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Carpal tunnel syndrome

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Saudamini Sharma
Saudamini Sharma

Carpal tunnel syndrome is a condition where the median nerve is compressed as it travels through the carpal tunnel in the wrist, causing pain, numbness, and tingling in the hand. It is often caused by repetitive wrist motions from occupations like data entry or assembly line work. Symptoms include tingling in the fingers, numbness, and weakness in the hand. Treatment starts with wrist splinting and anti-inflammatory drugs, while severe or persistent cases may require carpal tunnel release surgery to cut the ligament and relieve pressure on the median nerve.

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CARPAL TUNNEL SYNDROME
Carpal Tunnel (An Overview) • The Carpal Tunnel is in your wrist. • It is made up of the carpal bones and the flexor retinaculum (transverse carpal ligament). Carpal Bones
• Carpal tunnel syndrome (CTS) is a condition in which the median nerve is compressed as it travels through the wrist at the carpal tunnel and causes pain, numbness and tingling, in the part of the hand that receives sensation from the median nerve. The median nerve controls movement and feeling in your thumb and first three fingers (not your little finger).
Causes of Carpal Tunnel Syndrome • Women are actually 3 times more likely to have symptoms of carpal tunnel syndrome. • Most often a result of a person’s occupation. • Activities requiring continual use of the hands • Repetitive motions using force • Prolonged flexion or extension of the wrist • Gripping • Pressure over the palm • Trauma • Fractures • Vibration • Examples: data-entry, meat cutters, assembly, construction workers, and musicians
Pathophysiology The tendons of the hands are wrapped with a lining that produce a synovium fluid which lubricates the tendons With repetitive movement of the hand, the lubrication system may malfunction This reduction in lubrication results in inflammation and swelling of the tendon area Abnormally high carpal tunnel pressures exist in patients with CTS. This pressure causes obstruction to venous outflow, back pressure, edema formation, and ultimately, ischemia in the nerve.
Signs and Symptoms Tingling in the fingers Numbness in the fingers Aching in the thumb, perhaps moving up as far as the neck Burning pain from the wrist to the fingers Change in touch or temperature sensation Clumsiness in hands Weakness of grip, ability to pinch and other thumb actions Swelling of hand and forearm Change in sweat functions of hand
Tests and diagnosis • History of symptoms. Yourdoctor will review your symptoms. The pattern of your signs and symptoms may offer clues to their cause • Physical examination. Your doctor will conduct a physical examination. He or she will test the feeling in your fingers and the strength of the muscles in your hand. • Pressure on the median nerve at the wrist, produced by bending the wrist, tapping on the nerve or simply pressing on the nerve, can bring on the symptoms in many people.
• X-ray. of the affected wrist is recommend to exclude other causes of wrist pain, such as arthritis or a fracture. • Electromyogram. The test evaluates the electrical activity of your muscles when they contract and when they're at rest. This test can determine if muscle damage has occurred and also may be used to rule out other conditions. • Nerve conduction study. In a variation of electromyography, two electrodes are taped to your skin. A small shock is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel. This test may be used to diagnose your condition and rule out other conditions.
Treatments and drugs • Some people with mild symptoms of carpal tunnel syndrome can ease their discomfort by taking more frequent breaks to rest their hands, avoiding activities that worsen symptoms and applying cold packs to reduce occasional swelling. • If these techniques don't offer relief within a few weeks, additional treatment options include wrist splinting, medications and surgery.
Nonsurgical therapy • Wrist splinting. A splint that holds your wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness. Nocturnal splinting may be a good option if you're pregnant and have carpal tunnel syndrome. • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs such as ibuprofen (Advil, Motrin IB, others) may help relieve pain from carpal tunnel syndrome in the short term. • Corticosteroids. Your doctor may inject your carpal tunnel with a corticosteroid such as cortisone to relieve your pain. • Corticosteroids decrease inflammation and swelling, which relieves pressure on the median nerve. Oral corticosteroids aren't considered as effective as corticosteroid injections for treating carpal tunnel syndrome.
Surgery • If your symptoms are severe or persist after trying nonsurgical therapy, surgery may be the most appropriate option. • The goal of carpal tunnel surgery is to relieve pressure on your median nerve by cutting the ligament pressing on the nerve. • The surgery may be performed with two different techniques
• Endoscopic surgery. In endoscopic surgery, your surgeon uses a telescope-like device with a tiny camera attached to it (endoscope) to see inside your carpal tunnel and cut the ligament through one or two small incisions in your hand or wrist. • Endoscopic surgery may result in less pain than does open surgery in the first few days or weeks after surgery. • Open surgery. In open surgery, your surgeon makes a larger incision in the palm of your hand over the carpal tunnel and cuts through the ligament to free the nerve. This procedure may also be conducted using a smaller incision, which may reduce the risk of complications.

