Carpal Tunnel Syndrome
Carpal Tunnel Syndrome
Carpal tunnel syndrome is a common source of hand numbness and pain caused by compression of the median nerve. The carpal tunnel is a narrow, tunnel-like structure in the wrist. The bottom and sides of this tunnel are formed by wrist (carpal) bones. The top of the tunnel is covered by a strong band of connective tissue called the transverse carpal ligament. The median nerve travels from the forearm into the hand through this tunnel in the wrist and can become irritated by the tendons that bend the fingers and thumb that also travel through the carpal tunnel.
- Numbness or pain in your hand, sometimes worst at night
- Occasional hand tingling, numbness, or pins-and-needles sensation
- Numbness or pain that worsens with use
- Hand or wrist pain with typing on a computer
- Difficulty or pain with gripping, twisting, etc.
Thoracic Outlet Syndrome
The thoracic outlet is the space between your collarbone (clavicle) and your first rib. This narrow passageway is crowded with blood vessels, muscles, and nerves. Spasm and shortening from the pectoralis minor muscle can be a common source for compression to these vascular and nerve structures. At times people are born with an extra set of ribs called cervical ribs which can also compromise this space. Sometimes weak muscles in your chest are unable to hold the collarbone in place, putting pressure on the nerves and blood vessels that lie under it.
Symptoms depend on which nerves or blood vessels are compressed.
- Pressure on brachial plexus nerves with numbness, tingling into hands
- Pressure on the Axillary artery blood vessels can give the feeling like your arm is “asleep”
- Overhead activities worsen both types of compression
- Cold feeling in the hands, lack of circulation
- Your range of motion may be limited.
Tenosynovitis de Quervain – Thumb Injury
De Quervain’s tendinosis occurs when the tendons of the extensor pollicis brevis and abductor pollicis longus muscles become injured and inflamed. Swelling of the tendons and the tendon sheath can cause pain and tenderness along the thumb side of the wrist. This is particularly noticeable when forming a fist, grasping or gripping something, or when turning the wrist.
Signs of De Quervain’s tendinosis:
- Pain may be felt over the thumb side of the wrist. The pain is usually worse when the hand and thumb are in use. This is especially true when forcefully grasping objects or twisting the wrist.
- Swelling may be seen over the thumb side of the wrist.
- A “catching” or “snapping” sensation may be felt when moving the thumb.
- Pain and swelling may make it difficult to move the thumb and wrist.
Wrist or Hand Sprain/Strain Injuries
A wrist sprain is an injury to a ligament. Ligaments are strong bands of connective tissue that connect one bone to another. A wrist strain is an injury to the muscle or tendon. Tendons bind muscles to bones. Both are a common injury. There are many ligaments and tendons in the wrist that can be stretched or torn, resulting in a sprain or a strain. This occurs with an acute injury like a fall or can happen due to repetitive overuse jobs requiring the use of hands.
Wrist sprain symptoms may vary in intensity and location.
- Swelling in the wrist
- Persistent pain when you move your wrist
- Bruising or discoloration of the skin around the wrist
- Tenderness at the injury site
- A feeling of popping or tearing inside the wrist
- A warm or feverish feeling to the skin around the wrist
Trigger finger limits finger movement. When you try to straighten your finger, it will lock or catch before popping out straight. Trigger finger is a condition that affects the tendons in your fingers or thumb and progressively worsens over time. The tendon sheath attaches to the finger bones and keeps the flexor tendon in place as it moves. Injury occurs when the tight tendons rub in the protective sheath causing friction and gradual wear and tear.
Symptoms of trigger finger may include:
- A tender lump in your palm
- Catching when flexing and extending fingers
- Swelling in hand
- Popping sensation in your finger or thumb joints
Tendonitis and tenosynovitis are types of tendon injuries. They often occur together. The most common cause is the overuse of the affected tendon. Most of the time there is an injury, or several repeated small injuries or tears, to the tendon. This may initially cause some inflammation of the tendon. But, in the longer term, if these repetitive injuries continue, it can lead to tendon damage (degeneration). Computer work has become one of the leading causes of these conditions.
Tendonitis and tenosynovitis are types of tendon injury.
- Tendonitis means inflammation of a tendon that involve acute injuries accompanied by inflammation.
- Tendinosis means chronic degeneration of a tendon without inflammation. This is from failed healing of repetitive minor injuries rather than acute injury.
- Tendinopathy is a more general term than tendonitis and tendinosis and just means tendon injury, often chronic in nature.
- Tenosynovitis means inflammation of the sheath that surrounds a tendon. (The sheath is called the synovium.)