Carpal tunnel syndrome
What is carpal tunnel syndrome?
The median nerve is one of the most important nerves in the upper limb, providing sensitivity to the hands on the palmar face for the thumbs and fingers 2, 3 and 4 (only half of the finger).
Carpal tunnel syndrome is one of the most common compressive neuropathies that occurs when the median nerve is compressed in the wrist (carpal tunnel).
As time goes on, the disease worsens, which is why it is very important to diagnose and treat it early.
Causes of carpal tunnel syndrome
The most common causes that can promote carpal tunnel syndrome are:
-hereditary causes (carpal tunnel may be narrower in some people or muscle fibers may be present at this level)
-repetive movements of the joint or certain trades that may require the joint
-pregnancy or menopause that can cause water retention and inflammation
-presence of a formation that compresses the nerve (cyst, gouty tufts, etc.)
-an inflammation of the synovial sheath of the tendons
-chronic diseases: diabetes, rheumatoid arthritis, thyroid disease, kidney failure
-traumatic injuries (fractures / dislocations of the wrist, burns)
Symptoms of the disease include: numbness and tingling in the fingers I-III and the radial half of the finger IV that occur more frequently at night.
As the disease progresses these symptoms become permanent and appear: pain, tremors, muscle strength decreases - the patient drops objects from the hand and in severe forms there is an atrophy of the muscles in the tender area.
If left untreated, the disease completely and irreversibly affects the median nerve, leading to impaired hand function.
The diagnosis is established during the consultation with the specialist doctor based on the clinical examination of the hand and specific tests that confirm the diagnosis.
There is also an electrical investigation called EMG (electromyography) that shows us if there is a conduction disorder along the nerve and so we can determine the severity of compression of the median nerve.
The treatment is determined according to the stage of the disease and the severity of the symptoms and can be: conservative or surgical.
Conservative treatment (non-surgical):
-applies in the early stages or for transient reasons (task)
-consists of immobilizing the hand at night on a splint in a neutral position
-inflammatory year medication
-corticosteroid injections in
Surgical treatment(decompression of the median nerve in the carpal tunnel):
-is performed if the conservative treatment does not give results
-surgery is performed with local anesthesia and consists of a small incision in the wrist followed by the release of the nerve that is compressed, the inspection of the other elements of the carpal tunnel and the suture of the skin.
-The hand will be bandaged and immobilized on the splint to prevent joint movement that can lead to postoperative bleeding.
Immediately after surgery the area will be inflamed and stiff.
Postoperatively it is recommended:
-maintaining an elevated (raised) position of the hand to help reduce edema
-the first dressing is performed 24 hours after the intervention in order to inspect the wound
-removal of sutures will be done in 10-14 days
-the patient will wear a splint for 3 weeks
-the patient avoids lifting weights one month postoperatively
-pain or discomfort will be treated with medication
-mobilization of the hand begins early starting with the 5th day
What can happen if it is not treated in time?
In the absence of surgery the disease worsens leading to complete loss of sensitivity in the territory of the median nerve. Muscle atrophy in the tender area also occurs and muscle strength slowly decreases.
The patient ends up using his hand with difficulty, drops objects from his hand and will have unbearable nocturnal pain.