Carpal Tunnel Syndrome Neuropathy Of The Hands

Today's very informative post from mmcneuro.wordpress.com (see link below) talks about something that confuses many people who don't see their nerve problems as being a form of neuropathy. Remember the word 'neuropathy' just means 'nerve damage' and there are over 100 forms and over 100 causes. Carpal Tunnel Syndrome is one of those and is much more common than you think and can be caused by such diverse things as manual labour, pregnancy and even long-term computer work. As it says at the end of the article, if you suspect you may have Carpal Tunnel syndrome, consult your doctor and if necessary a neurologist. It is also possible to get Carpal Tunnel Syndrome while also having other forms of neuropathy, or other diseases, so if you think this article is not for you, it's always worth while boning up on your knowledge of how nerves work.


Numb tingling hands, it’s probably carpal tunnel syndrome

March 22, 2013

Numbness and tingling in the hands is most often from Carpal tunnel syndrome (CTS).

CTS is caused by compression of the median nerve as it travels across the wrist with the tendons between the carpal bones and the flexor retinaculum (also known as the transverse carpal ligament):

CTS is caused by compression of the median nerve under the flexor retinaculum also known as transverse carpal ligament.

Compression an injury to the median nerve causes numbness and tingling mostly affecting the thumb, index finger, middle finger, and half of the ring finger.

CTS usually causes numbness and tingling mostly in the thumb, index and middle fingers

More severe cases also cause weakness and wasting of the muscle at the base of the thumb that abducts the thumb away from the fingers (abductor pollicis brevis or APB):

Thumb abduction, the movement that is weak in more severe cases of CTS, where there is involvement of both motor and sensory median nerve fibers.

Wasting of APB muscle belly (“thenar eminence”) in severe CTS
In severe cases, the numbness can seem to affect the whole hand, and can even radiate up the forearm and arm:

Symptoms are often worse typing, driving, and frequently wake the affected patient up at night:

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CTS can usually be diagnosed on clinical grounds. A helpful physical finding is a tingling in the wrist and fingers caused by a tap over the carpal tunnel (Tinel’s sign):

In some cases, an electrodiagnostic study may be necessary to confirm the diagnosis:

CTS is usually “idiopathic” (we don’t know why it happened), but some cases are caused by diabetes,pregnancy, thyroid disease, joint swelling from rheumatoid arthritis, heavy manual work and work with vibrating tools.

Treatment usually begins with conservative measures, like avoiding exacerbating activities, and wearing a neutral position night splint:

Patients who do not improve with these conservative measures can undergo a surgical procedure to release the compressed median nerve:

Want to find out more?
Click here to take an on-line quiz to see if you have CTS.

Watch this on-line video tutorial explaining the causes and treatment of CTS:

If you think you might have CTS, you should make an appointment to see a neurologist.

http://mmcneuro.wordpress.com/tag/neuropathic-pain/

Restless Leg Syndrome Whats That

Today's post from theconversation.com (see link below) looks at an affliction which many people experience during their lives, without realising that it falls into the category of neuropathic disorders. It's important to realise that you can have neuropathy and restless leg syndrome; or restless leg syndrome can be a part of your neuropathy but equally, you can have RLS without any other symptoms of nerve damage. Many people are confused by exactly what it is and why it happens and this article goes some way to explaining it in terms we can all understand and maybe putting your mind at ease (if not your legs!!)
 

Explainer: what is restless leg syndrome?
Author Andrew Lavender March 29, 2016

Lecturer, Faculty of Health Sciences, Curtin University
Disclosure statement Andrew Lavender does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond the academic appointment above.

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Restless leg syndrome is a common affliction characterised by uncomfortable feelings in the legs accompanied by an irresistible urge to move the legs to relieve the sensations. People with restless leg syndrome often keep their legs moving by pacing or constantly moving their legs while sitting. The sensations commonly occur at night and have been described by patients as itching, throbbing, pulling, pins and needles or a creepy crawly feeling.

Onset of the sensations usually occur, or get worse, while the person is relaxed, sitting or lying down. Restless leg syndrome is known to affect both males and females of any age but is more common in women and older individuals. Misdiagnosis is not unusual since the symptoms tend to come and go and may be quite mild.

