Carpal tunnel syndrome

Text A
Carpal tunnel syndrome is the most common entrapment
neuropathy, affecting approximately 3 to 6 percent of adults in the
general population. Although the cause is not usually determined,
it can include trauma, repetitive manoeuvres, certain diseases, and

hu
pregnancy. Symptoms are related to compression of the median
nerve, which results in pain, numbness, and tingling or difficulty

t
gripping These symptoms often start slowly and come and go.
They're usually worse at night.
ee
N
Text B
ith

Causes
Carpal tunnel syndrome is caused by pressure on the median nerve.
W

The median nerve runs from your forearm through a passageway

in your wrist (carpal tunnel) to your hand. It provides sensation to
ET

the palm side of your thumb and fingers, except the little finger. It
also provides nerve signals to move the muscles around the base of
your thumb (motor function).
O

Anything that squeezes or irritates the median nerve in the carpal

tunnel space may lead to carpal tunnel syndrome. A wrist fracture
can narrow the carpal tunnel and irritate the nerve, as can the
swelling and inflammation caused by rheumatoid arthritis.
Many times, there is no single cause of carpal tunnel syndrome. It
may be that a combination of risk factors contributes to the
development of the condition.
Risk factors
A number of factors have been associated with carpal tunnel
syndrome. Although they may not directly cause carpal tunnel
syndrome, they may increase the risk of irritation or damage to the
median nerve. These include:
• Anatomic factors. A wrist fracture or dislocation, or
arthritis that deforms the small bones in the wrist, can
alter the space within the carpal tunnel and put pressure
on the median nerve.
People who have smaller carpal tunnels may be more

hu
likely to have carpal tunnel syndrome.

t
• Sex. Carpal tunnel syndrome is generally more common

ee
in women. This may be because the carpal tunnel area is
relatively smaller in women than in men.
N
Women who have carpal tunnel syndrome may also have
ith

smaller carpal tunnels than women who don't have the

condition.
W

• Nerve-damaging conditions. Some chronic illnesses,

such as diabetes, increase your risk of nerve damage,
ET

including damage to your median nerve.

• Inflammatory conditions. Rheumatoid arthritis and
O

other conditions that have an inflammatory component

can affect the lining around the tendons in your wrist and
put pressure on your median nerve.
• Medications. Some studies have shown a link between
carpal tunnel syndrome and the use of anastrozole
(Arimidex), a drug used to treat breast cancer.
• Obesity. Being obese is a risk factor for carpal tunnel
syndrome.
 • Body fluid changes. Fluid retention may increase the
pressure within your carpal tunnel, irritating the median
nerve. This is common during pregnancy and menopause.
Carpal tunnel syndrome associated with pregnancy
generally gets better on its own after pregnancy.
• Other medical conditions. Certain conditions, such as
menopause, thyroid disorders, kidney failure and
lymphedema, may increase your chances of carpal tunnel
syndrome.
Workplace factors. Working with vibrating tools or on

hu
•
an assembly line that requires prolonged or repetitive
flexing of the wrist may create harmful pressure on the

t
ee
median nerve or worsen existing nerve damage, especially
if the work is done in a cold environment.
N
Text C
ith

CTS sometimes gets better by itself in a few months, particularly if

you have it because you're pregnant.
W

Wear a wrist splint

ET

A wrist splint is something you wear on your hand to keep your

wrist straight. It helps to relieve pressure on the nerve. You wear it
O

at night while you sleep. You'll have to wear a splint for at least 4
weeks before it starts to feel better.
Steroids
If a wrist splint does not help, the GP might recommend a steroid
injection into your wrist. This brings down swelling around the
nerve, easing the symptoms of CTS. Steroid injections are not
always a cure. CTS can come back after a few months and you may
need another injection.
Painkillers
Painkillers like paracetamol or ibuprofen may help carpal tunnel
pain short-term. But there's little evidence to say they can treat the
cause of CTS, so it's important not to rely on them.
Hand exercises
There's a small amount of evidence to suggest hand exercises help
ease the symptoms of CTS.
Carpal tunnel syndrome surgery

hu
If your CTS is getting worse and other treatments have not worked,

t
the GP might refer you to a specialist to discuss surgery.Surgery

ee
usually cures CTS. It can take a month after the operation to get
back to normal activities.
N
Text D
ith

