Carpal tunnel syndrome
anatomy
The carpal tunnel is a narrow tunnel-shaped structure in the wrist. The bottom and sides are made up of the wrist (wrist) bones, and the upper part is covered by a strong band of connective tissue called the carpal transverse ligament. The median nerve controls feeling at the palm side of the thumb, index finger, and long fingers, as well as the muscles surrounding the base of the thumb. The flexor tendons are the ones that bend the fingers and the thumb. The tissue surrounding the folded tendons in the wrist is called the synovium. The synovium lubricates the tendons, which makes movement of the fingers easier. The carpal tunnel protects both the median nerve as it travels from the forearm to the hand and the flexor tendons.
Syndrome
Common symptoms are: numbness, tingling, and pain in the hand. A sensation similar to an electric shock, mostly felt in the thumb, index finger and long fingers; And strange sensations and pain moving up the arm towards the shoulder. Symptoms are often more severe on the thumb side of the hand. Symptoms usually start gradually and may come and go at first, and get worse over time. Symptoms often occur during the day when carrying a small object such as a phone, turning the pages of a book, holding a steering wheel, or other simple daily tasks. Feeling weak or clumsy can cause dropping things or problems with fine movements, such as a shirt button. If you are one of the many people sleeping with wrists limping, symptoms may wake you up at night. Often moving or shaking your hands helps reduce the severity of symptoms. If the condition is severe, the muscles at the base of the thumb may appear distinctly flat or smaller, atrophied, or lost.
the reasons
When something causes the synovium to enlarge, this swelling narrows the space inside the carpal tunnel, compressing the median nerve and causing numbness and pain in the hand. This is carpal tunnel syndrome. Several things can lead to the development of carpal tunnel syndrome, and in most cases, there is no single cause. Contributing factors may include: heredity (smaller carpal tunnels can be a familial trait); Hormonal changes due to pregnancy. Omar; Medical conditions (such as diabetes, rheumatoid arthritis, and thyroid imbalance); And the use of the hand over time, such as repetitive tasks performed during work or sports.
Personalize
In addition to talking to you about symptoms, activities, and medical history, your doctor may perform a variety of physical tests, such as: checking for muscle weakness at the base of the thumb; Test for numbness or tingling in the fingers and hands by pressing or tapping the median nerve, bending your wrists and holding them in place; And make you close your eyes before gently touching your fingers to test for sensitivity. X-rays are sometimes used, and an electrophysiology test may be done to help confirm the diagnosis and preferred treatment for your condition.
Non-surgical treatment
For many people, carpal tunnel syndrome can be eliminated without surgery, especially when symptoms are the result of a specific activity that can be modified or stopped. However, without some form of treatment, symptoms usually get gradually worse.
Brace or splinting - a brace or splint is worn at night, in which the wrist is held in a neutral position, preventing the nocturnal irritation of the median nerve that occurs when bending the wrists during sleep. Splints can also be helpful when worn during other daily activities that worsen symptoms.
Activity changes - Changing hand usage patterns can help you avoid situations that worsen the condition. When job requirements cause symptoms, a change or adjustment of function may sometimes help improve symptoms.
Medicines and steroids - Over-the-counter anti-inflammatory drugs, such as aspirin or ibuprofen, can be used to relieve pain. For more severe symptoms, corticosteroid injections sometimes provide temporary relief.
Physical therapy - Your doctor or physical therapist may prescribe specific exercises to help you improve strength and flexibility, restore mobility, and relieve uncomfortable symptoms. Physical therapy is often a key factor in successful recovery from a wide range of conditions and disorders.
surgery
Surgery may be appropriate when nonsurgical treatments do not provide relief, or in severe cases where nonsurgical options are unlikely to help. Severe and prolonged cases with persistent numbness and wasting of the thumb muscles may have already resulted in permanent nerve damage, and in these cases, complete recovery or complete resolution of symptoms is less predictable, even with surgical treatment.
Surgical techniques - This procedure is usually performed on an outpatient basis under local anesthesia. During conventional surgery, a palm incision is made and the roof of the carpal tunnel (transverse carpal ligament) is split to increase the size of the tunnel and reduce pressure on the nerve. After surgery, the new growth heals and grows through the mitosis, giving more room for the median nerve and the flexor tendons. When using an endoscopic technique, the surgeon makes a small incision in the skin and inserts a small camera (called an endoscope), which makes it possible to cut the ligament from inside the carpal tunnel and reduces healing time. Both conventional and laparoscopic procedures provide the same results and your doctor will recommend the surgery that is most appropriate for you.
Recovery
After surgery, you will be asked to frequently raise your hand above your heart and move your fingers to reduce swelling and prevent stiffness, but some pain, swelling and stiffness should be expected. You can use your hand normally, but with caution, and you may be asked to wear a wrist brace for up to three weeks. A minor sore on the palm is common for several months after surgery, and may persist