What Are The Carpal Bones?
The carpal bones are known far more commonly as the wrist. In actual terms, the wrist is a region made up of eight small bones, the carpal bones, that sit together in an arch-shaped cluster. They are:
Their positioning allows for the range of motion of your wrist, and the positions that you can (and cannot) flex your hand into.
They are held together, and to your arm and hand, by a network of ligaments. The development of these bones occurs during childhood and may not be fully complete until the age of 12.
Carpal bones come into common parlance these days by way of their connection to the carpal tunnel and the common affliction in that area – carpal tunnel syndrome.
The carpal tunnel can think of as the passage from the hand to the arm, bounded by the carpal bones and the flexor retinaculum, which is a region of connective tissue on the palm side of your wrist.
The carpal tunnel also contains tendons from surrounding muscle tissue and the median nerve. The median nerve runs all the way from the shoulder to the hand, with its branches supplying the muscles and skin of the hand.
And many of the muscles in the forearm, with the feeling of sensation and the signals to coordinate movement.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is known shorthand as CTS. The symptoms are tingles and numb sensations in the hand, leading to aches and pains, usually in the region from the thumb to the ring finger.
CTS troubles sufferers with its persistence and propensity to spread around the hand, wrist, and forearm area. Some people even have pains going up as far as the elbow. Over time the syndrome can lead to other effects, such as swelling and dryness of the hand, a loss insensitivity, and even muscle tissue wasting away.
The symptoms are stronger at night, but can be a hindrance at any time of the day as being able to perform everyday dextrous tasks starts to become a struggle.
It isn’t actually problems with the carpal bones or the muscles in the wrist directly that cause the symptoms of carpal tunnel syndrome, but the median nerve.
What happens is that it becomes compressed at the wrist area, and this can hamper the sense of touch and interfere with the processing of signals to make movements.
But what can compress the median nerve to start these problems in the first place? Mainly it’s due to tissue swelling around it, or narrowing of the carpal tunnel itself.
This can happen for a range of reasons and particularly known to happen to people whose professions or hobbies involve extended periods where the wrist is being repeatedly bent, vibrated, or controlling a tightly gripped hand.
So this could mean operating machine tools that vibrate, playing an instrument, or repetitive labor jobs.
More direct injury to the hand, such as a fracture, sprain, or swelling, can give similar results to adding pressure to the median nerve. Carpal tunnel syndrome can appear as a symptom of arthritis.
However, there are less apparent conditions in which CTS can also feature, such as obesity, diabetes, and an underactive thyroid.
There are a few mysteries around CTS. First of all, it is clear that some people are more prone than others. There is speculation as to whether small differences in anatomy can lead to some being more at risk than others.
A person’s risk factor is known to have genetic roots since many sufferers have a relative who also a sufferer. More mysterious still is why carpal tunnel syndrome can appear during pregnancy (and disappear afterward) or the menopause.
Treatment of Carpal Tunnel Syndrome
The first step to treatment is a successful diagnosis, which constitutes some simple physical demonstrations. An old way of diagnosing was to tap the wrist and see if that caused any tingles.
However, a more modern approach is to hold the wrist above the head for a minute, which in theory should cause the symptoms to appear.
It can be necessary to augment this with other types of tests. If other issues accompany the symptoms, a blood test will carry out for a more detailed understanding. Sometimes there is concern over the wellbeing of the nerves in your hand, and the consultant will perform what is known as a nerve conduction study.
This involves placing electrodes at points on your hand and running a gentle electric charge between. Seeing how the tissue reacts will reveal the extent of any nerve damage. Sometimes ultrasound imaging is required.
The primary strategy for treating carpal tunnel under most circumstances is to avoid carrying out the tasks that exacerbate the issue. However, there are obvious problems here where physical activity is a significant part of their financial livelihood, and merely taking painkillers obviously doesn’t make things any better in the long run.
A standard solution, therefore, is to use a wrist splint (UK: Wrist Support – US: Wrist Support), which provides physical support for the affected hands. This may single-handedly (excuse the pun) deal with the issue, although carpal tunnel can take months to entirely subside. Swelling can manage with a corticosteroid injection.
If nothing else works, then surgery is required, although it is a reasonably quick day surgery procedure. With the hand under a local anesthetic, the carpal tunnel depressurized by cutting ligaments in order for there to be less pressure on the median nerve.
This may sound like a drastic but effective way of dealing with the issue quickly but can carry its own set of complications, such as different pains occurring in the region or injury to nerves.
In view of the likely complications of CTS surgery, there are also alternative remedies available that minimize side effects.