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Carpal tunnel syndrome

  • 2. Carpal Tunnel (An Overview) • The Carpal Tunnel is in your wrist. • It is made up of the carpal bones and the flexor retinaculum (transverse carpal ligament). Carpal Bones
  • 3. • Carpal tunnel syndrome (CTS) is a condition in which the median nerve is compressed as it travels through the wrist at the carpal tunnel and causes pain, numbness and tingling, in the part of the hand that receives sensation from the median nerve. The median nerve controls movement and feeling in your thumb and first three fingers (not your little finger).
  • 4. Causes of Carpal Tunnel Syndrome • Women are actually 3 times more likely to have symptoms of carpal tunnel syndrome. • Most often a result of a person’s occupation. • Activities requiring continual use of the hands • Repetitive motions using force • Prolonged flexion or extension of the wrist • Gripping • Pressure over the palm • Trauma • Fractures • Vibration • Examples: data-entry, meat cutters, assembly, construction workers, and musicians
  • 5. Pathophysiology The tendons of the hands are wrapped with a lining that produce a synovium fluid which lubricates the tendons With repetitive movement of the hand, the lubrication system may malfunction This reduction in lubrication results in inflammation and swelling of the tendon area Abnormally high carpal tunnel pressures exist in patients with CTS. This pressure causes obstruction to venous outflow, back pressure, edema formation, and ultimately, ischemia in the nerve.
  • 6. Signs and Symptoms Tingling in the fingers Numbness in the fingers Aching in the thumb, perhaps moving up as far as the neck Burning pain from the wrist to the fingers Change in touch or temperature sensation Clumsiness in hands Weakness of grip, ability to pinch and other thumb actions Swelling of hand and forearm Change in sweat functions of hand
  • 7. Tests and diagnosis • History of symptoms. Yourdoctor will review your symptoms. The pattern of your signs and symptoms may offer clues to their cause • Physical examination. Your doctor will conduct a physical examination. He or she will test the feeling in your fingers and the strength of the muscles in your hand. • Pressure on the median nerve at the wrist, produced by bending the wrist, tapping on the nerve or simply pressing on the nerve, can bring on the symptoms in many people.
  • 8. • X-ray. of the affected wrist is recommend to exclude other causes of wrist pain, such as arthritis or a fracture. • Electromyogram. The test evaluates the electrical activity of your muscles when they contract and when they're at rest. This test can determine if muscle damage has occurred and also may be used to rule out other conditions. • Nerve conduction study. In a variation of electromyography, two electrodes are taped to your skin. A small shock is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel. This test may be used to diagnose your condition and rule out other conditions.
  • 9. Treatments and drugs • Some people with mild symptoms of carpal tunnel syndrome can ease their discomfort by taking more frequent breaks to rest their hands, avoiding activities that worsen symptoms and applying cold packs to reduce occasional swelling. • If these techniques don't offer relief within a few weeks, additional treatment options include wrist splinting, medications and surgery.
  • 10. Nonsurgical therapy • Wrist splinting. A splint that holds your wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness. Nocturnal splinting may be a good option if you're pregnant and have carpal tunnel syndrome. • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs such as ibuprofen (Advil, Motrin IB, others) may help relieve pain from carpal tunnel syndrome in the short term. • Corticosteroids. Your doctor may inject your carpal tunnel with a corticosteroid such as cortisone to relieve your pain. • Corticosteroids decrease inflammation and swelling, which relieves pressure on the median nerve. Oral corticosteroids aren't considered as effective as corticosteroid injections for treating carpal tunnel syndrome.
  • 11. Surgery • If your symptoms are severe or persist after trying nonsurgical therapy, surgery may be the most appropriate option. • The goal of carpal tunnel surgery is to relieve pressure on your median nerve by cutting the ligament pressing on the nerve. • The surgery may be performed with two different techniques
  • 12. • Endoscopic surgery. In endoscopic surgery, your surgeon uses a telescope-like device with a tiny camera attached to it (endoscope) to see inside your carpal tunnel and cut the ligament through one or two small incisions in your hand or wrist. • Endoscopic surgery may result in less pain than does open surgery in the first few days or weeks after surgery. • Open surgery. In open surgery, your surgeon makes a larger incision in the palm of your hand over the carpal tunnel and cuts through the ligament to free the nerve. This procedure may also be conducted using a smaller incision, which may reduce the risk of complications.