Articles Posted in Nerve Injuries

Many people are familiar with carpal tunnel syndrome (CTS) as a condition caused by repetitive stress injuries such as working with vibrating tools, heavy manual labor, and even less impactful but repeated movements such as typing. Within these categories, carpal tunnel syndrome is often a workplace injury. What is less well known, however, is traumatic carpal tunnel syndrome that can be triggered by a single injury to the hand or wrist from an event such as a motor vehicle collision, a sports injury, or a slip-and-fall injury.

traumatic carpal tunnel syndrome
Carpal tunnel syndrome in general results from compressing the median nerve where it passes through the wrist in the passage known as the “carpal tunnel.” This compression of the nerve can result in pain, tingling (paresthesias), and numbness in the fingers — thumb, index finger, middle finger, and part of the ring finger — and parts of the hand that are served by the median nerve, and in chronic or severe cases even much more serious symptoms such as muscle wasting. (There are also some non-trauma causes of CTS including arthritis, diabetes, certain drug reactions, or growths within the wrist — these can cause the same pressure on the median nerve that is associated with single traumatic and repetitive injury causes.)

Traumatic carpal tunnel syndrome — as well as the non-traumatic versions — is generally diagnosed based upon the reported symptoms and certain classic “signs” for the disease. Phalen’s Maneuver, for example, involves flexing the wrist and holding it in position — when pain or numbness appears within one minute in the fingers innervated by the median nerve, it is considered a positive sign, and the fast the symptoms appear the “more positive” the result is considered to be. Another test involves Tinel’s Sign in which the skin is gently tapped over the ligament band that forms part of the carpal tunnel. If this produces pain or tingling in the fingers of the median nerve distrution, the test is positive. Electrodiagnostic testing that examines the conductivity of the median nerve may often be used to confirm a suspected case of carpal tunnel syndrome.

Complex regional pain syndrome, or CRPS, is a relatively recent name for related conditions that have been known by other names in the past, such as “reflex sympathetic dystrophy” (RSD) and “causalgia.” What was often referred to as RSD in the past is now more commonly known as “CRPS-I,” and what was called causalgia is now more typically referred to as “CRPS-II.” Other names have included reflex neurovascular dystrophy, algoneurodystrohpy, sympathetically maintained pain, and Sudek’s syndrome. As might be guessed from the many names for these associated conditions, they are complicated and often not well-understood. They generally involve trauma to the peripheral nerves and have symptoms involving the sympathetic nervous system.

complex regional pain syndrome
Both versions of complex regional pain syndrome can result from trauma such as from motor vehicle collisions, sports injuries, and workplace injuries.

CRPS-I or RSD, can result from even very minor injuries, with no apparent nerve damage — in many cases people may not even recall a specific traumatic event when the complex regional pain syndrome symptoms show up weeks or months later. Fractured limbs, contusions, and even minor surgical procedures can result in the onset of CRPS-I symptoms, which often include a severe burning pain in the limb that is made worse with movement or by touching the limb. Other symptoms can include increased sweating and skin temperature in the affected area, and sometimes swelling. Long term symptoms can include skin constriction and reduced temperature in the limb. The skin, soft tissues and bone can atrophy, and the bone may develop osteoporosis.

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