Causes of Carpal Tunnel Syndrome

introduction

At a Carpal tunnel syndrome can result in a Damage to the median nerve come. This nerve runs right through the carpal tunnel, whereby the carpal tunnel is also traversed by several muscles or their tendons.

So it's a Bottleneckin which the nerve can be pinched. This entrapment and the associated Pain and sensitivity disorders in the area of ​​the hand are called carpal tunnel syndrome.

causes

At this point, the causes and the pathogenesis of the carpal tunnel syndrome are presented.

Although there are many known causes of carpal tunnel syndrome, the cause of its development remains in the individual case often unknown (over 50%). In medical terminology, one speaks of one idiopathic cause, because you don't know where the sudden loss of sensitivity come in the area of ​​the hand, or it is unclear why the nerve is suddenly narrowed in the area of ​​the carpal tunnel.
Even looking directly at the carpal tunnel during an operation does not change this. Generally speaking, the cause of carpal tunnel syndrome is either one Constriction of the median nerve in the carpal tunnel from the outside or, more often, one Pressing the nerve through the structuresthat with the nerve through the carpal tunnel pull.

Known causes of carpal tunnel syndrome

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Inflammatory changes

As part of inflammatory processes, fluid can accumulate in the carpal tunnel.

Tendonitis (synovitis) of the wrist flexor tendons is also more common. Normally, each muscle is surrounded by a tendon sheath so that there is no friction between the individual tendons. However, if these tendon sheaths are subjected to severe mechanical stress, they may become inflamed. Musicians in particular often suffer from tendinitis, but also athletes, handball and basketball players in particular are familiar with the problem.
Inflammation of the tendon sheaths causes them to swell. However, since the carpal tunnel is built very closely, there is enormous pressure in the area of ​​the carpal tunnel. This pressure is transferred to the median nerve running there. It becomes more and more narrowed by the swelling of the tendon sheaths and then leads to the classic symptoms of carpal tunnel syndrome.

A carpal tunnel syndrome can also occur in patients with rheumatic disease, as the inflammation of the joints can spread and thus lead to swelling and narrowing in the area of ​​the carpal tunnel, which in turn narrows the median nerve. Rheumatism is particularly important in this context.

Bony changes

One cause of carpal tunnel syndrome can be anatomical constriction be in the area of ​​the carpal tunnel. For example, in some patients the carpal tunnel forms during bone growth too tight from what then becomes a Constriction of the nerve leads, colloquially one often speaks of a Bottleneck syndrome when describing carpal tunnel syndrome. If this narrowing is determined by an anatomical event, it falls to the patient mostly in early youth on when bones and tendons increase.

Wear in the area of ​​the carpal bones (arthrosis) or also Bone tumors can also become a osseous constriction of the carpal tunnel.

Injuries

Near the wrist Fractions can through a remaining misalignment after their bony remodeling, pressure and constrict the median nerve from the outside.
However, even with correct healing, the carpal tunnel can narrow, as fractures usually come with a inflammation go hand in hand and these in turn become one swelling leads.

Also Overloads For example, in the context of sport can lead to an increase in volume and pressure on the median nerve.

Hormonal causes

There are various hormonal causes that lead to the development of carpal tunnel syndrome. Typically, the median nerve is then hypersensitive to pressure loads.

Since the symptoms of carpal tunnel syndrome occur particularly often in women who are going through menopause (menopause), it is assumed that water retention and swelling in the area of ​​the carpal tunnel leads to a constriction of the nerves. Although women’s menopause cannot be directly seen as the cause of carpal tunnel syndrome, there seems to be a certain connection.

Tissue swelling can also lead to carpal tunnel syndrome during pregnancy, although this should disappear again after pregnancy.

Read more on the topic: Carpal tunnel syndrome in pregnancy

There are other causes that are suspected to be related to carpal tunnel syndrome, although it is not entirely clear whether the disease is really the main cause of the symptoms. On the one hand, it is believed that an underactive thyroid (Hypothyroidism) can lead to a carpal tunnel syndrome; here too, swelling in the area of ​​the carpal tunnel is probably to blame for the narrowing. In addition, a connection between the syndrome and an overactive thyroid is suspected.

Metabolic diseases

A sugar disorder (Diabetes mellitus) and other metabolic diseasesthat occur less frequently, such as the Amyloidosis, Mucopolysaccharidosis, Chondrocalcinosis or gout can also lead to a tightness in the carpal tunnel.

In diabetics, a increased sensitivity to pressure of the median nerve as part of the Polyneuropathy (general nerve damage caused by sugar) suspected to be the cause of carpal tunnel syndrome. Other hypotheses assume that the impaired blood flow in diabetics is the cause of the swelling in the area of ​​the carpal tunnel and thus of the symptoms.

Ganglia

Mucosal sacs, called the ganglion, can also lead to carpal tunnel syndrome.

Consequences of the damage

The damaging influence, no matter what kind, leads to a Pressure damage to the nerve fibers of the median nerve.

It is almost always a matter of reversible (reversible) damage. That means the median nerve has the Ability to fully recoveras soon as the pressure damage has ended. This form of damage to a nerve is known in medicine as neurapraxia.
At too long damage duration but must with permanent loss of functionality of the median nerve. In such a case, the sensory disturbances can persist even after a successful operation and lost muscles can no longer be built up.

The sequence of the degree of damage is explained as follows:
First, a Pressure increase in the carpal tunnel to one Vascular restriction the vessels supplying the median nerves with oxygen. The consequence of Undersupply is a watery one swelling of the median nerve with damage to the nerve fibers. If the pressure damage continues, connective tissue cells sprout in the median nerve and damage it through the Tissue remodeling permanent. The median nerve reacts to pressure damage with a Loss of functionwhich affects both the feeling and the control function of the muscles. If the median nerve in the carpal tunnel is damaged, however, only those structures that are supplied by the median nerve after the carpal tunnel are affected. There is no, so to speak, ascending damage (forearm / upper arm). However, the sensation of pain in carpal tunnel syndrome can affect the whole arm, even if the hand is primarily affected.