Tunnel Syndrome

The level of repetitive motion tolerated without undue risk of injury varies widely depending on age, sex, and other health factors. While no specific limits have been established to avoid CTD symptoms, factors increasing risk include repetition of motion, work-rest cycles, force, and duration of the task. 

Carpal tunnel syndrome has been found increasingly among data entry clerks, cashiers, and individuals who perform keypunch tasks due to the static, restricted posture and high-speed finger movements. 

Cubital Tunnel Syndrome is compression of the ulnar nerve in the elbow, thought to be caused by resting the elbow on a hard surface or sharp edge. Symptoms include tingling in the ring finger and little finger. 

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Carpal tunnel syndrome caused by nerve compression from the swollen tissue... 

Children treated with GH replacement therapy rarely experience significant adverse effects, whereas adults are more susceptible to dose-related adverse effects. Treatment with GH may mask underlying hypothyroidism. GH-induced symptoms, such as edema, arthralgia, myalgia, and carpal tunnel syndrome, are common and necessitate dose reductions in up to 40% of adults. Benign increases in intracranial pressure may occur with GH therapy and generally are reversible with discontinuation of treatment. Often, GH therapy can be restarted with smaller doses without symptom recurrence. 

Continuously monitor for dose-related adverse effects such as edema, arthralgia, myalgia, and carpal tunnel syndrome. 

Peripheral neuropathies maybe widely disseminated or focal. Patients with disseminated polyneuropathy, whether demyelinative or axonal, usually demonstrate distal sensory and/or motor impairment. Multifocal neuropathy, also referred to as mononeuropathy multiplex, is often a consequence of lesions affecting the vasa nervorum, the blood vessels that supply peripheral nerves. The most common diseases to compromise the vasa nervorum and cause infarction of nerve fascicles are diabetes mellitus and periarteritis nodosa. Other frequent causes of mononeuropathy multiplex include infection (e.g. Lyme disease and leprosy) and multiple compression injury (e.g. bilateral carpal tunnel syndrome). When mononeuropathy... 

Table 36-1 lists some of the mechanisms important in governing the susceptibility of the PNS to disease and injury. Peripheral nerves, although toughened by their high content of collagen, are prone to injury to myelin by compression (e.g. carpal tunnel syndrome and tardy ulnar palsy) and to axons by excessive stretch (e.g. brachial plexopathy in newborn infants following a difficult delivery). Subcutaneous nerves, because of their exposed position, are also vulnerable to cold or heat injury. 

Physical signs include coarse skin and hair, cold or dry skin, periorbital puffiness, bradycardia, and slowed or hoarse speech. Objective weakness (with proximal muscles being affected more than distal muscles) and slow relaxation of deep tendon reflexes are common. Reversible neurologic syndromes such as carpal tunnel syndrome, polyneuropathy, and cerebellar dysfunction may also occur. 

Significant adverse reactions include edema vaginitis nervousness emotional lability hepatic dysfunction elevated blood pressure pelvic pain carpal tunnel syndrome sleep disorders fatigue tremor visual disturbances anxiety depression gastroenteritis. 

Maks/femaks Hematuria, gingivitis, carpal tunnel syndrome, cataracts, severe headache, vomiting, rash, photosensitivity... 

Nausea, backache, headache, breast tenderness, carpal tunnel syndrome Rare... 

Carpal tunnel syndrome, gynecomastia myalgia swelling of hands, feet, or legs fatigue asthenia Rare... 

Despite its considerable involvement in metabolic processes, no specific deficiency syndrome in humans has been attributed to vitamin B6 (19,103). A considerable number of nonvitamin functions have been suggested, but they remain controversial (102,103,108-111). These include roles in coronary heart disease, immune response, premenstrual syndrome, sickle-cell anaemia, asthma, autism, gestational diabetes, carpal tunnel syndrome, and cancer. 

