The median nerve is a nerve that is responsible for the movement of some muscles in the arm and palm. It is also responsible for receiving sensation from the outside of the palm. As the median nerve moves to the palm, it passes through a tunnel formed by bones and ligaments in the wrist called the carpal tunnel. A compression in this area causes the problem called Carpal Tunnel Syndrome.
CAUSES
The cause of Carpal Tunnel Syndrome is a narrowing in the tunnel through which the nerve passes. Sometimes this tunnel is narrow from birth. Additional factors that narrow the tunnel slightly over time cause complaints to occur. Trauma to the wrist, injuries, fractures, continuous manual labor, and working with a computer for too long are among the factors that cause narrowing in this area. Sometimes acromegaly, rheumatoid arthritis, pregnancy, menopause, cysts and tumor developments in the tunnel can also lead to Carpal Tunnel Syndrome.
SYMPTOMS
Symptoms in Carpal Tunnel Syndrome start slowly and progress slowly. . Burning, numbness and tingling occur in the palm. It is especially seen on the thumb, index finger, middle finger and partially ring finger. Sometimes patients may feel their hands are swollen and numb. In most patients, these symptoms first appear at night while asleep. It wakes the patient from sleep. By shaking his hands, the complaints are reduced and he falls asleep again. As the compression increases, the same complaints begin to appear during the day. He feels that he is starting to have difficulty holding an object with his hand and fingers.
Early diagnosis is important
As in many diseases, early diagnosis is important in Carpal Tunnel Syndrome. It carries. In this way, permanent damage to the median nerve can be prevented. The most important factor in diagnosis is to thoroughly investigate the characteristics of the patient's complaints. At this point, it is possible to make a diagnosis based on the patient's history. However, tests are performed if a loss of function is observed in the median nerve during the examination.
In the test called the Tinel test, sudden pressure and tapping on the nerve at the wrist level creates an electric shock. This test also helps diagnosis. In the Phalen test, bending the wrists backwards while the arms are extended forward increases the complaints. Sometimes called EMG (Electromyography) is used to support examination findings. An examination is also performed to show the nerves and nerve functions. EMG shows how much the median nerve is affected. If the EMG is normal, Carpal Tunnel Syndrome can be diagnosed. Ultrasound and MRI are rarely used for diagnosis.
TREATMENT
If there is a factor causing Carpal Tunnel Syndrome, it should be treated first. But such a factor cannot be detected in most patients. In this case, the patient is helped by one of the non-surgical or surgical methods, depending on the severity of the problem.
Drugs: Pain relieving, edema and inflammation reducing drugs are used. Cortisone is not usually used. Simple anti-inflammatories (painkillers) are usually sufficient.
Splint: A hand-wrist splint, which will be used especially at night, helps reduce edema by stabilizing the wrist. 2-3 weeks of use may be sufficient.
Exercise: When pain and other complaints decrease, simple stretching exercises can be used.
Surgery : If the complaints do not decrease with non-surgical methods or if the complaints decrease but then increase again, surgical intervention is required. During surgery, the wrist area is anesthetized with local anesthesia. After passing the skin and subcutaneous tissues, the thickened transverse carpal ligament that forms the front of the carpal tunnel is cut and the nerve is relieved. The process takes approximately 15-20 minutes. The patient is discharged on the same day. The patient should not do heavy work with that hand for 3-4 weeks after the surgery. The success rate of surgical treatment is very high. The risk of recurrence of the disease is very low. If surgery is required on both hands, it is appropriate to leave an interval of 2-3 months between two surgical procedures.
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