30/06/2021
Carpal tunnel syndrome
The carpal tunnel is a narrow passageway on the palm side of the wrist made up of bones and ligaments. The median nerve, which controls sensation and movement in the thumb and the first three fingers, passes through this tunnel along with the tendons to the fingers and thumb. When it is compressed into the tunnel, we have numbness, tingling, weakness, or pain in the hand, and this
This is called carpal tunnel syndrome.
Symptoms:
1- Pain and tingling
Carpal tunnel develops slowly. Initially, symptoms are noticed at night or upon early waking. This feeling is similar to the "pins and needles" sting that occurs when you sleep on your hand. During the day, you may notice pain or tingling when handling objects, such as a phone or book, or when driving. Moving your fingers usually helps.
2- weakness
As carpal tunnel syndrome develops, you begin to notice weakness in the thumb and first two fingers, and it may become difficult to make a fist or grip. You start dropping things, or you have difficulty doing things like grabbing a jar or button your shirt.
3- Sensation problems
Carpal tunnel syndrome can also cause the hands to feel numb. Some people feel like swollen fingers with their fingers, even though no swelling is present, or they may have difficulty distinguishing between hot and cold.
What Causes Carpal Tunnel Syndrome?
Often there is no single identifiable cause for carpal tunnel syndrome. But because the carpal tunnel canal is narrow and stiff, any swelling or inflammation in the area causes compression of the median nerve and thus pain occurs. Symptoms may be present in one or both hands (but symptoms usually develop first in the dominant hand).
Who gets carpal tunnel syndrome?
Women are three times more likely than men to develop carpal tunnel syndrome. Certain causes can also increase the risk of developing the syndrome. These reasons include:
Diabetes, gout, hypothyroidism, and rheumatoid arthritis.
Pregnancy
A sprain or fracture of the wrist
Can the work be blamed?
It is a common belief that repeated writing can lead to carpal tunnel syndrome. But in reality, the risk of infection is three times higher among ordinary workers than it is among data-entry and writing workers.
What happens if not treated?
Initially, symptoms of carpal tunnel syndrome come and go, but as the injury progresses, the condition gets worse, until symptoms persist. The pain may spread up the arm and all the way to the shoulder. Over time, if not treated, it can cause muscle atrophy on the side of the thumb. Even with treatment, strength and sensation may not be the same again.
Is it carpal tunnel syndrome or is it another disease? !!
Some diseases have symptoms similar to carpal tunnel syndrome. We mention among them:
Injury to a muscle, ligament or tendon
Arthritis of the thumb or wrist
• Neurological problems such as diabetic neuropathy
So how can we distinguish !!!
Your doctor will perform appropriate tests to rule out other similar conditions.
Diagnosis of carpal tunnel syndrome
There are several tests your doctor will perform to find out if you have carpal tunnel syndrome.
Among these tests:
1- The Tinel test involves clicking on the median nerve to see if numbness occurs in the fingers
2- The Fallen test, the doctor will tighten and press the back of your hands together for a minute to see if it causes numbness or tingling.
3- Electrophoresis tests (nerve mapping)
To confirm the diagnosis, your doctor will order a nerve conduction study. In this test, electrodes are placed on the hands and wrists, and small electrical shocks are applied to measure how quickly impulses are transmitted through the median nerve.
Another test, the electromyogram, uses a thin needle inserted into a muscle to measure electrical activity and assess damage to the median nerve.
treatment
1 - Rest and not move the hand
As for other causes, such as diabetes or rheumatoid arthritis, the cause needs to be treated. Your doctor may advise you to rest your hand and wrist and wear a brace to limit movement. Using them at night is essential to prevent the wrist from compression during sleep, which can trigger symptoms. Non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen, along with cold compresses, can reduce pain and are used in some cases.
2- Medicines
When symptoms become intolerable, your doctor may recommend corticosteroids by injection or by mouth.
Steroids will reduce inflammation around the median nerve and relieve symptoms. Other medications that may help include diuretics, which reduce swelling, and vitamin B6 as well.
3- Surgery
If surgery is needed, it is usually performed under local anesthesia. The overlying ligament is released at the top of the carpal tunnel to relieve pressure. This gives more space in the carpal tunnel. Sometimes this procedure is done endoscopically, using a small camera through a very small incision to guide the procedure.
What to expect after surgery!
There may be some swelling and stiffness after surgery, which can be resolved by raising your hand to the side of your heart and moving your fingers repeatedly. You may need to wear a wrist brace for a few weeks while the healing occurs, but you can use both hands. Pain and weakness usually improve within two months after surgery, but full recovery may take six months to a year.
4- Wrist strengthening exercises
When symptoms subside, you can learn from a physical therapist stretching and strengthening exercises to help prevent pain, numbness, and weakness from returning. A physical or occupational therapist can also teach you the correct ways to perform tasks so that you do not injure the median nerve again, which may cause symptoms to return.
Can carpal tunnel syndrome be prevented?
Although there is no specific way to prevent carpal tunnel syndrome, these things can help:
Standing in good posture
• Use comfortable tools and take breaks while working
• Extend hands and wrists regularly
Taking frequent breaks to move the arms and legs, straighten the back, and change position regularly during work.
