Carpal Tunnel Syndrome is a condition that occurs as a result of compression of a nerve called the "median nerve" at the wrist level. The patient may present with pain, numbness, tingling, or even loss of dexterity in the hand. Complaints may wake the patient, especially at night. During the day, it can cause unbearable pain during working hours.
First of all, let's get to know this "median nerve". The median nerve is a nerve that passes through our wrist area and provides skin sensation to the first 3 fingers of our hand and half of the 4th finger (ring finger). It also provides nourishment to the muscles that perform many movements of the thumb, which has a very important function in hand functions. This nerve passes through the wrist area between the tendons going to the fingers and reaches the hand. If this area is under pressure and there is a disorder in its conduction, a disease called Carpal Tunnel Syndrome develops.
Why is this nerve under pressure? The first thing that comes to mind are overuse situations. As the wrist moves up and down, pressure changes in the area where the nerve passes cause the nerve to remain under pressure. Those who have to use their wrists a lot and those who work in jobs that require demanding movements on the hands are at risk. It is especially common in people who work on computers, cooks, those who have to write constantly, and those who use their hands and wrists a lot, such as weaving and handicrafts.
Another important reason is hormonal reasons. The most striking example of this is pregnancy. Edema (water accumulation) in the soft tissues due to hormonal reasons during pregnancy causes the nerve to remain under pressure in the area it passes through. Apart from this, hormonal factors such as hypothyroidism (underactivity of the goiter gland) and menopause may also cause this disease.
In addition to hormonal factors, metabolic disorders may also cause conduction disorders in the median nerve. In diabetes, chronic kidney failure, some substances accumulate in the nerve sheath, and due to treatments such as chemotherapy, nerve conduction disorder may occur and Carpal Tunnel Syndrome may occur.
Fractures, dislocations, and soft tissue injuries involving the wrist area are also another factor. Sometimes, during fracture healing, the formation of fusion tissue towards the area where the nerve passes causes the bones in this area to become misaligned. Increased scar tissues that develop during soft tissue healing can also cause compression of the nerve in the area where it passes.
In inflammatory rheumatic diseases involving the wrist (such as RheumatoidArthritis), swelling in the joints and tendons in the wrist area can put pressure on the nerve.
>Although the causes are listed in this way, it is common that no cause can be found, and this condition is called idiopathic (cause unknown) Carpal Tunnel Syndrome, and most of the conditions fall into this group.
Carpal Tunnel Syndrome occurs in approximately 2% of the population. It is detected more frequently in women than in men, and it is most common between the ages of 40-60. It is relatively more common in the dominant hand (such as the left side in left-handers and the right side in right-handers).
Edema increases with inactivity in the wrist canal and patients wake up with numbness in their hands, especially at night. Waking up at night and feeling relaxed by shaking your hands is a very typical symptom. Patients may experience pain that radiates to the hand, forearm, or even up to the upper elbow. Incompetence may be observed in tasks such as fastening buttons that require fine dexterity in the hand, which is a sign of advanced disease.
When making the diagnosis, maneuvers that increase the pressure in the area where the nerve passes through the wrist are performed to see whether symptoms appear. Other possible causes should be excluded by carefully examining the neck, shoulder, elbow and wrist. A neurological examination of the arm and hand should be carefully performed to determine whether there is weakness in the muscles fed by the nerve. Because if there is weakness in these muscles (partial paralysis), the patient must be operated on immediately and the pressure in the area where the nerve passes must be relieved and the nerve must be released. Otherwise, the weakness may be permanent. Permanent weakness is important as it will cause serious impairment in the patient's manual dexterity. Again, loss of sensation in the skin area fed by the nerve should also be evaluated carefully. Because decreased sensation in the first 3 fingers may cause loss of dexterity, the risk of injuring the hand increases because the patient does not feel well.
The most important diagnostic method is EMG (electroneuromyography). Patients with moderate and severe involvement in this examination should be carefully evaluated for surgery. As we mentioned above, severe involvement and muscle strength It is important to protect the patient from possible loss of manual dexterity. If the patient does not require surgery, treatment begins by resting the wrist. A device that stabilizes the wrist (wrist rest splint) should be used for at least 3 weeks. In half of these 3 weeks, the splint should be used both day and night, and in the other half, it should be used only at night. In addition, treatment combinations consisting of physical therapy methods, local ozone or cortisone applications, neural therapy, acupuncture, electroacupuncture, median nerve stretching exercises, and tendon shifting exercises also provide very good results.
In addition to all these treatment efforts, in daily life. Some precautions should be taken to prevent the median nerve and the region in which it is located from being under pressure. For example, computer workers or people who do fine work with their hands need 3-5 minutes after 30 minutes of working time. The patient should rest, make gentle circular movements on the wrist, and make and unclench his hands into fists. Using ergonomic models of computer keyboards and supported mousepads can also be added to the work equipment. Using a wrist splint while working will prevent inappropriate movement of the wrist. Those who work with hand tools should thicken the handles of the tools and ensure that the holding and movement patterns change by working with different tools.
Those with hormonal diseases should ensure that their hormone levels are normal by careful monitoring.
I hope this information has helped you in controlling the disease if you have Carpal Tunnel Syndrome.
Hope you stay healthy.
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