it! :-) i've added more info, but destroyed the structure, i'm too tired at the moment. i'll (or someone else will) add headings, and more information. plus a general sorting out. Tristanb 10:45 28 May 2003 (UTC)
Don´t worry, I look forward to every single contribution ;-) Fantasy 11:28 28 May 2003 (UTC)

Has someone vandalised the current page? I ask this because I am wondering where the author got the correlation between breasts and CTS.

Treatment[edit]

Does anyone know anything about prevention? (Without commercial products)

There are many ways to prevent CTS. They are very simple yet effective and remain as the crucial part in CTS recovery. Believe me, they are general common sense:
  1. Maintain a good body posture, especially in the work place. In most of the cases, while sitting in front of a computer desk you want to make sure your shoulders are approaching a 90 degree angle and that your wrists are not resting on the edge of your desk.
  2. A break from work from time to time is definitely beneficial, lots of shorterm breaks have proven more effective that a few long breaks. A good pattern would be a 30sec break every 3-5mins.
  3. A person with a healthier lifestyle can be more immune to contracting CTS, longtime exposure to a repetitive task WILL EVENTUALLY lead to CTS, even if it takes 20yrs. Improved health can prevent and treat CTS being a combination of: if using a computer use a CTS prevention app, consuming B complex, wearing wrist braces at night and taking hypercium (an extract of St John's Wart).


I was reading the article and noticed that the Treatment section states that there are 6 types of treatment, and then proceeds to list 4 with 5 and 6 only being numbers in the paragraph. I have altered the paragraph to read 4 types of treatment and removed the numbers 5 and 6. this can be changed back when these mysterious fifth and sixth treatments are found.

--Tralfaz (Ralraz, yech) (talk) 16:00, 14 July 2008 (UTC)

Conservative Measures

Because the pressure within the carpal tunnel increases if the wrist is held in sustained flexion (usual sleep posture) or sustained extension, the initial treatment of carpal tunnel syndrome should include a splint that maintains the wrist in a neutral position at night. Clinical improvement with this simple measure adds further support to the diagnosis of carpal tunnel syndrome. Activities that provoke symptoms may be modified with simple measures such as adjustment of keyboard height and rotation of repetitive job activities. Injection of steroids into the carpal tunnel often decreases the inflammatory response around the flexor tendons and diminishes symptoms. To inject the carpal tunnel, a 25-gauge 1.5-inch needle is placed at the mar wrist crease just ulnar to the palmar is longus tendon. If the palmaris longus is absent, a line along the radial border of the ring finger is drawn to the wrist crease. Before placing the needle, patients are told they may experience an electric shock sensation in the fingers. If this sensation occurs, the needle may be in the median nerve, and the injection should not be given. The needle is withdrawn and placed a few millimeters ulnar. When inserting the needle, first the skin is punctured, then a pop is felt as the needle passes through the transverse carpal ligament. A mixture of a short-acting anesthetic and steroid is injected. Transient relief of symptoms after injection suggests a greater likelihood of a favorable result after surgical decompression. --VincenzoSorriso (talk) 08:21, 18 November 2013 (UTC)VincenzoSorriso

Diagnosis[edit]

An update regarding the Diagnosis of CTS. An article published by Kuschner SH, Ebramzadeh E, Johnson D, Brien WW, Sherman R. at Entrez PubMed, Nov, 1992, suggested that Tinel's sign is not useful in CTS diagnosis. While Phalen's test, remains as a accurate method. Shall this to be revised? OR anyone has any comments? See this: Tinel's sign and Phalen's test in carpal tunnel syndrome. --Garlics82 16:23, Nov 1, 2004 (UTC)


Another thing on the current diagnosis part; on the Phalen's test paragraph is merely state that if you feel pain/burning/tingling, it would be a sign, but it did not tell you that you're supposed to be looking for these sensations at the fingers, such as stated at the link to the Phalen's test. Pretty much anyone who bent to the extremes of their flexibility would experience discomfort at the wrist.--24.85.147.171 19:00, 31 August 2005 (UTC)


Physical examination is not a reliable way to diagnose cts. Manouevers above are 20-70% sensitive or specific at best. History with confirmator nerve studies are the gold standard. Roger, MD

Some questions[edit]

Is carpal tunnel syndrome some type of compartmental syndrome? If so, can it be treated using mannitol? --Eleassar777 17:19, 10 Feb 2005 (UTC)

After much reading on this, I was wondering if lack of D3 is a common cause. --Seb-Gibbs 00:13, 24 Feb 2005 (GMT)

While mannitol might possibly help, I think it's too aggressive of a drug to be used for this purpose. About D3, I fail to see how Vitamin D3 relates to the swelling and nerve damage in the wrist. But as this article states, B Complex has been shown to be very helpful. --TravisOwens 11:13, 30 Nov 2005 (EST)

Treatment[edit]

In the UK at least, nearly all carpal tunnel syndromes are treated with surgery, so much so that most NHS plastic surgeons spend their time doing operations to correct the problem. Think this needs editing... -- Unknown

