Carpal tunnel syndrome

Carpal tunnel syndrome. It responds to a fibrous thickening of the existing ligament in the palmar aspect of the wrists, in the area called the Carpal Tunnel, which compresses the anatomical structures that are between it and the bones ; such as the tendons , nerves, and blood vessels , causing pain and numbness. However, the main discomfort is due to compression on the so-called median nerve, which causes chronic inflammation and nerve damage.

The carpal tunnel is an anatomical space located on the anterior aspect of the wrist, made up of the carpal bones and the transverse ligament of the carpus, through which the aforementioned nerve passes, accompanied by nine flexor tendons.

Summary

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  • 1 Causes
  • 2 Age of onset
  • 3 Symptomatology
    • 1 Symptom location
  • 4 Diagnosis
  • 5 Computers and Carpal Tunnel Syndrome
  • 6 Treatment
    • 1 Non-surgical treatments
      • 1.1 Medicines
        • 1.1.1 Caution
      • 1.2 Exercise
      • 1.3 Surgery
    • 7 Sources
    • 8 External Links

Causes

It is listed as a cumulative trauma disorder, a disease that attacks the musculoskeletal system of the body and specifically affects the nerves and blood flow of the hands and wrists.

The problem results in a decrease in the size of the channel, or an increase in the volume of the content. The pathology is associated with pregnancy , rheumatoid arthritis or osteoarthritis and metabolic disorders such as diabetes or gout .

It can be caused by repeatedly carrying out stressful movements with the hand or by having the hand in the same position for long periods, as occurs with the practice of certain activities such as typing , knitting , playing the violin , etc., determine a circulation deficit in the ligament area, which is hardening and increasing its thickness.

When the compression on the nerve is maintained, the discomfort, which is mild and occasional at first, will progress more and more until it becomes intense and permanent.

The commonly proposed treatment is surgery , where part or all of the ligament that is thickened and compressed to the nerve is “cut”.

Age of onset

80% of patients are 40 years or older at the time of onset and is twice as common in women as in men.

Symptomatology

The symptoms of carpal tunnel syndrome are usually pain, numbness, a feeling of current, or a combination of all three. Numbness most frequently occurs on the thumb, index, middle, and ring fingers. Symptoms often occur at night but also during daytime activities such as driving or reading the newspaper. Sometimes patients notice a decrease in fist strength, clumsiness, or they may notice things falling off. In very severe cases, there may be a permanent loss of tenderness and muscles of the eminence tenar.

In summary, we could cite as the most frequent symptoms:

  1. Tickling in the fingers.
  2. Numbness of the fingers.
  3. Pain in the big toe, perhaps spreading to the neck.
  4. Burning from wrist to fingers.
  5. Changes in touch or sensitivity to temperature.
  6. Dullness of the hands.
  7. Weakness to grip, ability to prick, and other finger actions.
  8. Swelling of the hand and forearm.
  9. Changes in the sweat pattern of the hands. Vegetative disturbances.

Symptom location

Pain and sensitivity disturbances have very specific characteristics. The pain is usually very intense in the hand; it usually rises to the rest of the upper limb and it is not uncommon that it appears during night rest and improves with shaking of the hand or with the change of position. Alterations in sensitivity are located in the middle, index and thumb fingers, mainly in the palmar aspect and in the last phalanges of those fingers in the dorsal aspect.

Diagnosis

The most important feature is pain in the wrist and numbness ( paresthesia ) of the area supplied by the median nerve. The doctor performs physical examination tests by striking the nerve (Tinel’s sign) and flexing the wrist for 60 seconds to produce pain ( Phalen’s test ).

A specialized nerve conduction study called electromyography shows compression disturbances of the median nerve. However, up to 10% of affected patients may have normal electromyographs. The patient usually has numbness in the area indicated in the figure below.

The herniated cervical , or compression of the median nerve at the elbow or forearm, can simulate Tunnel Syndrome Carpo.

Computers and Carpal Tunnel Syndrome

The medicine is constantly changing, and what today is regarded as an absolute truth, tomorrow may be a mistake. This seems to be proven once again with a recent study carried out in Sweden , where the belief held by traumatologists and the general public about the influence of the computer keyboard in the appearance of Carpal Tunnel Syndrome is contested.

In this study conducted in 2645 people and published in November of the 2007 in the prestigious journal Arthritis and Rheumatism, it was reported that Syndrome Tunnel Carpo was less frequent in patients using more than 4 hours on the keyboard of the computer, which those who used it for 1 hour or less. In some way that is not specified in the article, the use of the keyboard may rather protect against the appearance of this disease .

A different thing is the mouse or computer mouse . In a 2003 study , conducted in Denmark and published in the JAMA magazine, it was found that people who use this device for 20 hours or more a week have a higher incidence of carpal tunnel and wrist tendinitis . Severe cases of thumb tendinitis have been seen in people who use the mouse very frequently .

