Orthopaedic Surgery/Carpal Tunnel Syndrome

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Orthopaedic Surgery

INTRODUCTION · AUTHORS · ACKNOWLEDGEMENTS · NOTE TO AUTHORS
1.Basic Sciences · 2.Upper Limb · 3.Foot and Ankle · 4.Spine · 5.Hand and Microsurgery · 6.Paediatric Orthopaedics · 7.Adult Reconstruction · 8.Sports Medicine · 9.Musculoskeletal Tumours · 10.Injury · 11.Surgical Procedures · 12.Rehabilitation · 13.Practice
Current Chapter: Upper Limb

Carpal Tunnel Syndrome
<<Compound Palmar Ganglion Distal Radius Fractures>>



What causes carpal tunnel syndrome? It is a bit like asking what causes traffic jams. It depends; many things. but then it all amounts to the same thing; sitting in traffic. On the other hand, the cause is nice to know as it is likely to influence how long you will be sitting there. If it was an accident, then the delay will be self limiting, if it was a cave in at the tunnel ahead then you had best figure a way to turn around. Similarly carpal tunnel syndrome can come about as a result of unaccustomed use. Use of the hands it seems can result in a transient thickening of the lubricating linings around the tendons. Their cumulative volume being increased has the effect of increasing the volume of tissue transiting the carpal tunnel, and a choke point is created. But the tendons do not come completely to rest, they continue to move as does the nerve only with more friction, and a higher interstitial pressure with resultant venous congestion, possibly leading to intercalary segment ischemia of the nerve, even eventual fibrosis. So it seems that whatever the initial cause of the traffic jam, secondary accidents happen as well as road rage and the situation eventually can become a nightmare. Why did they not make the road bigger in the first place? That is all well and good, however do we all wish to lug about great thick appendages with lots of room for all moving parts, how unwieldy would that be?

So it seems we know a bit more about what it is like to be in a traffic jam than we know about how to prevent traffic jams. We know what is happening to the nerve in carpal tunnel syndrome, we know what to watch for when it is coming on, we know who tends to get it. Life deals us some interesting problems, menapause means the tissues, have retained more fluid, the volume of the tendon, perineurium and tenosynovium collectively is enlarged and the space must be made larger to accommodate the change.

What causes carpal tunnel syndrome may be the question that is voiced, but the question being asked is really this. Who needs to pay for the surgery and the recovery and any residual disability from this carpal tunnel syndrome. It matters then whether the cars have gotten larger and slower, or whether there was a land slide on the roadway. The fix it different and the fault lies with different responsible parties.

Investigators may continue to work on what we mean by thickening. Are the tissues inflammed, are they bogged up with insoluble protein debris?Surgeons can work on ways to make the road way bigger without holding up the works too long. Epidemiologists and occupational medicine specialists and rheumatologists can hold forth on whats to be done to lessen the probability of the occurrence and individuals can listen to their bodies and live in harmony with their physiologic limits but when all is said and done we are likely to be dealing with carpal tunnel syndrome for some time to come.