Compression of the median nerve during its passage through the wrist’s carpal tunnel, a tiny tube, is the hallmark of Carpal Tunnel Syndrome (CTS), a common disorder that affects the hand and wrist. Pain, numbness, and other symptoms affecting hand function can be caused by this syndrome.
The Carpal Tunnel Anatomy
- Carpal Tunnel: A constricted, stiff ligament and bone passageway located at the hand’s base.
- The thumb, index finger, middle finger, and a portion of the ring finger are all sense organs that are supplied by the median nerve, which extends from the forearm into the palm of the hand.
- Tendons: This tunnel is also used by the nine tendons that flex the thumb and fingers.
Causes
- Repetitive Hand Motions: Tasks involving the wrist that need repeated motions, such typing, knitting, or working on an assembly line, can cause the tendons to bulge and pressure the median nerve.
- Health Conditions: A number of illnesses may be linked to the development of CTS.
- Diabetes: Increased sensitivity due to potential nerve damage.
- Rheumatoid Arthritis: Inflammation of the wrist tendons is a symptom of rheumatoid arthritis.
- Thyroid dysfunction: Causes the retention of fluid, which raises the pressure inside the carpal tunnel.
- Injury: The amount of room in the carpal tunnel can be decreased by sprains, fractures, or other trauma.
- Fluid Retention: Hormonal fluctuations, especially in women going through menopause or pregnancy, can cause swelling and put more strain on the median nerve.
Symptoms
- Mostly in the thumb, index, and middle fingers, numbness and tingling are most common at night.
- Pain: May be localised to the forearm, wrist, or hand; it may also occasionally radiate up the arm.
- Weakness: Having trouble gripping or pinching things, such holding a coffee cup or buttoning a garment.
- Swelling Sensation: Even in the absence of actual swelling, some people get the sensation that their fingers are swollen.
Diagmosis
Physical Exam:
Consists of:
To check if it causes tingling in the fingers, tap the median nerve at the wrist, also known as Tinel’s Sign.
Flexing the wrist to check if it causes symptoms is known as Phalen’s Manoeuvre.
Tests for electrodiagnosis:
Measures the electrical impulses as they pass through the median nerve in a study called nerve conduction.
Assesses the electrical activity of muscles using electromyography (EMG).
Treatment of Carpal Tunnel Syndrome
Depending on the intensity and length of the symptoms, Carpal Tunnel Syndrome (CTS) can often be efficiently treated with a mix of non-surgical and surgical procedures.
Non-Surgical Interventions
1.Splinting of the Wrist
Goal: Maintains a neutral wrist posture to reduce pressure on the median nerve.
When to Use It: Usually worn at night to avoid wrist bending, which can make symptoms worse.
2.Drugs
NSAIDs, or nonsteroidal anti-inflammatory drugs: Both naproxen and ibuprofen can help lessen pain and inflammation.
Corticosteroids: Prednisone and other oral or injectable steroids help reduce oedema and inflammation.
3.Injections of Corticosteroids
Goal: lessen carpal tunnel discomfort and irritation.
Effectiveness: May offer transient alleviation; utilise prior to contemplating surgery.
4.Modification of Activity
Ergonomic Adjustments: Modifying work execution techniques to lessen wrist strain. This may entail employing ergonomic equipment or rearranging the location of the computer keyboard.
Intervals and Physical Activity: Taking regular breaks from repetitious jobs and engaging in wrist and hand stretches.
5.Physical Medicine
workouts: Targeted workouts to strengthen and extend the wrist and hand muscles.
Manual therapy: Wrist mobilisation and median nerve pressure reduction techniques.
Surgical Treatments
- Surgery may be considered if non-surgical therapy are futile and symptoms last for at least six months.
1.Surgery to Release the Carpal Tunnel
The goal is to slice the ligament that forms the carpal tunnel’s ceiling in order to release pressure on the median nerve.
Surgery Types:
- Open Surgery: To cut the ligament, a bigger incision is made in the hand’s palm.
- Endoscopic Surgery: This type of surgery uses fewer incisions and a camera to guide the ligament-cutting procedure. Usually, this technique enables a faster recovery.
Following Surgery
- Recuperation: May take a few weeks or months. Resuming activities should be done gradually.
- Rehabilitation: To regain flexibility and strength, physical treatment may be suggested.
Complementary and Alternative Treatments
Yoga
- Benefits: Research indicates that yoga may help strengthen your grip and lessen pain.
The use of acupuncture
- usefulness: Although further research is required to validate its usefulness, some people experience symptom reduction.
Chiropractic Treatment
- Approach: Hand and wrist adjusting techniques, albeit there isn’t much proof of their efficacy.
Preventive Actions
Ergonomic Modifications
- Workstation Setup: Make sure that instruments such as keyboards and mouse are arranged to reduce wrist strain.
Continual Pauses
- Rest Periods: Taking regular pauses to allow the hands and wrists to heal from repetitive tasks.
Workouts
- Stretching: To preserve flexibility and lower the risk of CTS, perform regular hand and wrist stretches.
Conclusion
Compression of the median nerve in the carpal tunnel of the wrist results in the common ailment known as Carpal Tunnel Syndrome (CTS). It causes symptoms in the hand, especially in the thumb, index, and middle fingers, including pain, numbness, tingling, and weakening. Repetitive hand motions, certain medical disorders, and fluid retention are frequently associated with CTS.
There are both non-surgical and surgical approaches for treating CTS effectively. Relief can be obtained with non-surgical treatments such as corticosteroid injections, medicines, wrist splinting, and activity changes. Surgical treatments such as carpal tunnel release surgery may be required if symptoms do not improve. The use of complementary therapies like acupuncture and yoga may also be advantageous.
To lower the chance of acquiring CTS, preventative measures such as ergonomic modifications, frequent pauses, and stretching exercises are crucial. Maintaining hand function and preventing long-term nerve damage require early diagnosis and adequate treatment.
