Median Trap - CTS Causation

MEDIAN TRAP
Myxedema
Edema
Diabetes
Idiopathic
Acromegaly
Neoplasm
Trauma
Rheumatoid arthritis
Amyloidosis
Pregnancy

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Myxedema
Terminology:
myx(o)-:

• mucus; slime. [Greek]

edema:

• an abnormal accumulation of fluid in intercellular spaces of the body.

pitting edema:

• that in which pressure leaves a persistent depression in the tissues.

mucin:

• any of a group of protein containing glycoconjugates wth high sialic acid or sulfated polysaccharide content that compose the chief constituent of mucus.

-osis:

• disease; morbid state; abnormal increase. [Greek]

mucinosis:

• a state with abnormal deposits of mucins in the skin.

Definition:
A dry, waxy type of swelling (nonpitting edema) with abnormal deposits of mucin in the skin (mucinosis) & other tissues, associated with hypothyroidism; the facial changes are distinctive, with swollen lips & thickened nose.

Association with Carpal Tunnel Syndrome:
While studies have displayed a strong, positive association between hypothyrodism (hence myxedema) and carpal tunnel syndrome, the mechanisms of this association remains unclear.

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Edema
Definition:
An abnormal accumulation of fluid in intercellular spaces of the body.

Association with Carpal Tunnel Syndrome:
Accumulation of fluid within the carpal tunnel may exert pressure on the median nerve, cause carpal tunnel syndrome.

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Diabetes
Definition:
Any disorder characterized by excessive urine excretion.

Used alone, often refers to diabetes mellitus - a chronic syndrome of impaired carbohydrate, protein, & fat metabolism owing to insufficient secretion of insulin or to target tissue insulin resistance.

Association with Carpal Tunnel Syndrome:
Hyperglycaemia, characteristic of diabetes mellitus, can damage the blood vessels that supply the nerves & the nerve coverings, causing diabetic neuropathy with symptoms of numbness, pain & weakness on the affected limb (peripheral neuropathy is the most common form of diabetic neuropathy).

If the median nerve is damaged, carpal tunnel syndrome may result.

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Idiopathic
Terminology:
idi(o)-:

• self; peculiar to a substance or organism. [Greek]

-pathy:

• morbid condition or disease; generally used to designate a noninflammatory condition. [Greek]

Definition:
Self originated; occurring without known cause.

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Acromegaly
Terminology:
acr(o)-:

• extreme; top; extremity. [Greek]

-megaly:

• enlargement. [Greek]

Definition:
Abnormal enlargement of limbs, caused by hypersecretion of growth hormones after maturity.

Association with Carpal Tunnel Syndrome:
Acromegaly is a rare disease in which high levels of growth hormone lead to increases in the sizes of the hands, feet, and head, as well as changes in internal organs and the skin.

It is not clear whether acromegaly leads to the carpal tunnel syndrome because the soft tissues in the carpal tunnel swell & compresses the median nerve, or because the nerve itself swells - although studies have shown that it would appear to be the latter that is causing the syndrome.

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Neoplasm
Terminology:
ne(o)-:

• new; recent. [Greek]

plasm:

• plasma; formative substance (cytoplasm, hyaloplasm, etc.)

hyal(o)-:

• glassy. [Greek]

hyaloplasm:

• the more gluid, finely granular substance of the cytoplasm of a cell.

Definition:
Tumor; ay new and abnormal growth, specifically one in which cell multiplication is uncontrolled & progressive; may be benign or malignant.

Association with Carpal Tunnel Syndrome:
A tumor growth about the carpal tunnel may reduce the carpal tunnel space, effectively producing a compressing force on the median nerve. (e.g. carpal bone neoplasms)

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Trauma
Definition:
Injury; psychological or emotional damage.

Association with Carpal Tunnel Syndrome:
Acute carpal tunnel syndrome may develop following a major trauma to the upper extremity (typically a distal radius fracture), a carpal dislocation, or a crush injury where the median nerve is compressed by the loose bodies in the carpal tunnel.

Malunion post-fracture may also result in the median nerve being compressed by the inappropriately fused bones that may reduce the carpal tunnel space.

Wear & tear of the wrist joint associated with repeated use or repetitive motion may be related to carpal tunnel syndrome. However, opinions still remain divided on this subject.

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Rheumatoid Arthritis
Terminology:
rheumatism:

• any of a variety of disorders marked by inflammation, degeneration, or metabolic derangement of the connective tissue structures, especially the joints & related structures, and attended by pain, stiffness, or limitation of motion.

arthritis:

• inflammation of a joint.

-osis:

• disease; morbid state; abnormal increase. [Greek]

ankyl(o)-:

• bent; crooked; in the form of a loop; adhesion. [Greek]

ankylosis:

• immobility and consolidation of a joint due to disease, injury, or surgical procedure.

Definition:
A chronic systemic disease primarily of the joints, usually polyarticular, marked by inflammatory changes in the synovial membranes & articular structures & by atrophy & rarefaction of the bones.

In late stages, deformity & ankylosis develop.

Association with Carpal Tunnel Syndrome:
Rheumatoid arthritis is most characterized by joint damage; however it is really a systemic disease that affects the whole body.

Damage to the musculoskeletal structures surrounding the joints may cause the bones & tendons to become deformed, especially those of the hands & feet. Nerve entrapment is a common result of these deformities - entrapment of the median nerve would thus be a possible complication, leading to carpal tunnel syndrome.

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Amyloidosis
Terminology:
amyl(o)-:

• starch. [Greek]

-oid:

• resembling. [Greek]

-osis:

• disease; morbid state; abnormal increase. [Greek]

amyloid:

• starchlike; amylaceous; the pathologic, extracellular, waxy, amorphous substance deposited in amyloidosis, being composed of fibrils in bundles or in a meshwork of polypeptide chains.

• a pathologic proteinaceous substance, deposited between cells in various tissues & organs of the body in a wide variety of clinical settings.

Definition:
A group of conditions caused by accumulation of amyloid in organs & tissues, which compromises their function.

Associated disease states may be inflammatory, hereditary, or neoplastic.

Deposition may be local, generalized, or systemic.

Association with Carpal Tunnel Syndrome:
Amyloidosis results from abnormal folding of proteins, which are deposited as fibrils in extracellular tissues & disrupt normal function. Misfolded proteins are often unstable & self-associated, ultimately leading to the formation of oligomers & fibers that are deposited in tissues.

Accumulation of such insoluble protein deposits in the affected organs can cause stiffness & decreased functionality, precipitating carpal tunnel syndrome if the wrist is affected.

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Pregnancy
Definition:
The condition of having a developing embryo or fetus in the body, after the union of an ocyte and spermatozoon.

Association with Carpal Tunnel Syndrome:
Swelling is common during pregnancy, especially in the third trimester, as the mother's body will produce approximately 50% more blood & fluids to accommodate the growing baby. Hormone fluctuations may also contribute to edema about the extremities.

Water retention during pregnancy helps maintains the mother's body flexible, to allow room for expansion during pregnancy. The extra fluid contained in the tissues & muscles of the body helps the joints prepare for labor & delivery.

Excessive swelling about the wrist area may lead to the undesired compression of the median nerve, precipitating carpal tunnel syndrome-like symptoms; though the symptoms generally wear off once the swelling subsides.