Carpal Tunnel Syndrome is becoming more common thanks to the extensive use of computers and poor body mechanics. Remember you want your elbow at a 90-degree angle when you are typing and for your hands to be perfectly flat over the keyboard, no extension or flexion of the wrist! What Is Carpal Tunnel Syndrome? Compression of the median nerve between the carpal ligament and other structures within the carpal tunnel Entrapment of nerve results in pain or tingling Causes of Carpal Tunnel Syndrome Repetitive motion, specifically typing at a bad angle Improper desk posture Carpal Tunnel Syndrome Symptoms Burning, aching, tingling pain in the hand  and wrist starting from the middle of the 4th finger towards the thumb Pain can radiate to the forearm “Acroparesthesia” –  awakening at night with numbness Positive Tinel’s test: tapping the medial nerve results in pain and burning Positive Phalen’s maneuver: placing the hands together upside down with the outer side of the hand and wrist touching

Once you present with symptoms of carpal tunnel syndrome your healthcare provider will begin a medical work up to either diagnose or rule out carpal tunnel syndrome. Testing for carpal tunnel includes imagine and physical exam by medical provider. Imaging: to look at the radial nerve, in carpal tunnel you will often see swelling of the area around the nerve and/or compression of the nerve Electromygram (EMG) Nerve conduction studies X-ray of wrist Physical exam : includes the phalnes and tinels tests Phalens test: place hands back to back upside down for 60 seconds, tingling and pain will be produced in those with carpal tunnel Tinels: tap the inside of the wrist over the radial nerve, pain or tingling will occur in those with carpal tunnel Treatment: for carpal tunnel begins with lifestyle changes and pain medication Limit activity that produces symptoms Splint the hand and forearm Medications NSAIDS (Advil or Motrin) to reduce inflammation and pain Steroid injections at 6 week intervals to reduce inflammation and pain Surgical treatment: may be needed if lifestyle changes and rest do not improve symptoms Surgery for those who are not experiencing relief with limited activity and medications Release the transverse carpal ligament 10% will not respond due to nerve damage

Celiac disease is an autoimmune based, chronic inflammatory condition of the gi tract. People with celiac have a dysfunctional immune system response to the protein gluten that leads inflammation and damage of small intestinal mucosa. When the gluten, which is commonly found in grains like wheat, oats, brain, barley is consumed, antibodies and antigens signal the immune system to attack. Overtime this attack on the digestive tract can lead to decreased absorption of nutrients, diarrhea, gi upset, and other less common symptoms such as anemia and malnutrition. About 1% of population worldwide have celiac disease and only 5-10% of those with the condition are aware of having it. The incidence of Celiac is on the rise and is thought to have tripled over past 50 years. This may be explained partly due to higher awareness of the condition and better diagnosis methods, but could also be due to an increase in other risk factors associated with CD such as diabetes. Celiac disease results from interplay of both genetic and environmental factors. CD usually develops early in life, but in many patients symptoms may not appear till later in life. It occurs twice as often in females than males because the HLA gene loci DQ2/DQ8 are more frequently found in females than in male patients.Prevalence is higher in individuals suffering from anemia, diabetes, and other autoimmune diseases.

Celiac disease can present as an intestinal or extra-intestinal condition and in some cases may even be asymptomatic. Many cases go undiagnosed due to the failure to present any symptoms. Typical symptoms of celiac disease: Diarrhea Weight loss Gastric Upset Abdominal Pain Weakness and fatigue Atypical symptoms are often related to decreased absorption of nutrients or autoimmune responses and include Anemia Osteoporosis Dermatitis herpetiformis Autoimmune thyroiditis Clinical manifestation of Celiac depends on multitude of factors such as genetics, environmental factors, age, gender, and the extent of small intestinal inflammation. Refractory Celiac Disease (RCD) is defined by persisting malabsorption and villous atrophy after about one year of strict Gluten free diet. RCD is also more frequent in women than men. RCD can be type 1 or type 2 depending upon the presence of normal intraepithelial lymphocytes, or abnormal intraepithelial lymphocytes respectively.

Celiac disease in an autoimmune process in which the body makes antigens and antibodies in the presence of gliadin, the alcohol-soluble fraction of gluten. When gluten is consumed, the body mistakes its own gi tract cells for invader cells and antigens signal the immune system. Antibodies then attack the lining of the small intestine, most specifically the villi, which are the small finger like projections located on the surface of the lining. Overtime this attack on the digestive tract can lead to decreased absorption of nutrients, diarrhea, gi upset, and other less common symptoms such as anemia. Environmental Factors Among the environmental factors, gluten is the most common contributor in the development of Celiac disease. Gluten is present in grains like wheat, rye, oat, and barely and is rich in amino acids proline and glutamine. These residues are resistant to degradation by small intestinal proteases. Therefore, gluten protein is not digested completely and partial digestion leads to creation of multiple peptides. These peptides are generated by the action of enzyme tissue transglutaminase (tTG) which causes deamidation of gluten. The peptides are then presented by HLA DQ2 and HLA DQ8 molecules to T-cells. Both gluten as well as autoantigen tTG induce autoimmune response. In CD patients, gluten consumption leads to the production of tTG antibodies by B cells in small intestinal mucosa that can be detected in the serum.