What are the clinical manifestations of carpal tunnel syndrome?
Patients with carpal tunnel syndrome begin to notice numbness and tingling in the radial half of the three fingers (thumb, index, middle finger and radial half of the ring finger), which is especially pronounced at night. The numbness and tingling sensation is most pronounced in the middle finger, and some patients visit the clinic with numbness in the middle finger only.
As the disease progresses, patients feel dull pain, cramping and weakness in the hand, and often fall to the ground when holding objects. Some patients gradually feel atrophy of the greater pisiformis muscle (Figure 1) and weakness of the thumb against the palm. Some patients may also have no sensory disturbance and present to the clinic with simple atrophy of the greater piriformis muscle.
How is carpal tunnel syndrome diagnosed?
The diagnosis is not difficult based on clinical presentation and examination. Patients with nocturnal numbness that interferes with sleep and sensory disturbance distribution limited to the three and a half fingers on the radial side should be highly suspected of carpal tunnel syndrome.
Examination reveals that the area of sensory disturbance is limited to the three and a half fingers on the radial side, and if the hand muscles are atrophied, it is only limited to the greater pisiformis. Percussion of the transverse carpal ligament often induces radicular pain radiating to the index middle finger (so-called positive Tinel’s sign). Flexion of both wrists at 90 degrees for 1 minute often increases the paresthesias on the affected side and radiates to the index middle finger (positive Phalen’s sign). Compression of the transverse carpal ligament for 1 minute may also induce similar symptoms.
Check the neck and shoulder as well as the nerve reflexes to exclude cervical spondylosis. Especially in computer operators, carpal tunnel syndrome is often combined with neck and shoulder pain due to prolonged sitting work, so be careful to exclude nerve compression caused by cervical spondylosis. In a few cases, nerve compression caused by cervical spondylosis can also cause symptoms similar to carpal tunnel syndrome, but due to the compression of cervical nerve roots, the nerve involvement is widespread, and neck and shoulder activities often induce top-down radiating pain, and the area of sensory impairment and muscle involvement is not limited to the median nerve, so it is not difficult to differentiate after careful examination.
Laboratory tests for carpal tunnel syndrome are mainly electrophysiological. Nerve conduction velocity in the carpal segment that is significantly prolonged strongly suggests compression of the median nerve in the carpal tunnel.
How to relieve the symptoms after the onset of the disease?
1.Use a pillow to elevate the affected forearm when sleeping.
2.Use the normal hand more often and avoid using the affected hand too much.
3.Use different tools and change the way you use your hand.
4.Avoid prolonged wrist hanging position.
How to treat carpal tunnel syndrome?
Treatment options depend on the severity of the symptoms and the underlying lesion causing the carpal tunnel syndrome.
For those with mild symptoms, conservative treatment can be used, including wrist rest, brace immobilization, physical therapy, intracarpal tunnel closure treatment, etc., and can also be supplemented with blood-activating herbal infusions.
Medication includes oral neurotrophic drugs such as methylcobalamin to help nerve repair; non-steroidal anti-inflammatory and analgesic drugs, which can inhibit local inflammatory response and analgesia.
For those symptoms caused by overuse of the hands, it is important to adjust the work style appropriately, such as computer operators’ keyboard and seat height should be adjusted appropriately to make it more comfortable; take regular breaks at work and make passive stretching activities for the wrist joint.
It is generally believed that patients older than 50 years of age with persistent unremitting symptoms, with flexor tendon hyperplastic synovitis or with interphalangeal muscle atrophy should be operated as early as possible. Surgical release of the transverse carpal ligament usually results in immediate relief of painful symptoms. However, recovery of sensory function and muscle atrophy can take a longer time.
Can carpal tunnel syndrome be prevented?
In daily work and life, the following points can help prevent carpal tunnel syndrome
1. If you need to repeat a certain action of your hands for a long time at work (such as typing, needlework), stop frequently and let your hands rest.
2.Do not work with your hands too close to or too far from your body.
3, do not work for a long time to put your hands on the surface of hard objects.
4, often squeeze, stretch or shake hands when working.
5.Do not work with tools that are too big for your hands.
6, do not stand or sit in the same position all day.
7, if you need to use the keyboard for a long time, pay attention to adjust the seat height, so that the forearm and the keyboard at the same height, avoid hanging wrist tapping the keyboard.
8.Actively treat diseases that may secondary cause carpal tunnel syndrome
9, if you are overweight, to lose weight properly.
”Mouse hand” and carpal tunnel syndrome
With the widespread use of computers in daily work and life, the prolonged use of computers also brings some diseases to the hands. Some people have made up the term “mouse hand” to represent the hand disease associated with computer use; some people will “mouse hand” and carpal tunnel syndrome confused together. In fact, hand disorders associated with computer use are not limited to carpal tunnel syndrome. With the use of the mouse directly related to the disease, more common is the thumb stenosis tenosynovitis and radial stem tendinitis; and keyboard-related diseases, mostly seen in the carpal tunnel syndrome. In addition, working in front of a computer in a seated position for long periods of time can easily cause neck and shoulder pain and low back pain.