Carpal tunnel syndrome is a condition that occurs as a result of compression of the median nerve in the wrist region. In the narrow canal called the carpal tunnel in the wrist, the median nerve is located together with the flexor tendons and other structures that close the fingers to the palm. If this tunnel narrows or puts pressure on the median nerve, carpal tunnel syndrome develops. It is a nerve that leads to feelings. The median nerve is formed by the union of the C5, C6, C7, C8 and T1 spinal nerve roots of the brachial plexus in the brachial plexus. The median, which reaches from the brachial plexus to the armpit area and then to the elbow, passes between the forearm muscles and proceeds towards the wrist and the inner part of the hand. Passing through the carpal tunnel in the wrist, it branches into the thumb, index finger, middle finger, and ring finger. The branches of the median nerve provide movement and sensation to the muscles in the wrist and hand. At the same time, these branches control the joints and muscles of the fingers. The median nerve is surrounded by muscle and connective tissue in the carpal tunnel at the wrist. If the nerve is compressed or compressed here, the nerve dysfunction and related symptoms described above may occur.
Carpal tunnel syndrome may include the following symptoms: numbness felt in the thumb, index finger, middle finger and half of the ring finger. A feeling of weakness and clumsiness in the hand. Dropping hand-held objects. Pain is a burning or stinging pain felt in the wrist and fingers.
Nighttime symptoms: Numbness and pain usually increase at night or during sleep and may cause waking. There may be swelling or edema in the wrist and hand. As the disease progresses, night pains increase and sleep is disturbed. In addition, the muscle pad on the outside of the palm and the palm bones that provide thumb movements collapse (thenar atrophy and interosseous atrophy).
Carpal tunnel syndrome can usually occur for the following reasons:
Hormonal changes : Hormonal changes such as pregnancy or menopause increase the risk of carpal tunnel syndrome. it can flow. Trauma: Pressure on the carpal tunnel may occur as a result of wrist fractures, sprains, or other traumatic injuries.
Wrist structure: A congenital narrow or small carpal tunnel can press on the nerve.
Tendinitis: Inflammation or swelling around the wrist flexor tendons can press on the nerve. workers in jobs that require Especially male workers who have been working in rough jobs with their hands for years, whose hands have grown and callused, are the typical patient group. Pregnant women, due to hormonal changes. Those who have certain health problems such as obesity, diabetes, rheumatoid arthritis, hypothyroidism and chronic dialysis dependence.
Diagnosis of carpal tunnel syndrome: The patient's symptoms are evaluated: Symptoms such as pain, numbness and tingling in the hand are questioned. A physical examination is done. Hand and wrist area are examined, hand sensitivity and muscle loss are checked. Tinel test is applied: Pain and pricking in the area of nerve compression are tested by tapping lightly on the wrist. By bending the wrist, pressure is applied on the nerve in the carpal tunnel area and symptoms are triggered or worsened. It shows the extent of the disease, but the results are evaluated together with the results of the complaints and examination.
Carpal tunnel syndrome can be treated and treatment options may include:
Conservative treatment: In the first stage, resting the wrist Conservative treatment methods such as activity modification, use of wrist splints, physical therapy and wrist exercises can be tried.
Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroid injections can help reduce pain and inflammation
Surgical Treatment: In cases where there is no response to conservative treatments or when symptoms become severe, carpal tunnel dilation surgery can be performed to relieve pressure on the median nerve.
Some common carpal tunnel syndrome surgery methods are:
Carpal tunnel opening (Carpal tunnel release): In this method, it is used to reduce the pressure on the carpal tunnel. The structures inside the tunnel are cut or loosened. The surgeon opens the tunnel by making an incision above the carpal tunnel and releases the structures that compress the median nerve.
Endoscopic carpal tunnel opening: In this method, the carpal tunnel is entered using an endoscope (camera). The surgeon observes the inside of the tunnel with the help of the endoscope and makes the necessary cuts and loosenings to reduce the compression with special surgical instruments. In this method, smaller incisions can be used and the healing process can be faster. Mini open carpal tunnel opening (Minimally invasive median nerve decompression): In this method, carpal tunnel is opened using a smaller incision. The surgeon makes the cuts and loosenings necessary to reduce the pressure on the carpal tunnel. The entire carpal ligament is cut with a minimal entry and there is no risk of recurrence of the disease. The surgery is usually performed under local anesthesia or sometimes under general anesthesia. Wrist rehabilitation is important in the postoperative period and patients are recommended to use a shoulder strap for the first three days. Dramatic improvement can be expected in most patients immediately after surgery. The most appropriate surgical method and treatment for each patient is determined on the basis of the doctor's assessment and the patient's individual situation.
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