Rebuttal - Surgery is a horrible option for carpal tunny treatment imho. Many studies (Google for yourself) have shown it's not very effective, and obviously if the patient continues the stressfull task, carpal tunnel will only come back, and the surgery cannot be performed multiple times. I have known 2 people to have gotten the surgery here in the US and both said it wasn't worth it. The WikiPedia's health articles should not encourage treatments that are viciously unneccesary just because one country still performs such actions. (I will admit the US is riddled with inferior treatments ala the whole medicine industry). Considering mulitiple studies have shown surgery to be a poor option and not a single study has shown otherwise, the only proper editing would be along the lines of "While studies have shown surgery to be a poor option because of X, Y and Z, it is still a popular choice for treatment in the UK." To show it in any other light would be biased. -- TravisOwens 9/7/05

Re-rebuttal Travis, whats up with you? have you read any of the current medical literature? Carpal tunnel release enjoys excellent success and minmal complications and recurrence. If symptoms recurr, they are unlikely carpal tunnel. Instead of googling for your friendly merchant selling snake oil, why not look for reliable sources in the juried medical literature like in PUBMED.COM (the index of the national library of medicine) Roger Blauvelt, MD

Need to discuss Double Crush Syndrome[edit]

Not quite sure how to weave this into the article, but the double-crush syndrome needs to be mentioned.

See http://www.icpa4kids.org/research/chiropractic/carpal.htm and http://www.erinelster.com/carpal_tunnel.html for some references.

The key message is that the primary cause of carpal tunnel syndrome may actually be in the upper back or lower neck.

Excercises that relax and strengthen the back muscles can relieve the wrist symptoms in some cases.

I speak from experience -- a regular regimen of exercises approved by my osteopath prevents my carpal tunnel symptoms from flaring up. I was able to avoid any surgery.

No one has made mention oc CT Cream which is available and helps to alleviate the pain —Preceding unsigned comment added by 62.173.35.230 (talk) 11:49, 9 March 2008 (UTC)

Rick Rutt 22:18, 14 December 2005 (UTC)

We have an article for Crush syndrome -- are they related? --Arcadian 00:01, 15 December 2005 (UTC)
No, double crush refers to the median or ulnar nerve being compressed in the back as well as in the wrist. The compression in the back inflames the nerve so it is more sensitive to compression at the wrist. A problem with the median nerve causes numbness in the forefinger, 2nd finger, and one side of the 3rd (ring) finger. A problem with the ulnar nerve causes numbness in the 4th (pinky) finger and the side of the 3rd finger. If either nerve is inflamed, there can be a burning sensation at the wrist where the actual carpal tunnel resides. Note that I am not a doctor, just a person who has had carpal tunnel syndrome that was luckily treatable with exercise: pushups, situps, touch toes, etc. Rick Rutt 16:47, 16 December 2005 (UTC)

Rick Rutt 17:08, 18 December 2005 (UTC) I added double crush as one of the non-traumatic causes, and added these 2 URL links as external references.

While double crush is a sound clinical entity, it rarely has a true meaningful contribution to CTS. CTS by definition is a problem originating in the hand/wrist area. Anyone that sugessts "the primary cause of carpal tunnel syndrome may actually be in the upper back or lower neck" is by definition redefining the problem! We have enough confusion/conflict without that happening. A fair statement is that neck disorders may mimick CTS. This is easily determined however by history, physical exam and nerve studies. Another fair statement is that nomatter where on your body your complaint, you will not likely leave a chiropractor's office without treatment/manipulation to your neck or back.

My Teenage Daughter Just Diagnosed[edit]

I am looking for information on CTS that I can share with my teenage daughter and her coaches. She is 15 years old plays volleyball, is a cheerleader, and throws shot put and discus for her track team. Everything I have found so far discusses adults and things such as surgery and ergonomics. Unfortunately, we are a military family and do not get consistant treatment - you get whatever doctor is available and they don't put a lot of emphasis on dependents. Is there information for young athletes and their coaches? She has said that she will give up cheerleading, shot put and discus, but refuses to give up her volleyball. What can I do to help her.


First, get here an accurate diagnosis. While possible, CTS is very uncommon in teens. Other sources of hand pain is more common. Read the AAOS web site for info on cts and other disorders. Good luck, Roger, MD http://orthoinfo.aaos.org/brochure/thr_report.cfm?Thread_ID=5&topcategory=Hand

Dr. Brown, Dr. Brown... Paging Dr. Brown[edit]

It is unfortunate that Dr. Michael Brown has used the Wikipedia as an advertising page and in the process produced disinformation reguarding CTS surgical treatement and results. His results are not unlike most surgical treatments, and there are more widely used endoscopic methods out there with similar results. Attempts at correcting his entry are reversed. This lack of integrity of contributors is a weakness of this community forum, when greed and commercialism predominates. So sad. Shame on Dr. Brown.

