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Q: I have been troubled with carpal tunnel syndrome for about 10 years. Am I suffering any nerve damage by not having it treated?

-- C.M.

A: Carpal is one of the most common causes of chronic pain in the wrist. If the pain, tingling or numbness extends down into the two fingers next to the thumb, it's highly likely the problem is carpal tunnel syndrome. Pain can also extend up the arm all the way into the shoulder.

Carpal tunnel syndrome is caused by narrowing of the carpal tunnel, which results in mechanical compression of the nerves and the tendons that run through the area. The carpal tunnel is made up of the carpal bones on the thumb side of the wrist and a stiff ribbon of tissue in the same area. Two important structures go through this tunnel: the median nerve, one of the major nerves to the hand, and the tendons that are used to flex the fingers.

Narrowing of the carpal tunnel is usually caused by inflammation and subsequent swelling of the coverings of the tendons or joints. This disorder is also called entrapment neuropathy because the nerve is "trapped" by the swollen tissue.

The inflammation is often the result of work-related (job or otherwise) irritation caused by improper and repetitive use of the wrists, such as assembly line work or keyboarding.

Narrowing of the tunnel can also be caused by healing of wrist fractures and, less frequently, tumors or congenital defects. Carpal tunnel syndrome can be a feature of systemic (throughout the body) diseases, including arthritis, diabetes, sarcoidosis and leukemia.

Also, anything that causes swelling of tissue, such as pregnancy, heart disease and even PMS, can increase the swelling in the carpal tunnel even more.

The initial symptoms of compression of the median nerve include numbness, burning or aching pain, and tingling. There may also be a decreased ability to feel with the fingers, but this may not be particularly noticeable. The pain is often worse at night but may be worsened by activity, especially flexing of the wrist.

Carpal tunnel syndrome is usually distinguished from other disorders with similar symptoms by a simple test. In this test, when a pressure is applied to the carpal tunnel it causes pain. Medical imaging procedures can confirm the diagnosis even in cases with only slight entrapment of the median nerve.

The first steps of treatment should be to limit the offending activity and begin occupational or physical therapy. Often a physical therapist can provide good information about ways to protect your wrist from increased irritation, and thereby to stop the swelling. Elevating the affected arm and using a splint at night may help.

Injecting steroids directly into the carpal tunnel may help to alleviate the symptoms for some people. But this procedure is difficult and best left to a health care professional who is specifically trained and routinely does the procedure.

Surgery is usually the treatment of last resort for carpal tunnel syndrome. However, it can be very effective. Like any surgery, carpal tunnel surgery carries a risk of not working and even making matters worse.

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