Carpal tunnel syndrome (CTS) is a catastrophic condition that affects more than 8 million individuals in the United States and continues to rise every year.
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What is carpal tunnel syndrome?
Carpal tunnel syndrome is one of several repetitive strain injuries
(RSIs) that are everywhere; homes, businesses, assembly lines, grocery shops,
book clubs, construction sites, dentist offices, everywhere!
Because carpal tunnel syndrome is very common, and its effects are so distressing,
it is important to know all about it.
We should know how it occurs, what its symptoms are, the testing methods
used and options for management, as the prevention of any disease, starts with knowing
everything about it.
Carpal tunnel syndrome is a condition affecting the median nerve, which
delivers the function to the thumb, index, middle, and one-half of the ring finger.
Causes of carpal tunnel syndrome
Anyone may be impacted by this condition. Age is not a barrier. It is
being recognized that women are impacted more by this illness, compared to
males.
Though there are several explanations behind the etiology of carpal
tunnel syndrome, the main reason is the compression of tunnel walls.
As the tunnel walls compress,
they place pressure on the median nerve. As the median nerve is strained, it
creates carpal tunnel syndrome.
Congenital predisposition is also a cause of carpal tunnel disease. In a
majority of situations, the carpal tunnel is narrower than usual, which
causes the median nerve to stress.
The condition may develop fast if the wrist has been broken or damaged.
Also, rheumatoid arthritis can cause CTS.
In certain circumstances repeated stress-produced carpal tunnel strain
develops this condition. If a person’s employment entails, grasping, typing, or
digging, the hand becomes stretched and it directly strains the median nerve.
Repetitive wrist and hand activity lead to damage and swelling of
the subcutaneous tissues. These tissues comprise muscle, ligament, fascia,
sheaths, tendons, blood vessels, and peripheral and retinaculum nerves.
Due to the tiny and constricted route of the tunnel, these enlarged
tissues may compress together and cause concentrated pressure.
Carpal tunnel syndrome may also be trauma-related. These reasons include
fractures or damage of the wrist or one of the arm bones.
Internal hemorrhage in the wrist
leads to the creation of hematoma which produces the condition. If any one of the
carpal bones of the wrist becomes dislocated, it leads to the carpal syndrome.
Obesity is another prevalent cause of carpal tunnel syndrome. Women who
use contraceptive tablets might also go on to acquire this illness.
Symptoms and signs of carpal tunnel syndrome
Usually, the symptoms are more frequent in the thumb, index, and middle
fingers (Sometimes one-half of the ring finger).
It includes numbness, tingling, paraesthesia, pain, and stiffness in the
front aspect of the hand, wrist, and forearm.
These symptoms may not have to occur concurrently, and may only affect
one finger one day and then three fingers a few days later.
If a doctor delivers a carpal tunnel diagnosis and the symptoms are in
the ring and little fingers, it is NOT carpal tunnel syndrome!
The ulnar nerve, not the median nerve, delivers the function to the ring and
little finger.
Repetitive strain diseases involving these two fingers are generally
either Guyon’s syndrome, entrapment of the ulnar nerve in Guyon’s canal at
the wrist junction, or cubital tunnel syndrome, entrapment of the ulnar nerve
at the elbow junction.
This is a typical error done by many doctors since they often propose
surgery for the patient, leading to unneeded treatment, and what makes it
worse, is the incorrect condition!
Diagnosis of carpal tunnel syndrome
Whether symptoms of carpal tunnel syndrome do occur, physicians will
urge that a nerve conduction velocity (NCV) test or an Electromyogram (EMG) be
conducted to determine if carpal tunnel syndrome genuinely exists.
These tests are typically uncomfortable to the person being tested,
exceedingly costly, and often provide false positives and false negatives.
This is why it is advised that
manual carpal tunnel tests be conducted to acquire a more accurate
(and considerably cheaper) diagnosis.
Manual carpal tunnel tests take no more than 10 minutes, have a high
accuracy rate, are painless, and are relatively affordable compared to NCV and EMG testing.
Carpal tunnel syndrome tests
There are many manual carpal tunnel syndrome tests as:
• Phalen’s Test: The doctor asks the patient to flex his wrist for 30 to 60
seconds to compress the median nerve and exacerbate the symptoms.
• Reverse Phalen’s Test: The wrist is stretched for 30 to 60 seconds to stretch the median nerve and exacerbate the symptoms.
Stretching the median nerve if it already impinges can exacerbate the symptoms if a patient has carpal tunnel
syndrome.
• Tinnel Sign: Tapping directly on the median nerve at the wrist joint can
induce carpal tunnel symptoms to present themselves.
• Compression Test: Direct pressure is administered on the site of the
median nerve for 30-60 seconds to check whether carpal tunnel symptoms are
shown.
