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‘Carpal tunnel syndrome’ can be cured with medication

Carpal tunnel syndrome describes a very common and progressively painful/benumbed hand condition caused by a pinched nerve in your wrist. This is commonly referred as “CTS” in medical jargon. Several factors can contribute to carpal tunnel syndrome, including the structure of your wrist, certain underlying health problems and possibly patterns of hand use.

Carpal tunnel is a narrow passageway on the palm side of the wrist bound by bones and ligaments. The tunnel protects a main nerve to your hand and nine tendons that bend your fingers. Pinching of this nerve produces the numbness, pain and, eventually, hand weakness leading to “carpal tunnel symptoms”.

For most people who develop carpal tunnel syndrome, proper treatment usually can relieve the pain and numbness and restore normal use of their wrists and hands.

What are the symptoms?

Carpal tunnel syndrome typically starts gradually with a vague aching in your wrist that can extend to your hand or forearm. The common carpal tunnel symptoms include: Tingling or numbness in your fingers or hand, especially your thumb and index, middle or ring fingers, but not your little finger. This sensation often occurs while holding a steering wheel, phone or newspaper or upon awakening. Many people “shake out” their hands to try to relieve their symptoms.

As the disorder progresses, the numb feeling may become constant. Pain radiating or extending from your wrist up your arm to your shoulder or down into your palm or fingers, especially after forceful or repetitive use. This usually occurs on the palm side of your forearm.

This can get confused with another common neurological problem in hand due to pinched nerve in the neck, called cervical radiculopathy. A sense of weakness in your hands and a tendency to drop objects:

If you have persistent signs and symptoms suggestive of carpal tunnel syndrome, especially if they interfere with your normal activities and sleep patterns, you need to see your doctor. If you leave the condition untreated for long time, nerve and muscle damage can occur.

Risk factors

A number of factors has been associated with carpal tunnel syndrome. Although by themselves they don't cause carpal tunnel syndrome, they may increase your chances of developing or aggravating median nerve damage. These include: Structural abnormalities. A wrist fracture or dislocation that alters the space within the carpal tunnel can create extraneous pressure on the median nerve. Also, carpal tunnel syndrome is generally more common in women. This may be because the carpal tunnel area is relatively smaller than in men. Women who have carpal tunnel syndrome may also have smaller carpal tunnels than women who don't have the condition.

Nerve-damaging conditions

Some chronic illnesses, such as diabetes and alcoholism, increase your risk of nerve damage, including damage to your median nerve.

Inflammatory conditions

Illnesses that are characterised by inflammation, such as rheumatoid arthritis or an infection, can affect the tendons in your wrist, exerting pressure on your median nerve. Increase of body fluids. Certain conditions such as pregnancy, menopause, obesity, thyroid disorders and kidney failure, can affect the level of fluids in your body. Fluid retention may increase the pressure within your carpal tunnel, irritating the median nerve. Carpal tunnel syndrome associated with pregnancy generally resolves on its own after the pregnancy is over.

Work related factors

It's possible that using vibrating tools or on an assembly line that needs prolonged or repetitive flexing of the wrist may create harmful pressure on the median nerve, or worsen existing nerve damage.

These are our general observations but these factors haven't been established as direct causes of carpal tunnel syndrome. There is also little evidence to support extensive computer use as a risk factor for carpal tunnel syndrome, although it may cause a different form of hand pain.

Treatment

Patients with mild symptoms of carpal tunnel syndrome can reduce their discomfort by taking more-frequent breaks to rest their hands. Applying cold packs to reduce occasional swelling is also recommended temporary measure. If these techniques don't offer relief within a few weeks, additional treatment options include wrist splinting, medications and surgery. Splinting and other conservative treatments are more likely to help you if you've had only mild to moderate symptoms for less than 10 months.

Nonsurgical therapy

If the condition is diagnosed early, nonsurgical methods may help improve carpal tunnel syndrome. Methods may include:Wrist splinting. A splint that holds your wrist still while you sleep can help relieve night time symptoms of tingling and numbness. Nocturnal splinting may be a good option if you are pregnant and have carpal tunnel syndrome. Splinting is not widely used in our country.

Drugs

A group of drugs called non-steroidal anti-inflammatory drugs/NSAIDs may help relieve pain from carpal tunnel syndrome in the short term. However, there's no evidence, that these drugs can actually improve the carpal tunnel syndrome itself.

Steroid Injection

Your doctor may inject your carpal tunnel with a steroid, to relieve your pain. Steroids decrease inflammation and swelling, which relieves pressure on the median nerve. Oral corticosteroids are not considered as effective as corticosteroid injections for treating carpal tunnel syndrome. If carpal tunnel syndrome results from an inflammatory arthritis, such as rheumatoid arthritis, then treating the underlying condition may reduce symptoms of carpal tunnel syndrome.

Surgery

If your symptoms are severe or persist after trying non-surgical therapy, surgery may be the best option. Endoscopic surgery: Carpal tunnel surgery can be done using an endoscope, a telescope-like device with a tiny camera attached to it that allows your doctor to see inside your carpal tunnel and perform the surgery through small incisions in your hand or wrist. This technique is not widely available in Sri Lanka.

Open surgery

In most cases, surgery involves making a larger incision in the palm of your hand over the carpal tunnel and cutting through the ligament to free the nerve. This surgery is a 10 minute minor procedure and can be done as a day case under local anaesthesia. You will be encouraged to use your hand after surgery, gradually working back to normal use of your hand while avoiding forceful hand motions or extreme positions of your wrist. Soreness or weakness may take from several weeks to as long as a few months to resolve after surgery. If your symptoms were very severe before surgery, symptoms may not go away completely after surgery.

What are the home remedies that can be helpful?