<follow-up comment by different submitter> Agreed. With a little research one will find that carpal tunnel surgery is highly ineffective, with a high rate of relapse because the initial diagnosis is often incorrect. This Wikipedia entry is, unfortunately, very misleading and should be corrected. —Preceding unsigned comment added by 70.90.239.173 (talk) 14:12, 3 June 2008 (UTC)

This same issue has crept up in the endoscopic carpal tunnel article. However the idea that carpal tunnel surgery is ineffective is absurd. (Twinfejj (talk) 14:28, 6 April 2010 (UTC))

Readers may wish to judge the credibility of Dr. Michael G. Brown against his criminal record for spousal abuse and attempted murder of his ex-wie. [[1]]70.240.213.58 (talk) 19:50, 27 August 2010 (UTC)

Soft Tissue Therapy?[edit]

I removed the soft tissue therapy section entirely, since it is part of a group of edits across multiple articles by individuals seeking to push their own commercial products. If anyone has verifiable evidence that soft tissue therapy is actually a real medically approved therapy to treat CTS, feel free to remake the section. But include sources. --Xyzzyplugh 00:00, 14 February 2006 (UTC)

writer's cramp[edit]

Why does this topic link to writer's cramp (and vice versa)? Apart from being disorders that affect the hand, the two have nothing in common. Ikkyu2 01:11, 14 February 2006 (UTC)

The link may serve to help people realize this difference if the two are often confused. In fact, it might not hurt to mention in the article that there is a difference and what it is. This information could likely prove helpful to people not familiar with the terminology. --DanielCD 19:55, 16 February 2006 (UTC)

It is a common misconception that writer's cramp is CTS, so many people think they're getting CTS symptoms when it's just writer's cramp, and therefore it makes sense to link them to each other. 216.167.172.166 (talk) 11:21, 29 October 2008 (UTC)

Editing[edit]

I think the article could benefit from a vigorous copyedit. This is really good information. Perhaps the AID?

Notations such as these are not really correct: (Arch Internal Med 158:1506 1998 & Hospital Practice, March 1999). The standard format is to give the last names of the author(s) of the relevant articles and a year, leaving the reader to refer to the refence section for more details. Without the article names and authors, these references may be more difficult to find or confused with other articles in the same magazines/magazine volumes/issues etc. This should likely be remedied. Does the researcher have the full references? I would not mind adding them in proper format if they could be provided. --DanielCD 20:21, 16 February 2006 (UTC)

My grounds for the citation/source tag are that there's a lot of information here, and little of it is cited/referenced. As I said above, these aren't going to count as references as they are not complete. As there is some information that seems to be giving advice, please do not remove the tag without consulting here on the talk page. This is a subject that can be solidly referenced, so it shouldn't be a problem. I'm going to look for some sources as well. --DanielCD 21:04, 16 February 2006 (UTC)

Per the comment at the top of the page here: Could someone give voice to the concerns surrounding "Dr. Michael Brown"? Is there an issue or not? --DanielCD 21:09, 16 February 2006 (UTC)

...computer use did not increase a person's risk of developing carpal tunnel syndrome.

There is a citation here, but key information like this, along with needing complete citations to actual medical studies, could use more discussion. Computer use and its relation to CTS perhaps even calls for its own section.

One hundred and nine separate atraumatic conditions can cause CTS-like symptoms.

Can we say that the number is exactly 109? Some rewording might be in order here. --DanielCD 21:18, 16 February 2006 (UTC)

...recent studies and peer review articles have found no relationship between carpal tunnel syndrome and office-type work.

sigh --DanielCD 21:20, 16 February 2006 (UTC)

I'm not disputing these facts, but people need to leave the article not wondering whether it's a crock of s**t. We need to give readers more of a feeling of certainty regarding some of these things. I'm assuming many people would, off hand, associate CTS purely with office work. This may be a blatant misconception, but I'd like to see the reader leave thinking their misconceptions have been corrected, rather than wondering if the people who wrote the article know what they are talking about. The facts are not the issue: it's the writing, citing, and presentation. --DanielCD 21:39, 16 February 2006 (UTC)

I added a cleanup tag on the following grounds: this article is a mess. It needs some re-thinking, and perhaps even a re-write. --DanielCD 00:22, 17 February 2006 (UTC)

I have been working on cleaning this up now that the admin has come in and cleaned up the spam that was so poisoning. I am a MD and dont want to step on the alternatives toes, but I am trying to clean it up a bit. Thanks for the interest and contact me with questions.Rogerdoger 04:14, 20 February 2006 (UTC)

SPAM[edit]

I removed the following segment:

In 1991, the Brown Procedure Endoscopic Carpal Tunnel Release was patented by Michael G. Brown, M.D. of Houston, Texas. The procedure is performed on an outpatient basis. No hospital stay is required and the recovery period is approximately 2 days. An endoscope is used in two small cuts in the hand, which require no stitching afterwards, compared to the old technique of cutting through the palm to reach the tight ligament.
Thousands of patients have found relief from Carpal Tunnel Syndrome via the endoscopic procedure and it is now performed worldwide.
The Brown Procedure Endoscopic Carpal Tunnel Release is a patented procedure performed by surgeons all over the world. It has been the most successful advance in the treatment of Carpal Tunnel Syndrome since 1947. It is not an "alternative" therapy. Arthroscopic surgery is an extremely valuable tool for all orthopaedic patients and is generally

Vocabulary[edit]