Causes

In many cases of restless leg syndrome the cause is not known. However, it is thought to have a genetic link as many who experience restless leg syndrome have relatives who also experience the sensations.

Restless leg syndrome has been associated with some medical conditions including Parkinson’s disease, diabetes and peripheral neuropathy (any damage or disease of the nerves that impairs sensation, movement or gland function depending on which nerves are affected).

It can also be seen in those with iron deficiency or poor kidney function. Some women experience restless leg syndrome during pregnancy. Pregnant women who experience restless leg syndrome usually find the symptoms occur in the third trimester, with symptoms ceasing within four weeks of delivery.

Research has shown restless leg syndrome is likely related to dysfunction of neural circuits of the basal ganglia (a group of structures at the base of the brain with links to the area that controls movement), which uses the neurotransmitter dopamine. Dopamine is needed to control muscle activity for smooth, purposeful movement, so disruption of the dopamine pathways leads to involuntary movements. Parkinson’s disease is also a disorder of dopamine pathways of the basal ganglia and Parkinson’s patients often experience restless leg syndrome.

Individuals with chronic kidney failure, diabetes or peripheral neuropathy usually find relief from restless leg syndrome with treatment of the underlying condition.

Symptoms of restless leg syndrome may also be aggravated by certain medications. These include anti-nausea drugs, antipsychotic drugs, antidepressants and some cold and allergy medications that contain sedating antihistamines. The intake of alcohol or lack of good-quality sleep often triggers the condition.

Diagnosis

There is no test for restless leg syndrome. The four criteria below are used to diagnose the condition:

symptoms worsen at night and are minimal in the morning
there is a strong urge to move the affected limb or limbs
symptoms are triggered when trying to rest or relax
symptoms are relieved by moving the affected limb, and return when movement stops.

The descriptions given by the patient provide important information about when and how often the symptoms occur, so triggers can be identified and avoided where possible. Family history also helps to provide clues about the cause of the symptoms and potential interventions for treatment.

Diagnosing restless leg syndrome in children is particularly challenging since children find it hard to describe their symptoms and where and how often they experience them. This sometimes results in misdiagnosis as growing pains or attention deficit disorder.

Treatment and prognosis

Doctors focus on relieving symptoms by identifying triggers and relieving factors, and the presence or absence of symptoms during the day. Often the symptoms will resolve with treatment of an underlying disorder such as diabetes or peripheral neuropathy.

Making changes to your lifestyle may affect mild or moderate symptoms. This might include stopping or reducing your intake of caffeine, alcohol or tobacco.

If the symptoms are related to a dietary deficiency in iron, folate or magnesium, the symptoms can be treated with adjustments of diet or supplementing the diet with the appropriate supplement. This may be identified through a blood analysis by a GP.

When symptoms are more severe or associated with an underlying disorder, it is very important to consult a GP, who may refer you to a specialist.

While there is no cure for restless leg syndrome, there are options for therapy and control of symptoms to increase periods of restful sleep. Symptoms generally increase with age and the rate of this increase varies greatly depending largely on the associated disorder.

Some people experience periods of remission, which may last a few days or months. However, symptoms will usually reappear.

It is important to note that a diagnosis of restless leg syndrome is not an indication of any other, more serious, disorder such as Parkinson’s disease.

https://theconversation.com/explainer-what-is-restless-leg-syndrome-56140

Neuropathic Inflammation And Chronic Fatigue Syndrome

Today's post from webmd.com (see link below) is a fascinating look at the possible links between Chronic Fatigue Syndrome and nerve cell inflammation. Studies have shown that in most cases of people reporting chronic fatigue, there is evidence of inflammation of nerves in the brain. CFS is one of those mysterious diseases (much like neuropathy itself) which can be a life changer without due cause or reason and thanks to PET scanning, it seems that neuro-inflammation may play a significant role in the onset of Chronic Fatigue Syndrome. This may not seem directly linked to peripheral neuropathy but damage, degeneration or inflammation of nerve cells is the root cause of most of the 100 different types of neuropathy. Chronic Fatigue Syndrome may well turn out to be another on the list.