These may help you gain at least temporary relief from your symptoms:

Take quick breaks from repetitive activities involving the use of your hands. Rotate your wrists and stretch your palms and fingers. Take a pain reliever, such as ibuprofen or naproxen or others. Try wearing a wrist splint at night. Wrist splints are generally available at some pharmacies.

Avoid sleeping on your hands to help ease the pain or numbness in your wrists and hands. If pain, numbness or weakness recurs and persists, see your doctor.

Are there any lifestyle changes for prevention?

There are no proven strategies to prevent carpal tunnel syndrome, but you can minimise stress on your hands and wrists by taking the following precautions: Reduce your force and relax your grip. Most people use more force than needed to perform many tasks involving their hands. If your work involves a cash register, for instance, hit the keys softly. For prolonged handwriting, use a big pen with an oversized, soft grip adapter and free-flowing ink. This way you won't have to grip the pen tightly or press as hard on the paper.

Take frequent breaks. Give your hands and wrists a break by gently stretching and bending them periodically.

Alternate tasks when possible. If you use equipment that vibrates or that requires you to exert a great amount of force, taking breaks is even more important. Watch your hand position. Avoid bending your wrist all the way up or down. A relaxed middle position is best. If you use a keyboard, keep it at elbow height or slightly lower.

Improve your posture

Incorrect posture can cause your shoulders to roll forward. When your shoulders are in this position, your neck and shoulder muscles are shortened, compressing nerves in your neck. This can affect your wrists, fingers and hands.

Carpal tunnel syndrome is a very common condition which is easy to diagnose and treat. If left unattended it can lead to significant morbidity and disability.

Still significant number of cases are overlooked or misdiagnosed. Most important step in diagnosing this condition is a proper nerve conduction study performed by a qualified clinical neurophysiologist. This will not only confirm the diagnosis but also assess the severity and exclude any other mimicking conditions. By this way it is assured to get 100 percent success with surgery.

The writer is Consultant Clinical Neurophysiologist, Teaching Hospital, Kandy


Artificial livers, a step closer

Prometheus, the mythological figure who stole fire from the gods, was punished for this theft by being bound to a rock. Each day, an eagle swept down and fed on his liver, which then grew back to be eaten again the next day.

Modern scientists know there is a grain of truth to the tale, says MIT engineer Sangeeta Bhatia: The liver can indeed regenerate itself if part of it is removed. However, researchers trying to exploit that ability in hopes of producing artificial liver tissue for transplantation have repeatedly been stymied: Mature liver cells, known as hepatocytes, quickly lose their normal function when removed from the body. “It's a paradox because we know liver cells are capable of growing, but somehow we can't get them to grow” outside the body, says Bhatia, a senior associate member of the Broad Institute.

Now, Bhatia and colleagues have taken a step toward that goal. In a paper appearing in the June 2 issue of Nature Chemical Biology, they have identified a dozen chemical compounds that can help liver cells not only maintain their normal function while grown in a lab dish, but also multiply to produce new tissue. Cells grown this way could help researchers develop engineered tissue to treat many of the 500 million people suffering from chronic liver diseases such as hepatitis C, according to the researchers.

Large-scale screen

Bhatia has previously developed a way to temporarily maintain normal liver-cell function after those cells are removed from the body, by precisely intermingling them with mouse fibroblast cells. For this study, the research team adapted the system so that the liver cells could grow, in layers with the fibroblast cells, in small depressions in a lab dish.

This allowed the researchers to perform large-scale, rapid studies of how 12,500 different chemicals affect liver-cell growth and function.

The liver has about 500 functions, divided into four general categories: drug detoxification, energy metabolism, protein synthesis and bile production.

David Thomas, an associate researcher, measured expression levels of 83 liver enzymes representing some of the most finicky functions to maintain.

After screening thousands of liver cells from eight different tissue donors, the researchers identified 12 compounds that helped the cells maintain those functions, promoted liver cell division, or both.

Two of those compounds seemed to work especially well in cells from younger donors, so the researchers - including Robert Schwartz, and Stephen Duncan, a professor of human and molecular genetics at the University of Wisconsin - also tested them in liver cells generated from induced pluripotent stem cells).Scientists have tried to create hepatocytes from iPSCs before, but such cells don't usually reach a fully mature state.

However, when treated with those two compounds, the cells matured more completely.

Bhatia and her team wonder whether these compounds might launch a universal maturation program that could influence other types of cells as well. Other researchers are now testing them in a variety of cell types generated from iPSCs. In future studies, the MIT team plans to embed the treated liver cells on polymer tissue scaffolds and implant them in mice, to test whether they could be used as replacement liver tissues. They are also pursuing the possibility of developing the compounds as drugs to help regenerate patients’ own liver tissues.

Making connections

Bhatia and colleagues have also recently made progress towards solving another challenge of engineering liver tissue, which is getting the recipient's body to grow blood vessels to supply the new tissue with oxygen and nutrients. In a paper published in the Proceedings of the National Academy of Sciences in April, Bhatia and Christopher Chen, a professor at the University of Pennsylvania, showed that if preformed cords of endothelial cells are embedded into the tissue, they will rapidly grow into arrays of blood vessels after the tissue is implanted.

To achieve this, Kelly Stevens in the Bhatia lab worked with Peter Zandstra at the University of Toronto to design a new system that allows them to create 3-D engineered tissue and precisely control the placement of different cell types within the tissue. This approach, described recently in the journal Nature Communications, allows the engineered tissue to function better with the host tissue.

“Together, these papers offer a path forward to solve two of the longstanding challenges in liver tissue engineering - growing a large supply of liver cells outside the body and getting the tissues to graft to the transplant recipient,” Bhatia says.

- MNT

 

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