Ok, is it just me or is this article a little confusing if your not a doctor? I"m trying to write a report on CTS and I'm reading this too help as a first chice and I'm having to find places I can understand easier. What is a lateral 3.5 finger? I suggest we make the article more understandable to readers not in the medical field, like those of us in high school. H-BOMB 13:51, 20 October 2006 (UTC)


It appears that someone (Lilymuriel) botched the article. If you go back a couple dozen edits, then you can see the orignal text. The current text is crap. Can someone revert this? Rogerdoger

Policarpal SPAM?[edit]

In the Immobilizing Braces section of the article, the article states that there is a new type of brace (policarpal) that is very successful. When following the 'policarpal' link, you come to a wiki page that says there is no article by that name. When I googled 'policarpal', the first couple links are the manufacturers page, and then the exact same blurb as the one in the wiki article has been posted on a numer of different sites. Policarpal appears to be a proprietary name, and does not appear to be reviewed anywhere, nor is does it appear to be available from any other site.

I think it's SPAM. What do you think?

Meira Voirdire 04:19, 11 December 2006 (UTC)

Merge[edit]

The discussion regarding a merge between Carpal tunnel syndrome and Carpal tunnel is at Talk:Carpal_tunnel#Merge. Please post any relevant comments there.

Ergonomic computer pointing devices[edit]

Hi MarcoTolo,

Great work with your recent edits, your marathon effort has improved the article noticeably. I agree with your deletions except for this one, so while I have reinstated the Ergonomic computer pointing devices section you deleted, I am also posting here to invite comment on this from you and the other editors of this article.

I don't believe this section violates WP:EL#Advertising and conflicts of interest or Wikipedia:Conflict of interest because:

1. I am a database software developer, not a manufacturer or seller of pointing devices, so there is no commercial conflict of interest.
2. I am not employed or associated with any of those companies.
3. I do not maintain or contribute to the listed websites.
4. There are multiple links in this section to companies that compete head to head in the same market space.

I added the Ergonomic computer pointing devices section back on 18 January 2007 for the following reasons:

  • I could not find any ready resource on the web for locating these products.
  • These products are certainly relevant, possibly very important, for computer users suffering from Carpal tunnel syndrome.
  • I found multiple independent recommendations and endorsements for these products on other websites, while researching to work out which product to buy for myself. Please note that I left other products off this list, because I could not find such enthusiastic independent recommendations for them.

I want to do the right thing here, so I have reviewed Wikipedia:Spam#How not to be a spammer to which item 6 seems to indicate that adding a link to a product is ok, provided that others agree that the product is relevant.

I also reviewed WP:EL#Links normally to be avoided on which items 4 & 5 may be a concern in this case. I think that this particular case is an exception to the "normal" rule, because this list is very useful to readers, and for the same reason that products are identified on Entity relationship#ER diagramming tools and at Database management system#External references, because it makes Wikipedia more informative. I have striven to provide links to the most informative page of each website.

Is there a better way to handle this? There is not enough independent information on these products to create a separate Wikipedia page for each of them. Another possibility is to place a disclaimer at the top of the section, so I made a stab at doing that just now ... you're welcome to revise or delete that disclaimer as seems best.

Would it help if I attempted to list my sources for these independent recommendations here on the talk page?

Regards,
Matthew 1130 14:32, 25 January 2007 (UTC)

  • Matthew 1130 -- Kudos for taking the time and effort to write such a complete commentary for a revert; much appreciated. And, before I forget, my apologies for the unwarranted implication that you spammed the page -- I was too quick on the draw. Mea culpa.
You do make reasonable arguments about why the Ergonomic computer pointing devices (ECPD) section may be an exception to the general WP:EL guidelines. I must admit, however, that sites with SHOP NOW! and Buy Now! links make me very nervous. Yes, an ECPD list is useful to some Wikipedians, I'm just concerned about the impression such a list sets (not to mention the on-going difficulty in managing such a list). In the past, its been suggested in other articles to provide a base link to an ODP site like dmoz -- the ergonomic mouse section there is a little thin, though the Zero Tension Mouse appears in another category. (As an aside, opening the Perific site ends in a blank page (as in zero content after the http header response) for me under both Firefox and IE, and from both home and work).
I guess that, if I had my druthers, the CTS articles would stick with a link to an ODP site. I guess I'd need to think about how other options might work and do a little more research on current WP community consensus in situations like this. In any case, thanks again for your thoughtful input. -- MarcoTolo 01:31, 26 January 2007 (UTC)

Uncited statements[edit]

  • I've removed the follow sentence from the article, "B vitamins, specifically Vitamin B6, can have an anti-inflammatory effect on the nerves decreasing symptoms. A B-50 or B-100 complex daily provides relief for many people. It should be noted that dosages of B6 should not exceed 300mg per day." A statement this broad must be cited per WP:ATTRIB. -- MarcoTolo 02:25, 2 March 2007 (UTC)

Diagram[edit]

The diagram is kind of creepy, can we get one that doesn't look like a severed hand? --Candy-Panda 08:35, 8 March 2007 (UTC)

I've spent a fair amount of time looking for a freely-available alternative image (i.e. meets Wikipedia image policies); any suggestions? -- MarcoTolo 08:01, 13 March 2007 (UTC)
I created an SVG version of the diagram to replace the Gray's Anatomy Image: http://commons.wikimedia.org/wiki/File:Carpal-Tunnel.svg (DoPhotoShop (talk) 20:05, 15 March 2011 (UTC))

Plastic and Reconstructive Surgery article (November 2006)[edit]

"The most recent data, from Mayo Clinic microscopic studies (published in a November 2006 issue of Plastic and Reconstructive Surgery): indicates that it is in fact a shearing injury caused from the acute trauma of repeated motions. The scar tissue from during healing impedes the sliding motion at the tendon. Clearing any doubt that it is in fact work related."

