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Carpal tunnel syndrome

Carpal tunnel syndrome
  • Definition

    It is a condition in which there is excessive pressure on the median nerve. This is the nerve in the wrist that allows sensitivity and movement to parts of the hand. Carpal tunnel syndrome can cause numbness, tingling, weakness, or muscle damage in the hand and fingers.

    The median nerve provides sensitivity and movement to the side of the hand where the thumb is located. This includes the palm of the hand, the thumb, the index finger, the middle finger, and the side of the ring finger on the thumb side.

    The area in the wrist where the nerve enters the hand is called the carpal tunnel, which is normally narrow. Any inflammation can pinch the nerve and cause pain, numbness, tingling, or weakness. This is called carpal tunnel syndrome.

    Some people with this problem were born with a small carpal tunnel, but it is usually caused by doing the same hand and wrist movements over and over again. The use of vibrating hand tools can also lead to this syndrome.

    Studies have not shown that carpal tunnel syndrome is caused by typing on a computer, using a mouse, or repeating movements while working, playing a musical instrument, or playing sports; But these activities can cause pain and swelling of the tendons or bursa of the hand, which can narrow the carpal tunnel and cause symptoms.

    Carpal tunnel syndrome occurs mostly in people 30 to 60 years old and is more common in women than men.
  • Indications

    Non-surgical treatment

    If diagnosed and treated early, the symptoms of carpal tunnel syndrome can often be alleviated without surgery. If your diagnosis is uncertain or if symptoms are moderate, your doctor will recommend nonsurgical treatment at first. Non-surgical treatments may include the following:

    Placement of an orthosis or splint. Wearing a brace or splint at night will prevent your wrist from flexing while you sleep. Keeping the wrist in a straight or neutral position decreases the pressure on the nerve inside the carpal tunnel. Wearing a splint can also be helpful during the day when you do activities that worsen symptoms.

    Non-steroidal anti-inflammatory drugs (NSAIDs). Medications like ibuprofen and naproxen can help relieve pain and decrease inflammation.

    Changes in activity. Often symptoms occur when the hand and wrist are in the same position too long, particularly when the wrist is flexed or extended.

    If your work or recreational activities worse symptoms, changing or modifying these activities can help delay or stop the progression of the disease. In some cases, this may involve making changes in the workplace.

    Nerve slip exercises. Some patients may benefit from exercises that help the median nerve move more freely within the limits of the carpal tunnel. Your doctor or therapist may recommend specific exercises.

    Steroid injections. Corticosteroid (like cortisone) is a powerful anti-inflammatory agent that can be injected into the carpal tunnel. Although these injections often relieve painful symptoms or help calm worsening symptoms, sometimes their effect is only temporary. The doctor may also use a cortisone injection to help diagnose carpal tunnel syndrome.

    Surgical treatment

    If the non-surgical treatment does not alleviate the symptoms after a while, the doctor may recommend surgery. The decision to have surgery is based on the severity of the symptoms - how much pain and numbness are in your hand. In long-standing cases with constant numbness and deterioration of the thumb muscles, surgery may be recommended to avoid irreversible damage.

    The surgical procedure performed for carpal tunnel syndrome is called "carpal tunnel release." It aims to relieve pressure on the median nerve, by cutting the ligament that forms the roof of the tunnel. This increases the size of the tunnel and decreases the pressure on the median nerve. The transverse carpal ligament is cut during carpal tunnel release surgery. When the ligament heals, there is more room for the nerve and tendons.

    In most cases, carpal tunnel surgery is performed on an outpatient basis. The surgery can be done under general anesthesia, where you are completely asleep, or under local anesthesia, where only your hand and arm are numb. 

    In open surgery, the doctor makes a small incision in the palm of the hand and views the inside of the hand and wrist through this incision. During the procedure, the doctor will divide the transverse carpal ligament (the roof of the carpal tunnel). This increases the size of the tunnel and decreases the pressure on the median nerve.

    After surgery, the ligament can grow back gradually, but there will be more space in the carpal tunnel and the pressure on the median nerve will be relieved.
  • Risks

    The risks of anesthesia and surgery in general are:

    Allergic reactions to medications
    Respiratory problems
    Bleeding, blood clots, infection

    The risks of carpal tunnel surgery are:

    Wrist stiffness
    Lack of effectiveness of surgery to relieve symptoms
    Insufficient repair to heal
    Weakness of the hand and wrist, usually temporary
    Injury to a blood vessel or nerve during the procedure
  • Prospects (prognosis)

    Carpal tunnel surgery is performed on an outpatient basis and has very good results. The results will depend on the previous involvement of the median nerve before surgery, but they are satisfactory in more than 90% of patients after following the prescribed recovery process.

    Postoperative period of the surgery

    Follow all discharge and personal care instructions given to you.
    Recovery can take 1 to 2 months. You will probably have to wear a sling for a few days.
    You can take medicine to control pain according to the guideline.
    The time to go back to work or play sports will depend on the previous state of the nerve and can range from a few weeks to several months.
    Home or outpatient physical therapy can help you regain movement and strength in your hand and wrist. The duration of therapy will depend on the previous state of your median nerve before surgery.

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