22.Carpal tunnel syndrome vs Normal anatomy: Muscles of the forearm and hand
Carpal tunnel syndrome (CTS) happens when the median nerve, which runs from the forearm into the palm of the hand, become pressed or squeezed at the wrist. The carpal tunnel, a narrow, rigid passageway of ligament and bones at the base of the hand, that holds the median nerve and the tendons that bend the fingers. The media nerve provides feeling to the palm side of the thumb and to the index, middle, and part of the ring fingers. It also controls some small muscles at the base of the thumb. CTS is the most common and widely known entrapment neuropathies, in which one of the body’s peripheral nerves is pressed on (BRAIN, 2017).
Symptoms of CTS usually start slowly, with regular burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers. Sometimes there may be a feeling of swelling even though there is not any actual swelling. The symptoms often first appear in one or both hands during the night since many people sleep with flexed wrists. A person with CTS may wake up feeling the need to “shake out” the hand or wrist. As symptoms worsen, people might feel tingling during the day. Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In chronic and or untreated cases, the muscles at the base of the thumb may waste away. Some people are unable to tell between hot and cold by touch (BRAIN, 2017).
Some of the muscles, tendons and ligaments of the hand, as well as those of the forearm that affect hand movement, these are the muscles and tendons that are usually observed when testing for carpal tunnel (Healthline Medical Team, 2015).
Extensor digitorum: a forearm muscle responsible for extending all the fingers of the hand not the thumb (Healthline Medical Team, 2015).
Palmaris longus: slender triangle-shaped tendon, a fibrous band that connects muscles to bones, on the palm. About 14% of the world does not have this tendon but it does not affect movement or hand function (Healthline Medical Team, 2015).
Flexor retinaculum: strong band of fibrous ligament that stretches across the back of the wrist and help flex the hand (Healthline Medical Team, 2015).
Extensor retinaculum: close to the flexor retinaculum, a ligament that affects muscles that help extend fingers and other parts of the hand (Healthline Medical Team, 2015).
Abductor pollicis longus: forearm muscle that helps pull the wrist and the thumb away from the body (Healthline Medical Team, 2015).
Extensor pollicis brevis: muscle of the forearm that acts in conjunction with the abductor pollicis longus to extend and abduct the thumb (Healthline Medical Team, 2015).
Flexor digitorum profundis: this long forearm muscle flexes the wrist and fingers (Healthline Medical Team, 2015).
Pronator teres: muscle begins at the top of the humerus, crosses the forearm, and connects to the ulna. It helps to turn the palm downward (Healthline Medical Team, 2015).
These are the muscles and tendons that are usually observed when testing for carpal tunnel.
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