I've pulled this paragraph from the article because it appears to exaggerate the study outcome based on the abstract (i.e. it does not appear to "clear any doubt".) I haven't had a chance to dig up the full article; will do so as soon as possible. -- MarcoTolo 07:58, 13 March 2007 (UTC)

I have read the abstract and agree that the above satement is a gross extrapolation of some interesting histologic data. I comment as a orthopaedic hand surgeon

Rogerdoger

"medication and diet" section (what diet?)[edit]

Good day. Perhaps I've msised something but the "medication and diet" section does not seem to have any info on diet. Is this an oversight or should the word "diet" be removed from the section (or perhaps dietary content added). Thanks, Hu Gadarn 22:41, 22 March 2007 (UTC)

This is left over from a unreferenced dietary segment that was removed; I've corrected the subheading. Thanks for catching the error. -- MarcoTolo 22:50, 22 March 2007 (UTC)

Diet changes are unlikely to change your CTS symptoms.... Rogerdoger

CARPEL TUNNEL[edit]

WAS IN ACCIDENT HURT THE NECK AREA, LOTS OF PAIN, ALSO SHOULDER AREA, SO FOR ALMOST FIVE YEARS HAVE BEEN RUBBING NECK AND SHOULDERS AS IM IN SO MUCH PAIN, LAST FEW MONTHS HAVE HAD NUMBNESS IN FINGERS BURNING AND PAIN IN WRIST PAIN IN THUMB INDEX FINGER BOTH WRISTS IF I HOLD HANDS IN A STRETCHED POSTION BURNING AND PAIN START, ALSO IF I HOLD EVEN A CUB SOME TIMES WILL DO THIS AND HAVE DROPPED THINGS COULD THIS BE CARPEL TUNNELL FROM RUBBING MY NECK AND SHOULDERS MOST OF THE TIME??SANDRA —The preceding unsigned comment was added by 209.226.176.31 (talk) 03:01, 9 April 2007 (UTC).

It might be the strain of holding down the shift key too hard. --LiamE 16:07, 26 July 2007 (UTC)
Please stop yelling, it will aggravate your neck injury. Hu Gadarn 22:07, 26 July 2007 (UTC)

Osteopath claims[edit]

I, perhaps temporarily, move unreferenced claims of osteopath treatment to this page, since it might need discussion before any possible reinsertion:

CTS can also be treated with Osteopathic Manipulative Medicine, using a technique called carpal tunnel release. The carpal bones surrounding the tunnel are pressed apart and maintained in this position for several seconds. Although this technique is not curative, it does offer relief in mild cases.[citation needed]

Spinal manipulations performed by an osteopath, physical therapist or chiropractor may be appropriate to relieve compression of the nerve.[citation needed]

Mikael Häggström 07:58, 30 September 2007 (UTC)

Differentials[edit]

Can we get a list of differential diagnoses? CTS is well known, so people often think anything involving upper extremity discomfort must be CTS. I'd like to see a list that includes ulnar nerve problems, cervical disk problems, tennis elbow, and so forth. WhatamIdoing (talk) 04:24, 7 December 2007 (UTC)

some of use the computer only when lying on our stomachs[edit]

Often we see "better seating", "better sitting position". Well, some of us use the computer only when lying on our stomachs in bed, never sitting down in front of it. Just wanted to let you know. Not especially healthy perhaps, but that's how we use them. Jidanni (talk) 05:11, 23 February 2008 (UTC)

Heh I do this when I'm tired... And interestingly enough when I read this comment I was doing that... I'm also very prone to getting writer's cramp when I write an essay, but that's probably due to my unusual hand position and how tense I get when I try to write quickly. 216.167.172.166 (talk) 11:40, 29 October 2008 (UTC)

Unclear sentence[edit]

"Physiology and family history may have a significant role in individual's susceptibility." I didn't understand the meaning of the word "physiology" in this context. Was it originally supposed to be "genetics", or something else? Kindly clarify.

Also, the article has been rated "B" class under Project medicine, but only a "start-class" under Neurology. I think it is good enough to be "B" even for neurology. May be a GA, too with some improvements.

Regards.

