Nerve Compression in the Wrist (Carpal Tunnel Syndrome)
CTS is one of the common causes of hand numbness and pain. It is more common in women than men.
Anatomy
The tunnel through which the median nerve passes in the wrist is called the carpal tunnel. The tunnel is narrow and consists of carpal bones on its floor and sides. This U-shaped bone bed is covered by the ligament called transverse carpal ligament. Compression of the median nerve under this ligament is called carpal tunnel syndrome.
The median nerve controls the sensation and movements of the thumb, index finger and middle finger. Along with the median nerve, the tendons that give the fingers the ability to move pass through this tunnel.
Causes
Carpal tunnel syndrome occurs in the tunnel. It is formed by the pressure on the median nerve as a result of thickening of connective tissues, tendons or transverse carpal ligament. There is a sheath called synovium around the tendon sheaths, and their edema and thickening are common. Reasons for the formation of CTS:
Genetics, which is common in some families
- Excessive use of the hand; Keyboard, lace work, hand carpet weaving
- Hormanal changes; It is common in pregnant women
- It is common in older age
- It is common in diabetics, rheumatic diseases and thyroid patients.
In many cases, no cause can be found.
Clinical Findings and Complaints
The most common symptoms;
- Numbness, tingling and pain
- Electricity in the thumb, index and middle finger
- Pain and tingling radiating to the shoulder and elbow
The symptoms are mostly It starts slowly and especially the thumb is affected more. It occurs at any time, but is especially evident at night and can wake you up from sleep. Complaints may increase during the day while talking on the phone, driving and reading a book. There is a feeling of relief by waving your hand.
Symptoms come and go at first, but become permanent over time. Clumsiness increases, difficulty buttoning buttons, and dropping glasses while washing dishes may occur. If it progresses too much, weakening of the hand muscles occurs.
Physician Examination i
After discussing your medical history and complaints with the physician, your physical examination will be performed;
- Weakness in hand muscles
- Grip strength
- Testing numbness and tingling by holding the hand in certain positions
- Tests that provoke complaints by pressing the median nerve trace on the wrist
- Evaluating finger sensations and sensations with eyes closed
EMG may be taken to evaluate nerve conduction, and x-ray may be taken to view bone structures.
Treatment
In many patients The disease may progress despite precautions being taken.
Non-surgical treatment;
If the complaints are mild and there is a CTS of unknown cause, activity restriction, use of splints, medication and local Non-surgical treatment is possible with steroids. It is important to avoid movements that provoke pain.
Surgical Treatment;
If the complaint and clinical condition progress and there is no response to non-surgical methods, surgery may be considered.
In many serious cases, if there is no response to non-surgical methods, surgery is recommended as soon as possible because, in long-term cases, irreversible damage to the median nerve occurs.
Surgical Technique
Many cases are outpatient and outpatient and are performed under local anesthesia. The transverse carpal ligament is cut vertically and the median nerve is relaxed.
After the surgery, the operated hand is kept above the heart level for a few days to prevent swelling. This will reduce pain and stiffness. It is normal for pain, swelling and stiffness to develop after surgery. The wrist should be rested for up to 3 weeks. After a few weeks, the hand can be used for simple tasks. It may take up to six months for the numbness and tingling to subside. You can start by talking to your doctor about the time it takes to return to work, driving and other daily activities.
Complications
Rarely, bleeding, inflammation and nerve injury may occur.
Long-term results
Carpal tunnel may rarely recur and additional surgery may be required.
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