Carpal Tunnel Syndrome in Diabetes

S.Bamila

M.V. Centre for Diabetic Foot Care, Podiatry, Research & Management

Diabetes, alcoholism and obesity are medical problems that are associated with carpal tunnel syndrome

This is also common among people who perform repetitive motions of the hand and wrist. Typing on a computer keyboard is probably the most common cause of carpal tunnel syndrome. Other causes include sewing, driving, writing, playing some musical instruments, painting and so on.

The median nerve in the wrist supplies feeling and movement to parts of the hand. The area in your wrist where the nerve enters the hand is called the carpal tunnel. Carpal tunnel syndrome is pressure on the median nerve, and this can lead to numbness, tingling, weakness, or muscle damage in the hand and fingers. The condition occurs most often in people between 30 and 60 years, and is more common in women than in men. It also has a higher prevalence in people with diabetes and other conditions which directly affect the nervous system.


What causes Carpal Tunnel Syndrome?

* Doing the same action over and over again
* Uncomfortable joint posture
* High force
* Vibration
* Direct pressure
* Uncomfortable posture for a long time

Symptoms

* Numbness or tingling sensation in the thumb and the next two or three fingers of one or both hands
* Numbness or tingling sensation in the palm
* Pain spreading right up to the elbow
* Pain in the wrist or hand/s
* Problems with fine muscle coordination in one or both hands
* Wasting away of the muscle under the thumb (in advanced or long-term cases)
* Weak grip or difficulty in carrying heavy things like bags (a common complaint)
* Weakness in one or both hands
* Interruption of sleep with numbness and in pain in hands
* Poor circulation of blood in hands resulting in a temporary lack of sensation
* Cold hands
* Dropping objects especially small things.
* Loss of Grip Strength by Fore arms

Signs and Tests


Untreated CTS

* Numbness in the palm, thumb, index finger, middle finger, and thumb side of the ring finger
* Weak hand grip
* Tapping over the median nerve at the wrist may cause pain to shoot from the wrist to the hand (this is called Tinel's sign)
* Bending the wrist forward all the way for 60 seconds will usually result in numbness, tingling, or weakness (this is called Phalen's test)


* Electromyography
* Nerve conduction velocity
* Wrist X-rays should be done to rule out other problems like wrist arthritis
* MRI scan, ultrasound imaging

Using wrist splint at night or during sport activities, high-frequency sound waves directed toward the inflamed area , alternating warm and cold soaks, restricted movement, Vitamin B6 and acupuncture are some forms of treating this. Some stretching exercises can be done to prevent re-occurrence.

* Stretching exercises for Carpal Tunnel Syndrome


Pull forward and stretch both wrists and fingers as if they are in a hand-stand position. Hold for a count of 5.


Straighten both wrists and relax fingers.


Make a tight fist with both hands.


Then bend both wrists down while keeping the fist. Hold for a count of 5.


Straighten both wrists and relax fingers, for a count of 5.


Repeat the exercise (a-f) 10 times

Then let your arms hang loosely at the side and shake them for a few seconds.

* Wrist Curls without Weights: Sit in a chair with your forearm resting on your thigh (or on a table) keeping your palm up or palm down. Turn your wrist up about 2 to 3 inches and then slowly lower it down. Repeat 20 times.

* Shrugs

Stand with your arms by your sides. Lift your shoulders up to your ears and hold for 1 second. Then pull your shoulders back pinching your shoulder blades together. Hold for 1 second. Relax your shoulders. Do this 20 times.



Reference:

* Carpal Tunnel Syndrome in Patients with Diabetic Polyneuropathy : Bruce A Perkins, FRCPC; David Olaleye, PHd; Vera Bril, MD FRCPC

* Dr. Housang Seradge at the University of Oklahoma Orthopaedic & Reconstructive Research Foundation:
(http://ortho-ok.com.orrf.ORRF_CARPAL_TUNNEL_PREVENTION.html)

* Carpal Tunnel Syndrome Exercises – En Espanol
(http://www.medicinenet.com/carpal_tunnel_syndrome/article.html)

* [Carpal tunnel syndrome in diabetes mellitus].[Article in German]Bahrmann A, Zieschang T, Neumann T, Hein G, Oster P.