From an old physiotherapist (in your home town!) - symptoms tend to be worse at night because of fluid redistribution when you lie down for long periods. i.e. During the day, a disproportionate surplus of fluid accumulates in the lower limbs, especially in those who sit most of the day. When these people retire to bed, the fluid in the LLs redistributes more evenly, which sees some fluid go into the upper limbs. This increased interstitial fluid in the carpal tunnel is the source of increased pressure when in bed at night. - night symptoms are also contributed to because lymphatic drainage of fluid from the extremities is reduced during sleep. This is due to reduced muscle contractions helping to stimulate lymph flow, less sympathetic nerve activity. - obesity's role in CTS is partly explained by obesity's creation of lymph stagnation and overload. There's more ectopic fat deposition and waste to be handled by the lymph system when obese....and this is often not moved time efficiently....thereby leading to greater fluid retention. - Atherosclerosis also contributes to carpal tunnel pressure, because affected arteries are wider in diameter and less elastic, thereby taking up more space in the c. tunnel. - asymmetries in CTS when young vs old can be explained by asymmetries in muscle/tendon/artery/vein size in dominant vs non dominant upper limb. Typically, the dominant upper limb gets CTS first. CTS is an interesting pathology because it is an early indicator of fluid mgt disorders, due to the rigidity of the carpal tunnel. An even more interesting disorder is fluid mgt issues within the rigid cranium!! Any compromise of fluid flows within the cranium can have very very serious symptoms.....and it is likely many mood/cognitive/sleep/hormone disorders are due to compromised fluid flow in/around/out of the cranium, whether blood or CSF.
I operated on a carpal tunnel, it's such a satisfying procedure. The patients have immediate relief and it tends to heal well. Nice video. Thanks for the awesome explanation! 👌
Can you do a video on ABO blood types & Rhesus blood types? I'm an enigma in my family, as I have AB- & Rh-, while everyone else in my family has O+ & is Rh+. I've tried researching it, coming up with virtually nothing everytime. 🤷🏼♀️ No, no I'm not adopted. I've triple checked. To clarify, I know the Rh- shot you can get during pregnancy can affect the rhesus factor, (my biological Mom had to get it when she was pregnant with me) but going by blood comparability, my biological Mom's blood type and biological Dad's blood, didn't mix to begin with. Meaning just shouldn't exist??
I've had someone joke to me before that I'm going to get carpel tunnel from playing computer games that involve *a lot* of constant clicking, but I'm not sure I believe that and your video seems to align with that belief. Would you say this is genuinely possible simply from a lot of clicking with a computer mouse?
It would depend a lot on your posture and the positioning of your wrists… if your wrist is extended (like when holding the mouse), for prolonged periods of time there is a lot of pressure on the median nerve and over time this can lead to Carpal Tunnel. Look up ergonomic positioning for desk work/computer use
From an old physiotherapist (in your home town!)
- symptoms tend to be worse at night because of fluid redistribution when you lie down for long periods. i.e. During the day, a disproportionate surplus of fluid accumulates in the lower limbs, especially in those who sit most of the day. When these people retire to bed, the fluid in the LLs redistributes more evenly, which sees some fluid go into the upper limbs. This increased interstitial fluid in the carpal tunnel is the source of increased pressure when in bed at night.
- night symptoms are also contributed to because lymphatic drainage of fluid from the extremities is reduced during sleep. This is due to reduced muscle contractions helping to stimulate lymph flow, less sympathetic nerve activity.
- obesity's role in CTS is partly explained by obesity's creation of lymph stagnation and overload. There's more ectopic fat deposition and waste to be handled by the lymph system when obese....and this is often not moved time efficiently....thereby leading to greater fluid retention.
- Atherosclerosis also contributes to carpal tunnel pressure, because affected arteries are wider in diameter and less elastic, thereby taking up more space in the c. tunnel.
- asymmetries in CTS when young vs old can be explained by asymmetries in muscle/tendon/artery/vein size in dominant vs non dominant upper limb. Typically, the dominant upper limb gets CTS first.
CTS is an interesting pathology because it is an early indicator of fluid mgt disorders, due to the rigidity of the carpal tunnel.
An even more interesting disorder is fluid mgt issues within the rigid cranium!! Any compromise of fluid flows within the cranium can have very very serious symptoms.....and it is likely many mood/cognitive/sleep/hormone disorders are due to compromised fluid flow in/around/out of the cranium, whether blood or CSF.
I operated on a carpal tunnel, it's such a satisfying procedure. The patients have immediate relief and it tends to heal well. Nice video.
Thanks for the awesome explanation! 👌
Fantastic video Dr Matt! Keep up the great work!
Can’t wait for the book to come out
Well explained. Thank you 😊
Thank U our great doctor
You follower from Egypt
THANK U SO MUCH, awesome teacher....could u please NCLEX for nurses...it might be helpful.
Can you do a video on ABO blood types & Rhesus blood types?
I'm an enigma in my family, as I have AB- & Rh-, while everyone else in my family has O+ & is Rh+.
I've tried researching it, coming up with virtually nothing everytime. 🤷🏼♀️
No, no I'm not adopted. I've triple checked.
To clarify, I know the Rh- shot you can get during pregnancy can affect the rhesus factor, (my biological Mom had to get it when she was pregnant with me) but going by blood comparability, my biological Mom's blood type and biological Dad's blood, didn't mix to begin with. Meaning just shouldn't exist??
I've had someone joke to me before that I'm going to get carpel tunnel from playing computer games that involve *a lot* of constant clicking, but I'm not sure I believe that and your video seems to align with that belief. Would you say this is genuinely possible simply from a lot of clicking with a computer mouse?
It would depend a lot on your posture and the positioning of your wrists… if your wrist is extended (like when holding the mouse), for prolonged periods of time there is a lot of pressure on the median nerve and over time this can lead to Carpal Tunnel. Look up ergonomic positioning for desk work/computer use
Crutches .From the age of 9