The carpal tunnel is a narrow canal on the palmar side of the wrist joint with intermediate walking tendons and nerves. It includes the median nerve, which controls the movement and sensation of the thumb, index finger, and middle finger. When the carpal tunnel is narrowed, it will compress the nerve and produce numbness, weakness and pain in the palm of the hand, which is called carpal tunnel syndrome, also known as “mouse hand”. Symptoms 1. Pain Carpal tunnel syndrome starts slowly, and initially only manifests itself as occasional pain at night and pain in the morning, like a small pinprick, and rarely feels pain during the day. 2. Weakness Carpal tunnel syndrome progresses with reduced muscle strength in the thumb, index finger, and middle finger, limited clenching and grasping of objects, occasional sudden dropping of held objects, and clumsy movements such as using chopsticks and fastening buttons. 3. Sensory impairment There will be numbness in the palm of the hand, and some people may feel swelling of the fingers when they are not actually there, and there will also be a feeling of alternating hot and cold in the hand. Who is prone to carpal tunnel syndrome? There is often no exact cause because of carpal tunnel narrowing, and any inflammation or swelling of the tendon can cause pressure on the median nerve, resulting in pain and other symptoms. It can involve both sides at the same time, but the dominant hand is more likely to be involved. The prevalence is three times higher in women than in men. Common risk factors are as follows: 1. diabetes, gout, hypothyroidism, rheumatoid arthritis; 2. pregnancy (increased progesterone levels, fluid retention); 3. injury to the wrist joint; 4. frequent, high-intensity activities of the wrist joint. Carpal tunnel syndrome is often associated with prolonged mouse use. In fact assembly line workers have three times the incidence rate of white-collar office workers, and the use of vibrating devices in the hands also increases the incidence. One study found no significant increase in the incidence of carpal tunnel syndrome in people who used computers for long periods of time (more than 7 hours a day). Diagnosis Doctors perform a series of tests to make a diagnosis, such as Tinel’s sign (numbness and pain in the innervated area on percussion of the injured nerve is considered positive) and Phalen’s test/wrist flexion test (passive wrist flexion and numbness and pain in the innervated area of the median nerve within 1 minute is considered positive). Treatment 1. Firstly, treat the underlying disease, such as diabetes, gout, etc.; 2. It is important to have sufficient rest for the hand and wrist, sometimes it is necessary to wear wrist brace to reduce the activity, and wearing it at night can prevent the wrist joint from flexing during sleep, which will aggravate the symptoms; 3. Non-steroidal anti-inflammatory drugs such as ibuprofen to relieve the pain; 4. Ice packs; 5. If the symptoms are not relieved persistently, local injection of local anesthetic and a small amount of hormone can be used to eliminate the pain and inflammation; 6, Surgery, incision of the carpal tunnel to release the median nerve compression, currently available through a minimally invasive approach to surgery, early postoperative swelling and stiffness may occur, elevation of the arm and movement of the fingers can be relieved. If the condition is allowed to progress and is not treated promptly, there may be atrophy of the masseter muscle and irreversible loss of sensory muscle strength. Carpal tunnel syndrome is a very common disease, mostly in middle-aged and elderly women, with hand numbness and pain, aggravated at rest and reduced after activity as the main symptom, and most patients also wake up in the middle of the night with hand numbness and pain. In recent years, due to the popularity of computers, the age of onset is significantly lower, even in the 10-year-old secondary school students also occurred. The disease has only been gradually more widely recognized in recent years. It is also known as “mouse hand”. The carpal tunnel is a narrow, tunnel-like structure located in the wrist, at the bottom and on both sides of which are the carpal bones of the hand. The median nerve enters the hand through the carpal tunnel via the forearm. This nerve controls the palmar sensation of the thumb, index, middle and ring fingers, as well as the muscles that surround the base of the thumb (greater and lesser interphalangeal muscles). When a trauma, fracture, dislocation, sprain or wrist strain occurs in the wrist, the transverse carpal ligament thickens, the tendons in the carpal tunnel swell, the synovial membrane becomes bruised and edematous and then degenerates, or the carpal bone degenerates and proliferates, reducing the space of the confined canal cavity, thus compressing the median nerve and causing a series of symptoms such as numbness and weakness in the fingers, which is the main pathogenesis of carpal tunnel syndrome. Postoperative treatment methods The following treatment methods are adopted after the patient is released from external fixation 3 to 4 weeks after surgery. 1.Electro-acupuncture treatment Take the affected side of the fish interval, Sanma, Hegu, Yangchi, Yangxi, Waiguan, Hand Sanli and Quchi. After acupuncture, connect the SDZ-II electro-acupuncture treatment instrument, and keep the needle for 20 minutes, 3 times a week. 2.Manipulation therapy Combining traditional Tuina techniques with modern joint loosening techniques, using pushing, kneading, rubbing and other methods to loosen the soft tissues around the wrist joint and smooth the joint. The technique of traction and sliding of the radial carpal joint and thumb is performed with gradual force, as tolerated by the patient. Note that the direction of manipulation should be from the distal end to the proximal end. 3.Functional training Perform nerve impulse exercises for passive muscle movement and active contraction, including active exercises for wrist flexion and extension, thumb flexion and extension, palm-to-finger, etc.; do traction and resistance exercises to increase wrist flexion and extension and forearm rotation, as well as wrist and palm support exercises. 4.Physical therapy According to the different symptoms of patients in the functional training, pulse magnetic therapy, Chinese medicine decoction, ultra-short wave, interferential electricity and other treatments are given to promote local blood circulation, reduce swelling and pain, loosen adhesions and soften scars. 5.Warm water immersion Soak both hands in warm water twice a day for 15 minutes each time. Appropriate herbs to promote blood circulation and eliminate blood stasis can be added to the water to improve blood circulation in the hands and reduce the edema of synovial membrane in the carpal tunnel. 6.Limit activities The affected hand is fixed in a flat and extended position with a brace to limit activities, so that the affected hand can get sufficient rest and avoid congestion caused by excessive activities. 7, elevate the affected limb Patients with a history of nighttime numbness is particularly useful, after soaking in warm water, hand congestion, arterial blood supply increased significantly, venous anger, at this time, if the affected limb is elevated is conducive to venous reflux, unblocked blood circulation in the carpal tunnel is more conducive to decongestion, reduce the pressure in the carpal tunnel, so that hand numbness disappears. This also verifies the traditional view that night numbness is mainly the result of a drop in both arterial and venous pressure and venous blood stasis after falling asleep. 8, physical training wrist fingers completely dorsal extension, in the other hand with appropriate force fingers feel pressure within the wrist joint for the degree, both hands can push each other, push 2 to 3 times a day, each push 20 to 30 times. The 9 tendons in the carpal tunnel have a certain tension every day to squeeze the synovial membrane between and around the tendons, so that they do not proliferate and have a “weight loss” effect on the synovial membrane that has proliferated. Rehabilitation training 1. wrist mobility exercises 2. wrist stretching exercises 3. flexor tendon sliding exercises 4. wrist flexion exercises 5. wrist dorsiflexion exercises 6. grip strength exercises One of the objectives of rehabilitation treatment is to minimize the occurrence of disability.