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MUSCULO-SKELETAL


CARPAl tUnnEl SYnDRoME


CARPAl tUnnEl SYnDRoME (CtS) CAUSES A tInglIng SEnSAtIon, nUMBnESS AnD SoMEtIMES PAIn In tHE HAnD AnD fIngERS. tIM MCClURE tAKES A looK At tHIS CoMMon, BUt oftEn REStRICtIVE, DISoRDER.


By tim McClure M


usculoskeletal disorders are defined as injuries and disorders affecting the


body’s musculoskeletal system – this includes the joints, muscles, tendons, ligaments, nerves and discs.1


there are over 100 different types of musculoskeletal disorders, ranging from the very common to the extremely rare.2


these disorders can


be episodic or chronic in duration and may progress in their severity over time. though seldom life threatening, musculoskeletal disorders impair the quality of life of a large proportion of the adult population.3


Carpal tunnel syndrome (CtS) is a common musculoskeletal disorder that can affect the activities of daily life and sleep. It is the most common compression neuropathy of the upper


44 - PHARMACY In foCUS


limbs. With most studies citing prevalence at around five per cent in the general population and incidence on the increase, community pharmacists are ideally placed to counsel those affected with CtS in the primary care setting.4


CAUSES the carpal tunnel comprises eight small carpal bones, bound by the carpal ligament that lies across the palm-side of the wrist. Between this ligament and the carpal bones forms a passage called the carpal tunnel, through which various tendons and the median nerve pass. the median nerve gives feeling to the thumb, index and middle fingers and half of the ring finger, in addition to controlling movement of small muscles at the base of the thumb.5


Anything that decreases the amount of space in the carpal tunnel, or


increases the pressure within it can compress the median nerve and potentially lead to symptoms of CtS.6,7


CtS is not known.8 are certain recognised risk factors.


these include: • Activities with high hand/wrist repetition rate


• Pregnancy (up to 50 per cent of pregnant women develop CtS)


• obesity • Injuries to the wrist including fractures


• Patients with rheumatoid arthritis • family history of CtS (about one in four people with CtS have a close family member who also has or had the condition)4,5,7,8


CtS is three times more common is women than men, and becomes more likely as you get older.8 have shown strong evidence to


In most cases, the cause of However, there


support the increased risk of CtS associated with overuse of the hand and wrist in such jobs as assembly line work, gardening and occupations requiring a forceful grip. there is less robust evidence to suggest an association between computer-based work and CtS.7


Interestingly, some


studies show that CtS is actually less common in people who type all day than in those who carry out more strenuous activities.8


SYMPtoMS CtS encompasses a collection of symptoms including intermittent tingling, altered sensation, pain, weakness and impaired fine manipulation.7


Studies


Paraesthesia (pins and needles) is typically the first symptom to develop. this sensory loss is within the distribution area of the affected median nerve (see diagram 1).


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