What is the carpal tunnel syndrome?
Carpal tunnel syndrome is a painful condition that deteriorates over time.
It is caused by the pressure applied to the median nerve as it travels through the wrist.
The median nerve passes through the forearm reaching the hand, moving through certain anatomical passages which in particular cases exert pressure on the nerve. It is more common in women than in men.
The carpal tunnel is a fairly narrow and tubular anatomical structure of the wrist. The bottom and lateral walls of the tunnel are formed by the bones of the wrist. The roof is covered by a strong bundle of connective tissue called the “transverse carpal ligament”.
The median nerve passes through the tube and reaches the hand where it ends up in the muscles of the hand. The median nerve provides sensation to approximately the half palm, including the thumb, the index finger and the middle finger.
It is also responsible for the movement of the muscles around the thumb. In addition, the tendons responsible for bending the fingers and thumb pass through the carpal tunnel (flexor tendons)
Caption: Distribution of the median nerve in the hand. The red area is the nerve entrapment point.
Why is the carpal tunnel syndrome happening?
A person’s congenital predisposition is considered today the main cause of the disease. Anatomically, the carpal tunnel is smaller in people who develop the disease than in others who have no anatomical problem.
People performing heavy manual work are more likely to develop wrist and hand problems.
Usually no clear causal factor can be found.
Some sports activities predispose athletes to the disease, especially those who perform repetitively stretching and bending movements with their wrist and hand, as well as throwers (javelin, discus, hammer), athletes holding rackets (tennis, squash, badminton), gymnastics athletes as well as athletes ending up in a wheelchair due to overuse of the limb.
What are the symptoms?
Patients describe intermittent or persistent hallucinations and hand numbness, especially on the three fingers (thumb, index finger and middle finger). Pain occurs mainly during night hours and awakens the patient.
It is characteristic that the patient shakes the diseased upper extremity and places his hand in a cooler place to relieve the symptoms.
Many people report difficulty in holding objects with their hands (loss of hand grip), or inability to twist the key in the lock (loss of hand strength).
Caption: Areas of distribution of numbness (blue area) and pain (red area).
How can I be sure that I suffer from carpal tunnel syndrome?
Early diagnosis and treatment is very important to avoid permanent hand problems due to irreversible damage to the median nerve.
Clinical examination of the hand and the upper limb generally helps the orthopedist to determine the source of the patient’s symptoms and to design the proper treatment plan.
The wrist is clinically examined for pain, edema and skin color disorders (redness of the affected area indicates inflammation). Each finger needs an aesthetic sensibility test and the thumb muscles must be examined, as regards their vigor and muscle strength.
Blood tests for sugar control and rheumatologic parameters are usually necessary.
Simple radiographs often do not help diagnose the carpal tunnel syndrome.
Electromyography is a necessary test for definitive diagnosis.
It helps to estimate the phase of the injury (acute or chronic) as it examines nerve function.
Conservative treatment includes:
- oral anti-inflammatory treatment
- local patches
- special splints
- Physical therapy
- local cortisone injection
The specialized splint is usually worn during sleep at night.
It mainly protects against irritation of the median nerve when the patient bents his/her wrists while sleeping.
However, the splint can also be worn during daily activities.
Changes in activities – Alterations in daily activities that have proven to worsen the condition of the disease are helpful.
Physical therapy – Stretching and strengthening exercises can help people relieve symptoms. This process is supervised and guided by a physiotherapist.
Women can often develop symptoms of the carpal tunnel syndrome during pregnancy. These symptoms usually subside after childbirth, when body fluids equilibrium is restored. No treatment is needed.
Surgical treatment of the carpal tunnel syndrome is one of the most common orthopedic surgeries. The procedure lasts 10 minutes and the patient is discharged from the clinic one hour later.
When should I have surgery?
If the symptoms of pain and numbness in the hand last more than 6 months despite conservative treatment, then the condition must be treated surgically.
Why should I have surgery?
Because a persistent carpal tunnel syndrome will lead to permanent irreversible damage to the median nerve. This will result in permanent numbness and atrophy of the thumb muscles, a condition that will inevitably lead to a decrease in the muscular strength of the hand. This will result in a reduction of the functional capacity of the hand.
The two techniques used internationally are the open surgery and the endoscopic method.
The open surgery is performed with the aid of a surgical microscope for high accuracy of the surgical operations (microsurgical technique), while the endoscopic method is assisted by a special camera.
The orthopedic surgeon chooses the method by evaluating the severity of the condition for each patient individually.
Caption: Schematic depiction of the cross-section of the transverse ligament to release the median nerve. Skin incision