Carpal tunnel syndrome

Carpal Tunnel

The carpal tunnel is a narrow channel between the wrist and the hand. Tendons of as many as 9 muscles pass through this channel internally, as well as a nerve called the median nerve.

The carpal tunnel is characterized by an empty space due to the anatomy of the carpal bones, which join the transverse ligament of the carpus.

Carpal tunnel syndrome

Repeated compression of the carpal tunnel leads to an inflammation recognized as carpal tunnel syndrome.

Carpal tunnel syndrome manifests itself with pain, numbness and tingling. Typically, the affected areas are the wrist and the fingers of the right hand, but in some cases also those of the left (especially for those who are left-handed).

The perceived sensation is that of having numb fingers or tingling in the first four fingers, from the thumb to the ring finger. Furthermore, it is also common for the palm of the hand to feel numb.

In severe cases where the pain in the hand is strong, it is possible to feel a strong burning sensation.

Causes

The causes of carpal tunnel syndrome can vary.

Pregnant women are often affected by this condition, beginning after the first trimester. This occurs because of hormonal changes that cause water retention and swelling. The latter reduces the space inside the carpal tunnel, causing the median nerve to compress.

Genetic inheritance is another condition that can lead to the occurrence of the syndrome. Reduced dimensions of the canal may be due to a genetic trait.

Another factor is weight gain. In fact, the accumulation of fat inside the wrist causes compression of the nerve.

Even congenital factors can contribute to the development of the syndrome. People with narrow wrists seem more likely to be affected, although there is no absolute certainty about this.

Additionally, some diseases can advance the inflammation:

  • Diabetes: according to some clinical studies, diabetes predicts carpal tunnel syndrome, but the mechanism linking the two conditions is still unclear.
  • Rheumatoid arthritis: sometimes the first sign of this is the carpal tunnel syndrome.
  • Gout: is an inflammatory disease caused by the deposit of uric acid crystals.
  • Obesity: in this case, excess fat can compress the nerve and the tendons.
  • Chronic water retention and renal failure: both conditions can contribute to the accumulation of liquid in certain parts of the body, including hands and wrists.
  • Hypothyroidism: carpal and tarsal tunnel syndromes are also among the complications of this condition.

Finally, some work related activities such as daily computer and mouse use definitely contribute to the appearance of this syndrome.

Diagnosis

For carpal tunnel syndrome diagnosis, consult a specialist such as an orthopaedist or a neurosurgeon.

Normally, the diagnosis involves an objective examination and an assessment of the patient’s medical history and habits.

In some cases however, electromyography is used. This is an examination that, in the case of the carpal tunnel, involves the insertion of a small needle-electrode into the muscle.

The purpose of electromyography is to evaluate the health of the muscle and of the cells that control it, by measuring the electrical activity.

Other more specific tests are:

  • Tinel’s sign test, during which the doctor exerts a light pressure on the patient’s wrist to check for tingling.
  • Phalen’s sign test, also known as the Wrist Flexion Test, in which the patient pushes the dorsal surfaces of both hands together with the fingers pointing downwards. The aim in this case is also to check for any tingling sensation.

If the physical examination reveals the possibility of a wrist fracture, or a degenerative disease affecting the joints, then it is appropriate to perform a radiological examination.

Similarly, if the patient’s syndrome may have been caused by undiagnosed conditions such as diabetes, hypothyroidism, gout or rheumatoid arthritis, blood tests are usually prescribed.

Physical therapy involves the execution of physiotherapy exercises for the treatment and rehabilitation of the hand, hip, knee, foot and limbs in general.

Therapies

The cures and remedies for carpal tunnel syndrome depend on the duration and intensity of the symptoms.

In the next paragraphs we will examine the different therapies, from the less invasive to the more invasive ones.

NATURAL REMEDIES

Usually, natural remedies include:

  • The simple application of ice, especially when the wrist is inflamed.
  • Performing specific exercises for the carpal tunnel, such as stretching or strengthening exercises for the wrist.

However, these exercises should always be performed under the supervision of a specialist physician, such as a physiotherapist or an occupational therapist.

When the simple natural remedies are ineffective, more specific therapies are used.

CONSERVATIVE THERAPY

Conservative therapy involves the application of a wrist brace and the prescription of anti-inflammatory drugs mainly containing corticosteroids. These drugs are either taken orally or injected directly into the wrist.

In some cases however, neurotrophic drugs are preferred over doses of cortisone.

Treatment tends to be conservative especially in pregnant women and patients who are particularly young.

Unfortunately, this is not always sufficient to recover from the disease.

CARPAL TUNNEL INTERVENTIONS

When the symptoms are too intense and are present for at least 6 months, it is advisable to undergo a carpal tunnel operation.

The surgery involves cutting the band of tissues around the wrist. This way, the compression on the median nerve is reduced.

Doctors can decide to perform two different types of intervention:

  • Neurolysis procedure, in which the doctors make a single incision of approximately 5 cm in the wrist.
  • An endoscopic operation, which involves two incisions of just over 1 cm on the wrist and on the palm of the hand.

As a rule, both operations are performed under local anaesthesia, but endoscopic surgery allows faster rehabilitation.

The patient begins convalescence immediately after the operation. The wrist must initially be kept bandaged for a few days. It is then advised to start rehabilitation exercises using a wrist guard for the carpal tunnel.

Preventions

As mentioned earlier, this syndrome can be linked to some activities performed daily in the workplace.

Precautions can be taken to prevent this, for example performing stretching exercises and taking breaks from manual work.

Furthermore, it is advisable to always pay attention to body posture and the position of the wrist.

Prevention is therefore very important because it can avoid having to undergo intervention in the future.

If you liked this article, how about sharing it with your friends and colleagues?

Perhaps some of them are suffering from the syndrome at this moment, and would find it particularly useful!

 

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