Interestingly, the carpal bones were named for unique features possessed by each bone. Here are the eight listed below with associated name etymologies: ● Scaphoid: Boat shaped with a scaffold like tubercle on its lateral edge. ● Lunate: Half-moon (lunar) shaped. ● Triquetral: Pyramidal design with an oval facet on the palmar edge. ● Pisiform: Pea-shaped design with an oval facet on the dorsal edge. ● Trapezium: Quadrangular with a concave-convex articular distal surface. ● Trapezoid: Resembles as trapezoid shape. ● Capitate: Resembles a baseball cap design with its round head. ● Hamate: Wedge-shaped bone with a hook at its proximal base. The largest carpal bone is the capitate; the smallest carpal bone is the trapezoid. The overall design of the carpal bone structure is to transfer load force from the hand into the antebrachium. Because they are short bones, there is very little leverage strength allowed; therefore, these bones are not ideal to use to move heavy objects or to perform the same repetitive movements daily. Proper wrist alignment is crucial to avoid injury to the carpal bones when moving heavy objects and performing an occupational task that requires repetitive movements.
Unfortunately, the average client is unaware of their daily wrist alignment: This causes many people to develop carpal tunnel syndrome due to the prolonged, repetitive stress on the carpal bone structures. Carpal tunnel syndrome (CTS) involves median nerve impingement within the carpal tunnel on the anterior aspects of the wrist, through which the flexor muscle tendons travel. When these tendons become enflamed, pressure (due to swelling) is placed on the median nerve. The term “nerve impingement” is synonymous with nerve entrapment and nerve compression. In Figure 2, the red dot indicates the location of true carpal tunnel impingement. Figure 2: Nerves Involved in CTS
ETIOLOGY (CAUSE)
● Ergonomic factors, which include: ○ Workspace set up. ○ Repetitive nature of one’s occupation. ○ Use of tools, especially vibrational or fine machinery. Let us examine each item in greater detail. Because of the proximity of the carpal bones, a buckle fracture is a common occurrence. This type of fracture features two bones that experience excessive compression force as they are driven together. Activities that encourage wrist misalignment, such as typing and manual labor, can create the forces needed to compress bones, thus causing a buckle break. Less common fractures of the wrist region include pathologic, comminuted, oblique, and transverse fractures. Pathologic fractures result from a disease process and often involve a significant bone disease, such as osteoporosis or osteopenia. Certain autoimmune diseases, especially involving the thyroid gland, can also weaken bone structures. Comminuted fractures result in the bone shattering into many pieces. An oblique fracture presents as a bone that breaks at an angle. A fracture line in a transverse fracture is characterized as a ninety-degree angle within the bone. These three fracture types result from a traumatic event to the region, such as bracing for a fall or jamming one’s wrist while punching an object. mellitus, cancer, kidney conditions, infectious disease, myopathic conditions, and hypothyroidism. Additionally, autoimmune diseases, such as Guillian- Barre syndrome and systemic lupus may also cause nerve degeneration. Because the body’s immune system is compromised, bodywork efforts need to remain mild for the autoimmune disease patient regarding the length of session, the depth of pressure, and the intensity of tool and product application.
The most common causes of CTS include: ● Wrist fracture. ● Neurological disease. ● Increased fluid retention. ● Inflammatory arthritis conditions.
Wrist fracture A fracture is a break to a bone. If any of the carpal bones become fractured, several musculoskeletal challenges may result: First, the bones may deviate in placement, thereby narrowing the carpal tunnel region itself. Second, if a bone does not heal properly, a misalignment of skeletal structures may result. This can potentially narrow the carpal tunnel region. Third, the inflammatory response may create a myriad of symptoms that cause median nerve compression. The most notable symptom is swelling. Finally, previously injured bones are now compromised, which makes them more susceptible to future injury – especially if the client continues with repetitive stress to the wrist region. There are numerous types of fractures. A hairline fracture (also called a stress fracture ) features faint cracks that weaken the bone. An open fracture is characterized by damage to the skin, even tearing. This creates complex lesions that must heal—in addition to the bone. A closed fracture is a break in the bone; yet, the skin stays intact. Internal bleeding can be a concern with this type of fracture. Neurological disease Neurological diseases and auto-immune disorders often cause the deterioration of peripheral nerves and may contribute to carpal tunnel syndrome symptoms. Examples of some of these neurological diseases include amyotrophic lateral sclerosis, multiple sclerosis, spinal musculature atrophy, and Huntington’s disease. As the nerves degenerate, conductivity is either partially, or completely, impaired or impeded. This renders the nerve useless; the patient first witnesses the onset of muscle atrophy, and then further complications of CTS results. Be wary of peripheral neuropathy in a patient. Common conditions that cause this phenomenon include diabetes Increased fluid retention Fluid retention within the body can happen due to a variety of reasons. Chronic inflammation, autoimmune disease,
cardiovascular disease, hormonal changes, menstrual cycles, and acute injury are all potential causes of fluid retention within
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