Carpal tunnel syndrome has been reported in six patients taking aromatase inhibitors (29). Most subsequently experienced relief after withdrawal and/or switching to tamoxifen. In clinical trials of anastrozole and exemestane, carpal tunnel syndrome occurred in about 3% (30,31,32). 

Nishihori T, Choi J, DiGiovanna MP, Thomson JG, Kohler PC, McGum J, Chung GG. Carpal tunnel syndrome associated with the use of aromatase inhibitors in breast cancer. Clin Breast Cancer 2008 8(4) 362-5. 

It is not clear how this could have resulted from the treatment, but it might have entailed fluid redistribution in or around an old appendicectomy scar. It may be noted that nerve entrapment is recognized as a possible adverse effect of oral contraceptives in the carpal tunnel syndrome. 

Carpal tunnel syndrome due to somatropin is probably dose-dependent and was reported in 4.8% of subjects in a double-blind trial (10). 

The use of growth hormone in adults over the age of 60 years without growth hormone deficiency has been reviewed (109). The adverse effects were the same as those found in adults deficient in growth hormone peripheral edema, paresthesia, carpal tunnel syndrome, glucose intolerance, and gynecomastia in men. The adverse effects were dose-related. There were no long-term data available about safety, in particular the risk of cancer. 

In addition, clay wedging, throwing, and building can cause hand and wrist injuries, including median nerve damage resulting in carpal tunnel syndrome (identified by numbness in the thumb and first three fingers). 

To minimize clay dust inhalation, it is best to buy premixed clay. Potters should change clothes before leaving their work area. Fresh clay should be used to minimize bacteria and mold growth. To avoid median nerve damage and resulting carpal tunnel syndrome, the potter s wrist should be unflexed frequently. A face mask can be worn when clay dust is present. 

Sheehan M. 1990. Avoiding Carpal Tunnel Syndrome A Guide for Computer Keyboard Users. Available at http //reporterbigskyoffice.com/content.php id=36. 

Some of the clinical features with which this syndrome is associated include carpal tunnel syndrome, peripheral neuropathy, cardiomyopathy, malabsorption, and nephrotic syndrome. 

There are many types of steroid hormones in the body, such as the sex/gonadal hormones testosterone and estrogen, thyroid hormones, growth hormones, and stress hormones, which serve various normal functions. One type of steroid— corticosteroids or glucocorticoids—is secreted by the adrenal glands (located just above the kidneys). These steroids, particularly synthetic versions of them, have powerful antiinflammatory actions that help to relieve pain. They are often given as an epidural injection to relieve neck or back pain that results from a compressed or pinched nerve. They can also be injected directly into a joint to relieve pain caused by inflammation in conditions such as tendonitis (inflammation of the tendons), carpal tunnel syndrome, tennis elbow, bursitis (inflammation of sac-like cavities in tendons or muscles that allow them to slide easily over bone), or other joint pain. Professional athletes, who routinely experience one or more of these conditions, are often given local steroid injections. Frequently, the steroid is combined with a local anesthetic such as lidocaine. 

Authors who reported a case of carpal tunnel syndrome due to pyridoxine deficiency in a patient taking tranylcypromine (SEDA-9, 21) later collected data (6) on six patients taking phenelzine (up to 75 mg/day for up to 4 months). All developed low concentrations of pyridoxine and a variety of symptoms, including numbness, paresthesia, and edema of the hands, as well as an electric shock sensation in the head, neck, and arms. The symptoms resolved completely after the addition of pyridoxine 150-300 mg/day to the treatment regimen. 

Paradoxically, pyridoxine itself can also cause pathology in the central nervous system consisting of necrosis of dorsal root ganglia neurons and a centrifugal axonal atrophy and breakdown of peripheral and central sensory axons (Xu et al., 1989). This may occur at doses as low as 200-500 mg/d. However, in clinical trials using 100-150 mg/d to treat carpal tunnel syndrome, no toxicity was reported, suggesting that this a safe dose in adults. On the other hand, there are insufficient data to recommend long-term use of pyridoxine in children. 

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