—KetanPanchaltaLK 16:31, 12 June 2008 (UTC)

Guitar.[edit]

It is common knowledge that carpal tunnel syndrome can be acquired through guitar playing if the guitar neck is held improperly. this is also the case for a lot of other activities, though, such as typing, for example. So I'm not sure that anything about this should be added to the page or not-- just thought I'd throw it out there that CTS is common discussion amongst guitar players. —Preceding unsigned comment added by 75.16.231.26 (talk) 23:18, 27 August 2008 (UTC)

If you play a !lot!, it may not matter how you hold your guitar. Simply put, constant overuse will find the dielectric myelin sheath being eroded/damaged and crosstalk between nervous/elect ronic communication channels results in CTS. Too much of anything hurts. Rjnoonan (talk) 00:49, 12 August 2010 (UTC)

Anatomy[edit]

What is "TCL"? It isn't defined anywhere on the page. Thanks Shrdlu junction (talk) 00:57, 16 October 2008 (UTC)

I believe TCL refers to the Transverse Carpal Ligament, 1st mentioned in section 1, "History." i see ur question is 2 years old, so i hope u found an answer before now.
Ragityman (talk) 13:41, 11 December 2010 (UTC)

symptoms and indications[edit]

i was dignosed with cts a few months ago and tend to disagree with the following bit in the article:

"Psychosocial factors

Studies have related activity-related upper extremity pain with psychological and social factors, but most such pains are nonspecific but commonly mislabeled as carpal tunnel syndrome. Psychological distress correlates with increased pain at work, as do other psychosocial stressors such as job demands, poor support from colleagues, and work dissatisfaction.[9]

As mentioned elsewhere on this page, carpal tunnel is characterized by numbness, not pain. Therefore, any associations between stress and carpal tunnel syndrome are debatable."

when first diagnosed i was experiencing numbness for a few months including my index finger. but i get bouts of pain, especially sewing by hand, picking up objects "the wrong way", leaning on my hands etc. so pain in my opinion is definitely associated with cts. after a long day at work, i get pain up and down my forearm, which i believe is how far the nerve runs?? and being a nerve, shouldn't it experience some pain being under pressure and all??

Jashca (talk) 09:17, 20 January 2009 (UTC)


Further Evidence[edit]

as discussed above, I have found an interesting article in a newer medical journal that will back up my view above. When I have the energy I will update the article.

Jashca (talk) 07:39, 4 February 2009 (UTC)


Adductor Pollicis[edit]

The article mentions atrophy of the adductor pollicis in carpal tunnel syndrome. But, adductor pollicis is innervated by the ulnar nerve and not by the median nerve. Does it really atrophy or is this a mistake?

Tyger25 (talk) 03:16, 26 April 2009 (UTC)Tyger25


In my opinion, it is tightness of the muscles joined by the transverse carpal ligament that is causing the pressure. The nerve compression isn't causing these muscles to waste. The tightness, which can be handled like any other muscle tightness, is causing the compression.

Something is causing the ligament to be tight. It has muscles on either end. Aren't tight muscles on either end of that ligament going to create tension in the ligament?

Stretchwithme (talk) 01:22, 23 September 2009 (UTC)

Also, check out this image: http://en.wikipedia.org/wiki/File:Gray423.png See the common sheath around the flexor digitorum sublimis and profundus? Stiffness of this sheath maybe the cause of the pressure on the nerve as well. Massage can break up the adhesions surrounding this sheath.

Stretchwithme (talk) 14:13, 23 September 2009 (UTC)

I am sympathetic to massage therapists attempt to somehow relate muscle tightness to carpal tunnel sydrome directly. Firstly, the transverse carpal ligament is a "ligament" (go figure). Ligaments by definition anchor bone to bone without the intervention of muscle. No muscle involved. Muscular atrophy is SO solidly caused by denervation which is SO solidly casued by nerve compression. Also, there is no "sheath" of significance seperate from the carpal tunnel itself, which is created by bone and ligament (passive structures, no muscle involved). They form a rigid conduit, that does not change much in dimension after growth ends. A massage therapist would be better off selling edema control, as the swelling in the soft tissues (flexor tenosynovium) is the culprit here. However, as massage is lovely and nice, it is palliative, giving only transient relief. —Preceding unsigned comment added by 173.10.94.65 (talk) 17:27, 25 March 2010 (UTC)

An Answer At Last[edit]

there were too many symptoms that i couldn't ignore, now a year after being diagnosed with cts, i have discovered that i have a thyroid problem - an under active one at that - hypothyroidism. Its more common than anyone thinks and this symoptom is actually a rather common one to indicate hypothyroidism.

Jashca (talk) 13:11, 22 June 2009 (UTC)

Removal of "caused by sexual intercourse" section[edit]

I've pulled these edits from the article:

Carpal tunnel syndrome can be caused by sexual intercourse when either the male or the female partner uses the wrists as anchors to support the weight of the upper body, which puts tremendous pressure on the wrists. Add to that the repetitive motion needed to achieve orgasm and you have the perfect recipe for carpal tunnel syndrome(author=Zenian J title=The role of sexual intercourse in the etiology of carpal tunnel syndrome.journal= Med Hypotheses year=2010 date=Jan 7 {Epub ahead of print}. The reason why no one has yet come forward to blame sexual intercourse for his/her condition is because sexual intercourse is considered a normal avtivity. Besides, it takes several hours after the initial injury for the symptoms of carpal tunnel syndrome to develop, during which time most people are asleep, having had sex just before going to sleep. The first time patients become aware of their condition is when they wake up in the morning or when they try to use their hands later that day by which time it is too late to make the connection between sexual intercourse and carpal tunnel syndrome.

