Carpal tunnel syndrome corresponds to compression of the median nerve through the wrist. This nerve provides sensation to the thumb, index, long and half of the ring finger. It is also responsible for innervating the muscles of the base of the thumb.
The carpal tunnel is an anatomical zone between the carpal bones and the annular carpal ligament. The median nerve passes through this channel accompanying the 9 flexor tendons of the fingers.
Any condition that makes the area inside the carpal tunnel smaller or increases the size of the tissues within the tunnel can lead to symptoms of CTS. The carpal tunnel cannot expand so any condition that causes abnormal pressure in the tunnel can produce symptoms of CTS. And any increase in pressure within the carpal tunnel can reduce blood flow to the nerve, leading to loss of nerve function.
Carpal tunnel syndrome is very common in general population, particularly during pregnancy and in women around the age of 50.
Manual workers, especially those who perform repetitive work (packaging, cleaning women, typing …) are more likely to be affected by this pathology.
Finally, those diseases that increase tendon thickness are most frequently associated with carpal tunnel syndrome: hypothyroidism, rheumatoid arthritis, amyloidosis, diabetes.
Symptoms of CTS is gradual tingling and numbness in the areas supplied by the median nerve. This is typically followed by dull, vague pain where the nerve gives sensation in the hand. The hand may begin to feel like it’s asleep, especially in the early morning hours after a night’s rest.
Whether acute or chronic, pain associated with carpal tunnel syndrome may even spread up the arm to the shoulder. If the condition progresses, the thenar muscles of the thumb can weaken, causing the hand to be clumsy when picking up a glass or cup. If the pressure keeps building in the carpal tunnel, the thenar muscles may begin to shrink.
– First treatment is the use of a brace: A HYPERLINK “http://www.eorthopod.com/images/ContentImages/hand/hand_carpal_tunnel/hand_carpal_tunnel_treatment01.jpg” wrist brace keeps the wrist in a resting position decreasing the symptoms in the early stages of CTS. A brace can be especially helpful for easing the numbness and pain felt at night because it can keep your hand from curling under as you sleep. The wrist brace can also be worn during the day to calm symptoms and rest the tissues in the carpal tunnel.
– If these simple measure fail to control your symptoms or in severe cases, surgical treatment is needed. Surgical procedure is done to relieve pressure on the median nerve. By releasing the pressure on the nerve, the blood supply to the nerve improves, and most people get relief of their symptoms. The procedure is performed under locoregional anesthesia (without general anesthesia) and on an outpatient basis (you do not stay in the clinic).
Surgery can be performed using the usual 2 cm hand incision technique, or by using the endoscopic technique with a small 1 cm incision.
After surgery, the wrist is immobilized with a bandage for 3.4 days. It is important to move fingers from the day after the intervention.
The duration of recovery varies according to the individual being in most cases immediate. If the nerve pressure has been going on a long time, the median nerve may have thickened and scarred to the point that recovery after surgery is much slower.
A nerve recovers at the rate of one mm daily
In manual workers, work reincorporation is usually possible 3 weeks after the intervention.
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