There are many nerves and branches running through our arms and legs. The function of these nerves is to ensure the functioning of the relevant muscle groups and to receive the sensation of their regions and transmit it to the brain. Each nerve can be compressed at one or more points and cause disease. The most commonly studied and well-known of these is the compression of the nerve called the median nerve at the wrist level. This condition is called carpal tunnel syndrome.
When the pressure inside the carpal tunnel canal increases for any reason, the nerve is compressed and nerve compression occurs. It creates an annoying problem that affects and even prevents the person's daily, business and sports life, and in advanced cases, makes sleep disturbance and hand use difficult due to night awakenings. It is a very common condition in orthopedic practice and is known as nerve compression among the public.
What are the causes?
There are many predisposing factors for carpal tunnel syndrome.
Any problem that increases intracanal pressure for an internal or external reason may cause nerve compression. This situation most commonly occurs in people who do some professions and housework that require them to use their hands with the wrist joint bent. In these people, there is thickening and edema in the tendons and tendon sheaths adjacent to the median nerve due to overuse. This situation is also very evident in rheumatic diseases such as rheumatoid arthritis.
Sometimes, it may occur as a symptom of diabetes, thyroid and growth hormone disorders, and it occurs quite frequently in diabetic patients.
A common condition is pregnancy. In the last 3 months of pregnancy, water retention (edema) increases in the body, affecting the carpal tunnel and making it edematous. After birth, the problem usually regresses and recovery occurs as the edema in the body resolves.
How does it present?
The first complaints are pain and numbness. and tingling. Pain and numbness are in the form of burning and start from the 2nd and 3rd fingers and go up to the level of the palm and forearm. Sometimes it hits the shoulder and neck area and is confused with shoulder problems. During work or daily hand use (talking on the phone), the person He feels the need to rest his hand due to getting tired easily, numbness and pain (such as reading a newspaper, using a keyboard-mouse, doing knitting-crocheting). Often the first complaints occur at night during sleep. It wakes the person up from his sleep and the complaints disappear after shaking or rubbing his hand. In severe cases, the frequency of night awakenings increases and it takes longer for the pain and numbness to subside or the numbness becomes permanent. As the degree and duration of compression increases, muscle weakness and wasting begin in the hand. The person says that he cannot squeeze objects due to numbness and loss of sensation, as well as loss of strength, and that they slip out of his hands.
How is it diagnosed?
Carpal tunnel syndrome can be diagnosed by listening and examining the patient. EMG examination should be performed for definitive diagnosis, determination of the level of compression, grading and documentation of the problem. It may be necessary to have direct x-ray, ultrasound, MRI and laboratory tests to make a differential diagnosis of similar problems, to detect accompanying problems and to investigate predisposing causes. It is most often confused with problems such as spinal calcification in the neck area and cervical disc hernia, and should be considered in the differential diagnosis.
How is carpal tunnel syndrome treated?
The most important factors that determine the treatment and type of treatment; The duration of the problem, the severity of the complaints, the EMG finding and its degree, whether there is muscle wasting, what is the cause of the tightness.
As pre-operative treatment; The use of a wristband that keeps the hand in a neutral state during daily, work and sports use, the application of edema-inflammation relieving or dissolving medication, teaching the position of using the hand, and physical therapy methods are performed. Although controversial, cortisone can be applied into the canal. Some medications and vitamins that help nerve sheath healing may be given. If all these non-surgical methods fail, the patient's complaint, examination and EMG findings are evaluated together and a decision for surgery is made.
How is surgery performed in the treatment of carpal tunnel?
The patient is evaluated as a whole. The type of anesthesia is local or block anesthesia unless there is a contrary situation. The surgery takes about 5-15 minutes. The patient was discharged on the same day is done. There is no postoperative pain, or even if there is, it is minimal and easily controlled with painkillers. Postoperative hand use can be started within a few days.
The most basic factor determining the success of the surgery is the duration and degree of compression. Generally, the numbness and pain complaints disappear in the first night and the patient feels a significant relief. It may take some time for the numbness to subside in long-term and heavy compressions.
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