Medical Hypotheses is not considered a reliable source (per WP:MEDRS). -- MarcoTolo (talk) 15:29, 27 January 2010 (UTC) hulla baloo

Editorial Comments[edit]

Need to rename ‘Frequency’ section as ‘Prevalence’. and put near top of the document

All anatomical structure (median nerve, carpal tunnel, any muscles/bones) should be linked to another page using the double brackets.

Under Physiotherapy, create a link for physiotherapy and occupational therapy

Needs a section on stretching, perhaps with some pictures. Scholarchanter (talk) 01:00, 1 June 2010 (UTC)

So, have you started, yet? — Preceding unsigned comment added by Ragityman (talkcontribs) 14:00, 11 December 2010 (UTC)

Active devices need cleanup[edit]

I moved the following section below to here because reinsertion of any of it needs some cleanup first, including:

  • Scientific evidence of efficacy in CTS, that is basically, some references
  • Rewrite to summarize concepts rather than seemingly to advertising individual brands

Now it looks like only the bottom part is of interest: In short there is no study or paper that shows that these over the counter devices work. Mikael Häggström (talk) 14:22, 27 June 2010 (UTC)

Active medical devices[edit]

Newer types of treatments are emerging which are both palliative and physiologically modifying. These are active medical devices. While braces or splints have been used palliatively, the newer designs attempt to influence the pathophysiology of carpal tunnel syndrome and attempt to reverse its causes.

The newest of these is the Carpal Therapist which is an electrically powered massaging device worn on the wrist and arm. The principle is that manipulative therapy, which is generally effective in alleviating symptoms of carpal tunnel syndrome, can be reproduced mechanically. Therefore, deep tissue massaging is produced by the device in a particular pattern in order to attenuate the tendons and to drain interstitial fluid from the inflamed carpal tunnel. This combined effect reduces the pressure inside the carpal tunnel and therefore alleviates the symptoms caused by median nerve compression.

Another active medical device is The Carpal Solution. It is composed of a series of adhesive tape strips, which, when applied in a certain orientation, reportedly initiates stretching and re-shaping of the wrist’s anatomy. The re-shaping produces less strain inside the carpal tunnel, and therefore relieves the pressure on the median nerve.

Yet another device called WristTrac is a brace with a built-in traction system. The hand is placed into the brace and a knob is used to manually increase tension (traction) on the wrist. This presumably results in stretching of the wrist tendons, which in turn attenuates them within the carpal tunnel. It is thought that this results in less inflammatory pressure and therefore reduced pain.

In short there is no study or paper that shows that these over the counter devices work. Indeed the natural history of carpal tunnel symptoms may be of exacerbations and remissions and often something may seem to work when in fact it has no real long term effect.

Crashing Firefox[edit]

This page keeps crashing firefox for me. 70.26.75.218 (talk) 00:27, 23 August 2010 (UTC)

Very strange formulation in opening section (intentionally tight area)[edit]

I am no medical expert, but the following sentence is problematic:

The carpal tunnel is an intentionally tight area and it seems that the variation occasionally tends towards "too tight".
Intentionally?
Whose intention?
Gods? Evolutions?
I don't think we need God's intentions in this article, and evolution doesn't have a goal/intention anyway.
So "Intentionally" is a poor formulation and seems to say more about the worldview of the author than CTS.
I suggest removing the word completely.
(Since I am no medical expert I won't change the main article, just in case I misunderstand something completely about the use of the word "intentionally". I hope somebody else can confirm this and change it.)
80.101.129.221 (talk) 09:56, 13 January 2011 (UTC)Erwin Moller

"A predominance of pain rather than numbness is unlikely to be caused by carpal tunnel syndrome no matter what the result of electrophysiological testing." Can't see citation, but found the citation. Can someone add?[edit]

Don't know of any International Standard Serial Number (ISSN) citation tool. I'm new to this.

CARPEL TUNNEL SYNDROME : A REVIEW Gadhave S. V.1*, Moon R.S., Kshirsagar R.V. 1Department of pharmaceutics, School of Pharmacy, SRTM University Nanded-431606, Maharashtra.

Publication Ref No.: IJPRD/2011/PUB/ARTI/VOV-2/ISSUE-12/FEB/017 ISSN 0974 – 9446

http://www.ijprd.com/CARPEL%20TUNNEL%20SYNDROME%20_%20A%20REVIEW.pdf

"A predominance of pain rather than numbness is unlikely to be caused by carpal tunnel syndrome no matter what the result of electrophysiological testing."

Thanks — Preceding unsigned comment added by 68.149.158.238 (talk) 10:03, 28 February 2012 (UTC)

Extrapolating the patient population from one study[edit]

I am confused by the statement in Carpal tunnel syndrome#Work related, "in one recent representative series of a consecutive experience, most patients were older and not working". It is supported by [1].