Treatment

Treatments for carpal tunnel syndrome should start as soon as possible, following medical instructions. Less obvious causes, such as diabetes or arthritis, should be treated first. Initial treatment generally involves keeping the affected hand and wrist at rest for at least 2 weeks, avoiding activities that may worsen symptoms, and immobilizing the wrist with a splint or splint to prevent further damage from twisting or flexing the wrist. If there is inflammation, applying cold compresses can help reduce swelling.

Non-surgical treatments

If the person is young and the symptoms are mild and of a short duration, analgesics , infiltration and immobilization with a splint may be indicated . If the symptoms are severe, the treatment commonly proposed is surgery, where part or all of the ligament that is thickened is “cut” and compressing the nerve.

Medicines

Under special circumstances, various medications can relieve pain and swelling associated with carpal tunnel syndrome. Non-steroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and other over-the-counter pain relievers, can help alleviate symptoms that have been present for a short time or as a result of forced activity.

Orally administered diuretics (“water pills”) can decrease swelling. Corticosteroids such as prednisone or lidocaine, injected directly into the wrist or taken by mouth, can relieve pressure on the median nerve and provide immediate temporary relief to people with mild or intermittent symptoms.

Caution

People with diabetes or predisposed to diabetes should be aware that prolonged use of corticosteroids can make it difficult to regulate insulin levels. Corticosteroids should not be taken without being prescribed by a doctor.) Additionally, some studies show that vitamin B6 (pyridoxine) supplementation can alleviate the symptoms of carpal tunnel syndrome.

Exercise

Stretching and strengthening exercises can be beneficial for people whose symptoms have decreased. These exercises can be supervised by a properly trained physical therapist to treat physical impairments through exercise, or by a properly trained occupational therapist to assess patients with physical impairments and help them acquire skills to improve their health and well-being.

Alternative therapies – Acupuncture and / or chiropractic treatments have benefited some patients, but their true efficacy has not been proven. Yoga is the exception, as it has been shown to reduce pain and improve hand pulse in patients with carpal tunnel syndrome.

Surgery

Carpal tunnel decompression is one of the most common surgical procedures in the United States. This surgery is generally recommended if the symptoms last for at least 6 months and involves separating a piece of tissue around the wrist to reduce pressure on the median nerve. The surgery is performed under local anesthesia and does not require hospitalization. Many patients require surgery on both hands. Here are the different types of carpal tunnel decompression surgery.

Open decompression surgery is the traditional procedure used to correct carpal tunnel syndrome. It consists of making an incision of up to 2 inches in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel (set of bones of the doll). The procedure is generally done under local anesthesia and is outpatient, unless there are unusual medical considerations.

Endoscopic surgery can result in faster functional recovery and cause less postoperative discomfort than traditional open decompression surgery. The surgeon makes two incisions (about ½ inch each) in the wrist and palm, inserts a camera attached to a catheter, looks at the tissue on a screen, and cuts the carpal ligament (the tissue that holds the joints). This two-port endoscopic surgery (incisions), usually performed using local anesthesia, is effective and minimizes scarring and softening, if any. Endoscopic portal surgery for carpal tunnel syndrome is also available.

Although symptoms can be relieved immediately after surgery, full recovery from carpal tunnel surgery can take months. Some patients may have infections, nerve damage, stiffness, and pain in the incision. Occasionally the wrist may lose strength as a result of having cut the carpal ligament. Patients should undergo physical therapy after surgery to restore wrist strength. Some patients may need to make changes to their work activities or even change jobs after recovering from surgery.

Recurrence of carpal tunnel syndrome after treatment is unusual. Most patients make a full recovery.

There is also the MOVHA physiotherapy technique, which allows to contribute to the resolution of the problem in a non-invasive way, improving the circulation of the ligament, undoing fibrosis , reducing its inflammation and optimizing the elimination routes of all the debris retained in the area. of the injury.

The treatment consists of sessions of mobilization of the connective tissue, a true massage to the tissues under the skin, using the effect of vacuum, a mechanism very similar to that of the ancient and popular “suction cups”, but through a high-tech equipment equipped of a sophisticated electronic control, which allows to adjust intensity, frequency, pulse and depth in the application of the vacuum, according to the lesion to be treated and the situation of each patient, to go gradually and gradually restoring the anatomical normality in the area treated with the consequent improvement of the disease and its symptoms. The treatment program is structured in thirty minute sessions, three times a week at the beginning.

In general terms, between 12 and 18 sessions are required when the problem affects one hand, and there are no other associated diseases or injuries (arthritis, tendinitis and others). The number of sessions will depend on factors such as age, severity, age of the injury and associated diseases.

The favorable results are observed already from the first 6 therapy sessions , and practically all the patients who complete their treatment achieve stable and lasting relief, the percentage of recurrences (becoming ill again) is less than 10% after two years. Without a doubt, it is an excellent option before surgery, not only because of its lower cost, but also because it has no risks or side effects. In addition to being able to perform as many times as necessary, surgery is not

 

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