1.What is carpal tunnel syndrome?
The median nerve and the flexor tendons of the fingers travel in a narrow, tubular gap on the palmar side of the wrist joint, a channel called the carpal tunnel. It is susceptible to compression, which produces neurological symptoms. The median nerve controls sensation in the thumb, index finger, middle finger and part of the ring finger, and innervates some of the small hand muscles that are responsible for moving the fingers and thumb. Sometimes, thickened peritendinous tissue or other masses crowd the space of the tunnel, causing compression of the median nerve. This causes pain, weakness, or numbness in the hand that radiates into the arm. Although this symptom may also be seen in other conditions, carpal tunnel syndrome is the most common cause.
2. What are the symptoms of carpal tunnel syndrome?
Symptoms usually occur gradually with burning, tingling, or itching in the fingers, especially numbness in the thumb and on the palmar side of the index and middle fingers. Patients have little or no significant swelling in the wrist. These symptoms usually first appear at night, either unilaterally or bilaterally, and may be relieved by waking up in pain and “shaking the hand”. When weight is added, daytime tingling may be felt. Grip strength decreases and it may be difficult to form a fist and grasp small objects. If left untreated, the thumb muscles may atrophy and lose the ability to judge hot and cold.
3. What are the causes of carpal tunnel syndrome?
Carpal tunnel syndrome is often the result of a combination of factors that increase the pressure in the carpal tunnel, resulting in neurological symptoms. Rather than a problem with the nerve itself. The most likely cause is due to a congenital carpal tunnel that is smaller than others. Other factors include: swelling of the wrist due to trauma, such as a sprain or fracture; overactive pituitary gland, hypothyroidism, rheumatoid arthritis; wrist strain, compression, and repeated use of vibrating hand tools; and changes in hormone levels in the body during pregnancy or menopause that cause fluid retention in the carpal tunnel. Cysts or tumors in the carpal tunnel. And other unknown causes.
4.Who are prone to carpal tunnel syndrome?
Women are three times more likely to develop carpal tunnel syndrome than men, perhaps because women have a smaller carpal tunnel than men. It often occurs first in the dominant hand (the hand most often used) and produces severe pain. Patients with diabetes or other conditions that directly affect neurotropism are more likely to develop carpal tunnel syndrome. Carpal tunnel syndrome usually occurs only in adults.
Carpal tunnel syndrome can occur in anyone in any industry, but it is particularly common in people in manual labor-intensive positions such as those working on assembly lines – manufacturing, sewing, finishing, cleaning, meat, poultry or fish packing. These individuals are three times more likely to have the condition than normal.
5. How is carpal tunnel syndrome diagnosed?
Early diagnosis and treatment is important to avoid permanent damage to the median nerve. Careful examination of the hand, arm, shoulder, and neck is needed to understand impairments in daily activities and to rule out other conditions with symptoms similar to those of carpal tunnel syndrome. Examine the wrist for pressure, swelling, warmth, and discoloration. Check the sensation in each finger and examine the greater interphalangeal muscles for signs of strength and atrophy. Routine laboratory tests and X-rays can reveal the presence of diabetes, arthritis, and fractures.
The doctor may use specific tests to induce symptoms of carpal tunnel syndrome.Tinel test: The doctor presses on the palmar side of the patient’s wrist, at the median nerve. The Phalen test, flexing the wrist, produces one or more symptoms, such as numbness and tingling or increased pain, within 1 minute, demonstrating the presence of carpal tunnel syndrome.
Electromyography is often required to confirm the diagnosis. Electrodes are placed in the hand and wrist and small amounts of electrical stimulation are applied to measure nerve conduction velocity. A fine needle is inserted into the muscle to understand the electrical activity of the muscle, which can determine the severity of damage to the median nerve. ultrasound imaging can show damage to the median nerve. Magnetic resonance imaging (MRI) can show the anatomy of the wrist.
6. How is carpal tunnel syndrome treated?
If there is an underlying condition, such as diabetes or arthritis, it should be treated first.
Initial treatment usually includes rest, wrist avoidance, and wrist splinting. If there is inflammation, cold compresses can help reduce swelling.
Non-Surgical Treatment
Medications – A variety of medications can relieve pain and swelling. NSAIDs, such as aspirin, ibuprofen and other over-the-counter pain medications, can provide relief and work quickly. Oral diuretics can reduce swelling. Corticosteroids (such as prednisone) or the drug lidocaine, which can be injected directly into the wrist or taken orally to reduce pressure on the median nerve (note: caution for diabetics) In addition, some studies have shown that vitamin B6 supplementation can reduce the symptoms of carpal tunnel syndrome.
Exercise-Sometimes, certain activities can relieve symptoms, and depending on the patient’s complaints, a physical therapist can help with training.
Alternative therapies-Acupuncture, but its effectiveness remains unproven. An exception is yoga, which can reduce pain and improve symptoms.
Surgery
Carpal tunnel syndrome is one of the most common surgical procedures performed in the United States. If symptoms are more than 6 months old, surgery is recommended to cut the transverse carpal tunnel ligament to reduce the pressure on the median nerve. The surgery can be performed under local anesthesia. Many patients require bilateral surgery.
The following are the types of surgery for carpal tunnel syndrome.
Traditional open surgery where an incision of about 2 inches is made to sever the transverse carpal ligament and enlarge the carpal tunnel.
Endoscopic surgery may allow for faster functional recovery and less postoperative discomfort. Two small incisions are made, a camera tube is inserted, viewed on a screen, and the carpal ligaments are cut. This is usually performed under local anesthesia. Scarring and scar induration can be minimized. Not many are performed in China and experience is limited.
Although some patients can have immediate relief of symptoms after surgery, full recovery from most symptoms may take several months. Some patients may have infections, nerve damage, stiffness and painful scars. Occasionally, there can be weakness. After surgery, patients should receive physical therapy to help restore wrist strength. Some patients may need to adjust their work position.
Recurrence of carpal tunnel syndrome after treatment is rare. Most patients recover completely.
7.How to prevent carpal tunnel syndrome?
In the workplace, workers can do relaxation activities, increase rest time, wear splints to keep the wrist straight, and use proper posture and wrist position. Wear fingerless gloves that can help the hand warm and flexible. Ergonomics can be used to redesign tools and tool handles to keep the worker’s wrist in a natural position.