Carpal Tunnel Syndrome (CTS) in Diabetes

(Median nerve dysfunction; Median nerve entrapment)

Ms. Seena Rajsekar, Ms.S. Bamila

Podiatry Dept. 

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

Causes, incidence, and risk factors

The key risk factors in the workplace that causes the Carpal Tunnel Syndrome include:

• Repetition 
• Awkward joint posture 
• High force 
• Vibration 
• Direct pressure 
• Prolonged constrained posture 

A number of medical problems are associated with carpal tunnel syndrome, including:

• Bone fractures and arthritis of the wrist
• Acromegaly
• Diabetes
• Alcoholism
• Hypothyroidism
• Kidney failure and dialysis
• Menopause, premenstrual syndrome (PMS), and pregnancy
• Infections
• Obesity
• Rheumatoid arthritis

Symptoms

• Numbness or tingling in the thumb and next two or three fingers of one or both hands
• Numbness or tingling of the palm of the hand
• Pain extending to the elbow
• Pain in wrist or hand in one or both hands
• Problems with fine finger movements (coordination) in one or both hands
• Wasting away of the muscle under the thumb (in advanced or long-term cases)
• Weak grip or difficulty carrying bags (a common complaint)
• Weakness in one or both hands
• Interruption of Sleep with Hands Numbness and in Pain 
• Poor Circulation of blood in Hands there by Hands falling asleep 
• Cold Hands 
• Dropping Objects especially small objects. 
• Forearms warm and Loss of Grip Strength by Forearms 

Signs and tests

• 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 (such as wrist arthritis)
• MRI scan, ultrasound imaging

Carpal Tunnel Syndrome(CTS) Treatment 

Treatment of carpal tunnel syndrome should initially be conservative and led by your Doctor. The first period of treatment should include complete rest for the wrist.Following a period of immobilisation, stretching and strengthening exercises can be used to help prevent a reoccurrence of symptoms .IF  symptoms persist over a 6 month period, surgery may be required.

EXERCISES FOR CARPEL TUNNEL SYNDROMES (CTS)

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

B. Straighten both wrists and relax fingers.

C. Make a tight fist with both hands. 

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

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

The exercise should be repeated 10 times. 

 F. 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). With your palm up or palm down. Bend your wrist up about 2 to 3 inches and then slowly lower it down. Repeat 20 times.

• Shrugs

Stand with your arms by your side. 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 and repeat 20 times. 

Other  conservative  methods of treatment are as follows:

• Wrist splint:  

      Typically the splint is worn at night or during sports. The splint is used for several weeks or months, depending on the severity of the problem, and may be combined with hand and finger exercises.

• Ultrasound employs high-frequency sound waves directed toward the inflamed area and helps in reducing pain.
• Ice and Warmth. Ice may provide benefit for acute pain. Some patients have reported that alternating warm and cold soaks have been beneficial.
• Vitamin B6. Vitamin B6 (pyridoxine) is often used for carpal tunnel syndrome
• Acupuncture.
• Limiting Movement. If possible, the patient should avoid activities at work or home that may aggravate the syndrome. The affected hand and wrist should be rested for 2 - 6 weeks. 

Do's and Don'ts:

Avoid over extending and flexing your wrist. Also, avoid keeping your wrist in an extended or flexed position for long periods of time. That is why your doctor gave you a wrist splint to wear. It is very helpful to wear the wrist splint at night as well. If your pain and numbness does not improve, consult doctors.

Source:

• Carpal Tunnel Syndrome in Patients With Diabetic Polyneuropathy  Bruce A. Perkins, FRCPC,David Olaleye, PHD and Vera Bril, MD, FRCPC 
• Source:  By Dr. Housang Seradge at the University of Oklahoma Orthopaedic & Reconstructive Research Foundation (http://ortho-ok.com/orrf/ORRF_CARPAL_TUNNEL_PREVENTION.htm).
• 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.