Possible Clues to Chronic Fatigue Syndrome
Inflammation may play a role, small study suggests 
By Alan Mozes HealthDay Reporter WebMD News from HealthDay
FRIDAY, May 2, 2014 (HealthDay News)

Seeking better insight into chronic fatigue syndrome, a new brain scan investigation has pinpointed what could be the first evidence of a connection between nerve cell inflammation and the onset of this debilitating and somewhat mysterious illness, researchers say.

The finding stems from a small PET scan study, led by Yasuhito Nakatomi of the RIKEN Center for Life Science Technologies in Hyogo, Japan. The study involved just nine patients with chronic fatigue syndrome and 10 healthy participants.

However, the investigators believe that their initial results are the first to show that neuro-inflammation is a distinct feature of chronic fatigue syndrome. This inflammation affects specific areas of the brain that are commonly linked with the kind of fatigue, pain, depression, and thought-process difficulties long associated with the syndrome, the researchers noted.

"While the results will need to be confirmed in larger studies, it is a very exciting finding," said Suzanne Vernon, scientific director of the CFIDS (Chronic Fatigue and Immune Dysfunction Syndrome) Association of America. She was not involved with the new study.

"This is the first time images of this type of brain inflammation have been seen in chronic fatigue syndrome," she added, "and provides the evidence of the seriousness and debilitating nature of this disease."

The findings appeared online recently in advance of print publication in the Journal of Nuclear Medicine.

The root cause of chronic fatigue syndrome is the subject of much debate. While some health experts believe it is bacteria driven, others think it's most probably brought on by a virus.

The syndrome -- which can take hold without warning -- is typically characterized by extreme exhaustion, muscle and joint pain, sleep difficulties and thinking problems. The result is often an inability to perform even simple everyday tasks.

In the new study, all the participants first filled out questionnaires that asked them to indicate to what degree they were experiencing any telltale signs of chronic fatigue syndrome.

Brain imaging was then conducted in key areas of the brain, including the cingulate cortex, hippocampus, amygdala, thalamus, midbrain, and pons regions.

All signs of neuro-inflammation were then stacked up against chronic fatigue syndrome symptoms.

The result? While nerve cell inflammation was found to be "widespread" throughout the brains of chronic fatigue syndrome patients, no such inflammation was observed among the healthy study participants.

Vernon said the study also found a graded relationship between levels of inflammation and the severity of disease.

"The higher the inflammation, the more severe the patients' symptoms," she noted.

The study authors further found that neuro-inflammation spiked in patterns that directly correlated with chronic fatigue syndrome symptoms, ratcheting up in brain regions that are central to thought-processes typically impaired by the condition.

That said, Nakatomi's team did not establish a direct cause-and-effect relationship between brain changes and chronic fatigue syndrome. And the finding does not make clear whether such brain inflammation actually precedes the onset of the condition or occurs as a result.

However, the authors suggested that their work should be viewed as a "proof of concept" that brain scanning could be a useful way to screen for chronic fatigue syndrome, to both diagnose the disease and assess disease severity on a case-by-case basis.

Dr. Jim Pagel, an associate clinical professor at the University of Colorado Medical School System, said the study findings make sense, and might be most helpful in the context of future research.

"There's no question that chronic fatigue syndrome is a real diagnosis. It's just a question as to how do you actually make that diagnosis? What is the definition? What are the criteria?" said Pagel, who is also director of the Sleep Disorders Center of Southern Colorado, in Pueblo, Colo.

"And for that I wouldn't say that this work ties PET scans to a clear method for diagnosis, or to any clear treatment approach," he said.

"I really don't think this means that everybody should go out and get a PET scan to diagnose [chronic fatigue syndrome]," Pagel said. "But at the same time, it doesn't surprise me at all there would be a potential level of nerve inflammation in certain groupings of people with [the condition]. It certainly fits with what we know. And I think this finding will be useful as the research continues."

http://www.webmd.com/chronic-fatigue-syndrome/news/20140502/brain-scans-spot-possible-clues-to-chronic-fatigue-syndrome