Prevention
W

There are no proven strategies to prevent carpal tunnel syndrome,

but you can minimize stress on your hands and wrists with these
ET

methods:

• Reduce your force and relax your grip. If your work

O

involves a cash register or keyboard, for instance, hit the

keys softly. For prolonged handwriting, use a big pen with
an oversized, soft grip adapter and free-flowing ink.
• Take short, frequent breaks. Gently stretch and bend
hands and wrists periodically. Alternate tasks when
possible. This is especially important if you use equipment
that vibrates or that requires you to exert a great amount
of force. Even a few minutes each hour can make a
difference.
• Watch your form. Avoid bending your wrist all the way
up or down. A relaxed middle position is best. Keep your
keyboard at elbow height or slightly lower.
• Improve your posture. Incorrect posture rolls
shoulders forward, shortening your neck and shoulder
muscles and compressing nerves in your neck. This can
affect your wrists, fingers and hands, and can cause neck
pain.
• Change your computer mouse. Make sure that your
computer mouse is comfortable and doesn't strain your

hu
wrist.

t
• Keep your hands warm. You're more likely to develop

ee
hand pain and stiffness if you work in a cold environment.
If you can't control the temperature at work, put on
N
fingerless gloves that keep your hands and wrists warm
ith
W
ET
O
Time: 15 minutes
• Look at the four texts, A-D, in the separate Text
Booklet.
• For each question,1-20,look through the texts, A-D,
to find in this Question Paper
• Answer all the questions within the 15 Minute time
limit
• Your answers should be correctly spelt.

hu
Carpal tunnel syndrome : Questions

t
ee
1. CTS is generally more common in women
N
2. Raynaud phenomenon
3. Pain medications help to relieve carpal tunnel pain are
ith

4. Common entrapment neuropathy

W

5. Reduce your force and relax your grip

ET

6. Can affect the lining around the tendons in the wrist

O

7. Certain conditions, may increase chances of CTS

Questions 8- 14

Answer the questions,8-14,with a word or short phrase

from one of the texts. Each answer may include words,
numbers or both.

8. Which drugs help to brings down swelling around the

nerve, easing the symptoms of CTS - - - - - - - - -?

t hu
9. What will help to keep your hands and wrists warm,

ee
while working in a cold environment - - - - - - - - - - - - -
-----------?
N
10. Which spinal nerve is compromised in carpal
ith

tunnel syndrome - - - - - - - - - - - - - - - - - - - - - - -?
W

11. What assures a complete cure of carpal tunnel

syndrome - - - - - -?
ET

12. Which metabolic disorder causes the risk of

O

damage to the median nerve - - - - - - - - - - - - - - - - - ?

13. Which differential diagnosis is characterised with

tenderness near base of thumb - - - - - - - - - - - - -?

14. Which physiological changes are increasing the

pressure and , irritating the median nerve due to fluid
retention - - - - - - - - - - ?
Questions 15-20

Complete each of the sentences, 15-20, with a word or short

phrase from one of the texts. Each answer may include
words, numbers or both.

15. The symptoms of CTS often start slowly and come

and go but usually worse at - - - - - - - - - - - - -?

hu
16. The experimental findings suggest - - - - - - - - - - -
help ease the symptoms of CTS?

t
17.
ee
Median nerve provides sensation to the palm side
N
of your thumb and fingers, except - - - - - - - - - - - - -?
ith

18. Neck pain, numbness in the thumb and index

W

finger may be a sign of - - - - - - - - - - - - - - - condition

too?
ET

19. Wearing a - - - - - - - - - - at night while you sleep

will reduce the pressure on the nerve by keeping the
O

hands straight?
20. A - - - - - - - - - - - - - - - - - - can narrow the carpal
tunnel and irritate the nerve, may leads to swelling and
inflammation?

End of Part A
Proceed to Part B & C