Carpal tunnel syndrome symptoms, Mechanism and treatment
Carpal tunnel syndrome is a neurological condition, which affect our hands. As it involves with hands, this has become more disabling disease entity in world. Most of the diseased persons are females.This condition is usually presenting with the involvement of the both hands. The signs and symptoms may be the numbness of the medial side of the hands and arms.
Mechanism of carpal tunnel syndrome
The wrist of your are is a very complex structure. It contains large number of very important nerve fibers, blood vessels, tendons and the muscles which are involving in the proper function of the hand. The flexor retinaculum is a tendon sheath which covers these structures at the wrist join. As the presentation of large number of structures, it is very complex and tight area.
The Median nerve is the one of the very important nerve in that area.The pathophysiology behind carpal tunnel syndrome is the compression of Median nerve under the flexor retinaculum. The median nerve gives sensory supply to Palmer aspect of lateral 3 ½ fingers of hand, and motor supply to several small muscles of hand ,including muscle which help us to oppose thumb with other fingers (Opponens pollisis). Therefore signs of impairment of both sensation and muscle function is seen in this area
symptoms and signs of carpal tunnel syndrome
A patient may mostly present with an Aching pain and parasthesia (pins &needles) over lateral 3 ½ fingers, which typically arise at night and, severity may have caused sleep disturbances also. Patient would say that pain will go off by shaking hand.
The history of dropping plates, glasses like objects which carried by them, unnoticed and worsening of pain with activities like washing will be there.When looking at patients palm we can observe wasting over medial side of palm (wasting of Thena eminence) if disease course is prolonged
Doctors use Phalen’s test, Tinnel’s test and Duran’s test( Flexion Compression Test) to clinically diagnose the Carpal tunnel syndrome (CTS)
What are the causes for Carpal tunnel syndrome
There are a lot of causes and risk factors for this disease. Most of time we can not find exact cause for this. This is called idiopathic carpel tunnel syndrome .Other than that, this may arise due to compression of tunnel wall, compression with in tunnel and due to changes in median nerve.
Compression of tunnel wall
- Trauma (distal radial fracture )
- Rheumatoid arthritis( thickening of the surrounding sinovium and tissues)
- Subluxation or dislocation of wrist
Compression within tunnel
- Fluid retention ( pregnancy menopause,hypothyroidism,obesity)
- Space occupying lesions ( benign tumors like lipomas , ganglions )
Changes in median nerve
- Diabetes mellitus
- Peripheral neuropathy ( Alcohol)
Diagnosis of Carpal tunnel syndrome
Diagnosis of the carpal tunnel syndrome is mostly depend on the history and the examination findings of the doctors. Sometimes nerve conduction test are done.
Management of Carpal tunnel syndrome
Following procedures are used in the management of the carpal tunnel syndrome now a days. But these are temporally methods of management. The most effective treatment is the surgery.
- Night splintage of wrist in extension
- Injecting corticosteroids
- Avoiding the precipitatory activities
Carpal tunnel decompression surgery
As mentioned above most effective way of the carpal tunnel treatment is the carpal tunnel decompression surgery. It is done under local anaesthesia with a small incision. Therefore you can be recover with the wound soon. You can even leave the hospital at the evening for your normal works.
After this surgery symptoms may or may not fade quickly. How ever it will take months to return the normal strength of wrist and hand.