Prevention of carpal tunnel syndrome
Some of the things you may do to prevent carpal tunnel syndrome:
- Regular workout for your wrists and hand
- Avoiding too much stress on your hands and wrists
- Follow a healthy posture when sitting at your computer
- Usage of acupuncture or osteopathy
- Get your arms, and wrists massaged
- Avoid stresses on your wrists. Use your elbows and shoulders instead
- Take short breaks during work
- Warm up before you start your work
- Avoid sleeping on your hands
- If you are a regular user of the computer you can set your keyboard in a flat position rather than a slanting position. Do not rest your wrists on the keyboard
- Type softly
- Sleep in an upright posture to reduce strain on your nerves
- Don't knot the hand bandage excessively tightly
Treatment of carpal tunnel syndrome
If a positive diagnosis comes back, most physicians will push for
surgery, a technique that has a poor success record and is to only be
undertaken as a last option following all other conservative treatment
approaches that have been tried.
Conservative treatment is the key to effective healing from carpal
tunnel syndrome and gaining not just short-term but long-term relief as well.
The following is a list of conservative therapies that should be
performed to assist avoid carpal tunnel syndrome from occurring, but
also repairing carpal tunnel syndrome if it is already established.
•
Ergonomics: Utilize correct ergonomic tools
and equipment while working.
•
Rests: Take brief breaks every 30 minutes
while working to avoid excessive strain on the hands.
•
Stretches: Stretch the muscles that ‘close’
the hands since these are the muscles that are worked all day long in tasks
such as typing, writing, clutching a driving wheel, using a computer mouse,
carrying groceries and etc.
When a muscle is engaged in the activity, it gets shorter, so it needs to be
stretched and lengthened both during and after the activities are performed.
•
Exercises: Training and strengthening the
muscles that are needed to ‘open’ the hands, since these muscles do not get
much direct exercise. (i.e. People do not turn doorknobs, hold items, type,
operate a computer mouse, or lift things using the backs of their hands).
Carpal tunnel syndrome surgery (CTS surgery)
Over time, carpal tunnel syndrome may weaken the muscles of your hands
and wrists. If symptoms continue for too long, your illness will keep
getting worse.
If any of these seem like your case, your doctor could propose surgery:
- Other therapies — including braces, corticosteroids, and adjustments to your daily routine — haven’t helped.
- You experience pain, numbness, and tingling that don’t go away or get better in 6 months.
- You find it tougher to hold, grab, or squeeze items as you previously did.
What are surgery options?
There are two primary forms of carpal tunnel release surgery: open and
endoscopic. In both circumstances, your doctor slices the ligament surrounding
the carpal tunnel to ease the pressure off the median nerve and relieve your
symptoms.
After the procedure, the ligament pulls back together, but with greater
space for the median nerve to travel through.
Open surgery entails a bigger cut, or incision — up to 2 inches from
your wrist to your palm.
In endoscopic surgery, your surgeon creates one opening in your wrist.
They may even make one in your arm.
These incisions are smaller, approximately a half-inch apiece. They then
implant a small camera in one of the holes to guide them while they cut the
ligament.
Because the holes are smaller with endoscopic surgery, you may recover
quicker and have less discomfort. Ask your doctor which procedure is best for
you.
Results and Risks of CTS surgery
Most patients who undergo carpal tunnel surgery discover that their
problems get resolved and don’t come back.
If you have a really severe case,
surgery may still help, but you may still experience numbness, tingling, or
pain from time to time.
Risks exist with every procedure. For both forms of carpal tunnel
release surgery, they include:
- Bleeding
- Damage to your median nerve or neighboring nerves and blood vessels
- Infection of your wound
- A scar that hurts to touch
What’s the CTS surgery like?
First, you’ll have local anesthetic — medicines that numb your hand and
wrist. You may also obtain drugs to assist keep you quiet.
When the procedure is done, your doctor sutures the holes close and
places a big bandage on your wrist. This shields your wound and prohibits you
from utilizing your wrist.
Your doctor and nurses will keep a watch on you for a short time before
allowing you to go home. You’ll likely leave the hospital the same day. Overnight
stays are unusual.
You may experience relief from symptoms the same day as your operation,
but total recovery takes time. Expect to experience discomfort, edema, and
stiffness following the procedure.
Your doctor will let you know
what drugs could help. You may experience some discomfort ranging from a
few weeks to a few months following surgery.
Your bandage will be on for 1-2 weeks. Your doctor may prescribe exercises to undertake at this time to move your fingers and prevent them from
growing too stiff.
You may use your hand gently in the first 2 weeks, although it helps to
prevent too much tension.
Slowly, you may come back to more usual activities, like:
Driving (a couple of days after surgery (
Writing (after a week, but anticipate 4-6 weeks until it seems easier).
Pulling, grabbing, and pinching (6-8 weeks out, but only mildly. Expect
10-12 weeks until your full strength returns, or up to a year in more extreme
situations. (
Your doctor will speak to you about when you can return to work and if
you’ll be restricted in what you can accomplish.
Will you need occupational therapy?
If you do, your doctor will prescribe it after your bandage comes off.
You’ll learn exercises to increase your hand and wrist mobility, which may help
speed up recovery.
Some individuals notice that their wrists aren’t as strong after surgery
as they were before. If this occurs to you, occupational therapy may assist
strengthen your strength.
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