Table of Contents
What is carpal tunnel?
Our wrist structure is like a tunnel in which posteriorly there are few bones and anteriorly there is a strong ligament also known as the carpal ligament.
Flexor tendons of fingers and an important nerve is known as the median nerve passes through this tunnel.
What is carpal tunnel syndrome?
As mentioned above, the median nerve passes through the carpal tunnel. It supplies and controls movements of the thumb and two and half fingers from the thumb. The function of this nerve is to provide power to the muscles of the hands means it control the movement of the hand including all sensations of hand skin such as cold, hot, pain, burning, etc.
For any reason, if there is compression or inflammation of the median nerve it causes different symptoms and the most common is tingling, numbness, or pain and this condition is known as carpal tunnel syndrome (CTS).
What are the symptoms of carpal tunnel syndrome?
Due to compression or inflammation of the median nerve, its functions are disturbed producing different symptoms such as…
Tingling or numbness of fingers. Sometimes feeling of current in fingertips.
Loss of sensation in fingers or fingertips.
Dropping of things. For example, a dropdown of mobile phones during talking on the phone.
Mild to moderate pain in hand and fingers especially at night.
What are the causes of carpal tunnel syndrome?
The exact causes for carpal tunnel syndrome are not known in around 50% of the cases. Remaining 50% of patient have diabetes, thyroid problems, lower hemoglobin level, obesity, rheumatoid arthritis, pregnancy, injury to wrist joint, some working conditions of hands that gives more stress to wrist, etc. are some of the reason that can cause the syndrome.
It is more common to females than males and the ratio is around 10:2. This may be due to narrow carpal tunnel in females.
You are more prone to develop the syndrome if your work is such that have overuse of the wrist or stress injury to the wrist joint. These types of work job may include heavy typewriting, hairstyling, baking, musicians, sewers, kneading, etc.
Diagnosis of carpal tunnel syndrome
A nerve conduction study also known as EMV-NCV is done in which different electrodes are placed on the skin and it measures the strength and signal of the median nerve.
An electromyogram measures the strength of the muscles through electrodes placed into the muscle.
X-ray, ultrasound, or MRI may also be done to know the structure of the hand and any bone deformities.
Phalen test also known as Wrist Flexion Test is helpful to diagnose the stages of the syndrome and it can be also done at home.
Blood investigations are done to detect any other medical conditions such as diabetes, thyroid problems, anemia, etc.
Are there any stages of carpal tunnel syndrome?
Phalen test or Wrist Flexion test is one of the important tests to detect the syndrome and its stages.
Stages are as follow
Stage 3: Symptoms appear within 0 to 30 seconds
Stage 2: Symptoms appear within 30 to 60 seconds
Stage 1: Symptom appear within 60 to 90 seconds
If you are able to hold the flexed position for more than 90 seconds then there are fewer chances of the syndrome.
But remember, you may still have carpal tunnel syndrome even if you are able to hold the position for more than 90 seconds. In such cases final diagnosis is made by different diagnostic methods such as EMV-NCV or nerve conduction study of the median nerve.
Treatment of carpal tunnel syndrome
The initial stage of the syndrome may be treated with medicines, exercises, and proper care of the wrist. But in advanced stages and in most of the cases surgery is advised.
Surgery includes cutting the carpal ligament which results in widening of the carpal tunnel and decompression of the median nerve. There are mainly two types of surgery. One is open surgery and the other is endoscopic surgery.
The below table guides you about the advantages and disadvantages of open and endoscopic surgery.
|
|
Endoscopic surgery |
Open surgery |
|
Incision |
around half-inch |
around 2 inch |
|
Stitches |
1 to 2 stitches |
10 to 12 stitches |
|
Recovery |
fast |
takes time |
|
Infection possibility |
very less |
few chances of infection |
|
Recurrence of the syndrome |
1 to 2% |
8 to 10% Mainly due to adherence of nerve with stitches |
Carpal tunnel syndrome FAQs
Do I have to take steroid pills after surgery for carpal tunnel syndrome?
Recently used advanced endoscopic surgery have many benefits. During surgery, the median nerve is not touched or damaged. Therefore this surgery provides the best results and doesn’t require steroid medication in most cases.
What care should be taken after carpal tunnel syndrome surgery?
After the operation, care for wrist joint movement should be taken for at least one or one and half months such as avoiding washing clothes, kneading the flour, sewing, knitting work, driving a bike or car, etc.
Is there any problem after surgery of CTS?
Most cases recover in one and one and half months after the operation of carpal tunnel syndrome. Till this time you need to keep continue the medicines prescribed by your doctor which mainly include vitamin supplements and take utmost care of your wrist as advised.
Very few cases take more time to heal than normal. This may be due to anatomical variation of the median nerve which can be in 10-30% of people. This results in damage to the median nerve causing delayed recovery. But this happens occasionally and in very few cases.
Very few cases may have complications after surgery such as fever or redness, swelling, bleeding, fluid oozing, and pain at the site of the incision. In most cases, there are no complications of the surgery.
What are the chances of recurrence of carpal tunnel syndrome after surgery?
Carpal tunnel syndrome may reoccur in 1 to 2% of the cases after surgery. It is a very less percentage of the recurrence.
Does physiotherapy helpful in carpal tunnel syndrome?
In mild cases and after the surgery of CTS, your physiotherapist will guide you for exercise, care, and work modification of the wrist joint.
Physiotherapy is aimed to relieve the symptoms of CTS and take care of the median nerve, soft tissue, and carpal bone around the wrist.
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