  1. ^ LOZANOCALDERON, S (1 March 2008). "Patient Satisfaction After Open Carpal Tunnel Release Correlates With Depression". The Journal of Hand Surgery. 33 (3): 303–307. PMID 18343281. doi:10.1016/j.jhsa.2007.11.025.  Unknown parameter |coauthors= ignored (|author= suggested) (help)

I don't have access to this paper and would like some help from anyone who does.

  1. What is the meaning of "representative series of a consecutive experience".
  2. The paper does not appear to be about epidemiology. Is our use of the paper an instance of synthesis or is the paper a good source for statements that
    1. most CTS patients are older and not working and
    2. this means CTS is unlikely to be work related

Jojalozzo 21:18, 12 March 2012 (UTC)

I have just read it, can email you the pdf if you like but it's probably not worth it. The 'representative from consecutive experience' means that they took a random sample of 200 patients out of 917 operated by a single surgeon between 2000 and 2004 - they did this in 2006 so they were asking patients about their symptoms 2 years or more after surgery.

The paper is indeed not about epidemiology - it was designed to assess whether long term post-operative satisfaction could be related to some other variables with a particular focus on depression. Unsurprisingly they found that depressed people thought their hand symptoms were worse. That does not of course necessarily indicate causation - having bad hands might well increase your chance of being depressed and depression might make your hand symptoms feel worse, or they may both be related to a third variable. The other, again unsurprising, finding is that patients with more severe disease tend to have lower satisfaction/function.

So far as age and work status is concerned - the return rate from their sample was 82/200, ten were unemployed/disabled and 26 retired, 25 desk work, 17 light duty and 4 heavy duty - so 56% were working, and presumably more may have been when they were operated. Age range was 34-92y with a mean 61y SD 12.8 - they quote these figures like this so I guess the age distribution was approximately normal. I'm not sure whether that justifies describing them as 'older' - which is a remarkably vague term.

The authors said nothing in their discussion about CTS being work-related one way or the other but this study really adds nothing useful to the body of knowledge on either epidemiology or work-relatedness. All studies derived from surgical series are highly unrepresentative because few people with CTS ever get to surgery and the ones that do have been highly selected to begin with. This particular study then involves two further selection processes. Firstly this surgeon only ever operated on people with abnormal NCS and secondly the sample who returned the postal questionnaires are self selected and may not be representative even of the 917 cases they started with.

I haven't edited the body of the wiki article because I've made a decision not to get involved with trying to maintain two information sources on CTS but this particular reference should probably not be linked in this way. Curiously however, in my own practice, most patients are indeed 'older and not working' but this is not the right study to support that view.

Dr Jeremy D P Bland 29th May 2012 — Preceding unsigned comment added by Jeremydpbland (talkcontribs) 18:31, 29 May 2012 (UTC)

Ambiguous[edit]

An image refers to left and right hands, but the right hand is on the left, and the left hand is on the right, and it is difficult to tell which hand the image is referring to. — Preceding unsigned comment added by 125.253.96.100 (talk) 11:34, 6 May 2012 (UTC)

"There is little clinical data to prove whether repetitive and forceful movements of the hand and wrist during work or leisure activities can cause carpal tunnel syndrome. Other disorders such as bursitis and tendonitis have been associated with repeated"[edit]

"There is little clinical data to prove whether repetitive and forceful movements of the hand and wrist during work or leisure activities can cause carpal tunnel syndrome. Other disorders such as bursitis and tendonitis have been associated with repeated motions performed in the course of normal work or other activities."

http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm — Preceding unsigned comment added by Bboyjkang2 (talkcontribs) 03:30, 7 June 2013 (UTC)

Trimmed this[edit]

"A type of therapy gaining in popularity aims to actually reverse the underlying cause of carpal tunnel syndrome by altering the anatomy and physiology of the carpal tunnel. This therapy can be applied using a device that actively changes soft tissues by reducing tendon micro-adhesions and inflammation. The [[Carpal Rx]] accomplishes this by producing a deep tissue massage called myofascial release over the wrist and forearm. This motion results in reduced compression on the median nerve and ultimately, alleviation of symptoms. [1]"

  • Study does not appear to be pubmed indexed.
  • Data was 36 patients who received therapeutic message. There was no control group. Gah it is amazing what can get published. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:38, 8 June 2014 (UTC)

Contradicting statements regarding birth control pills causing CTS?[edit]

In the introduction:

"The use of birth control pills does not affect the risk."

But in the causes section:

"Some common conditions that can lead to CTS include obesity, oral contraceptives, [...]"

Seems like one of these needs correction. I don't know which one though. The second has a cite for the entire sentence, but the article is paywalled so I can't confirm citedness.

ChristopheBiocca (talk) 13:28, 30 May 2016 (UTC)

Thanks for pointing this out and updated Doc James (talk · contribs · email) 09:33, 31 May 2016 (UTC)

Review[edit]

Lancet Neurology doi:10.1016/S1474-4422(16)30231-9 JFW | T@lk 22:47, 12 October 2016 (UTC)

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  1. ^ http://bjp.sagepub.com/content/8/2_suppl/5.full.pdf#page=34