Carpal Tunnel Syndrome is the most common entrapment neuropathy of the upper extremity, which is caused by the compression of the median nerve at the wrist level as it passes through the carpal tunnel. Carpal tunnel in the wrist; It is a tunnel whose base and sides are formed by the wrist bones, and its roof is formed by the transverse carpal ligament. A total of ten anatomical formations pass through this tunnel, including the median nerve, the thumb and eight bending beams of the other four fingers. As a result of any volumetric increase in these synovial anatomical structures, the median nerve, which is the most sensitive to pressure among these formations, is affected and a clinical picture called “Carpal Tunnel Syndrome” occurs.
What are the Causes of Carpal Tunnel Syndrome?
Often the cause is unclear. Pressure on the nerve can occur in several ways: Postural causes such as keeping the wrist bent for a long time may narrow the volume of the carpal tunnel.
What are the Symptoms of Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome may sometimes spread to the elbow, arm, even shoulder and neck, pain, burning , tingling and numbness or combinations of these complaints occur together. Numbness and tingling The ma is usually on the thumb, index finger, middle finger, and ring finger. Symptoms usually occur at night; During daily activities such as driving, reading the newspaper and talking on the phone, symptoms may increase and affect a person's quality of life.
In very severe cases, permanent sensory loss may develop and a condition called "thenar muscle wasting", muscle wasting at the base of the thumb, may occur. In such cases, the opposition movement of the thumb may be impaired, the grip may become weak and problems may arise in their fine grip. Symptoms such as dropping small objects from their hands may be added to the complaints of patients who are not treated in advanced stages.
Sometimes, the symptoms of other diseases may resemble the symptoms of Carpal Tunnel Syndrome. In order to reveal the true cause of the complaints, other problems should be investigated with the tests recommended by the physician. These include;
- Muscle, ligament or tendon injuries
- Arthritis of the thumb or wrist,
- Wrist injury with fracture,
- Neck spine Nerve problems such as nerve root compression,
- Diabetic neuropathy due to diabetes.
How is Carpal Tunnel Syndrome Diagnosed?
The medical history of the patients is very important. General medical condition, how the patient uses his hand and previous accidents should be questioned. X-rays are checked to rule out other conditions such as arthritis or fractures. If necessary, MRI examination and blood tests are also added.
Electromyography (EMG) and electrical nerve conduction studies are performed to exclude other possible nerve diseases and to confirm the diagnosis of carpal tunnel syndrome.
What is the Treatment of Carpal Tunnel Syndrome?
Symptoms can sometimes be eliminated with non-surgical approaches. It may be helpful to diagnose and treat other medical conditions, to change the usage habits of the hand, and to splint the wrist to relieve pressure on the median nerve. Wearing a splint at night can help reduce sleep-interfering symptoms.
Using painkillers and anti-inflammatory drugs, in very special cases A steroid injection into the carpal tunnel (albeit rare) to reduce swelling around the nerve may (temporarily) relieve symptoms in some patients.
If the symptoms are very severe or do not regress, surgical treatment is inevitable and the right treatment option. With surgical treatment, the ligament forming the roof of the carpal tunnel is cut, and the volume of the channel in which the nerve is located is expanded, the median nerve is directly relieved by reducing the pressure on the nerve.
The techniques used in the surgery (open or closed techniques), and the surgical incisions (classical or mini-incisions) may vary. The aim and goal is the same in all techniques: to expand the carpal tunnel volume, to directly reduce the pressure on the nerve; It is to relax the nerve with the neurolysis process to be applied to the nerve under magnification.
It should be kept in mind that the earlier the treatment is started, the more successful results can be achieved.
Carpal tunnel surgery is usually an outpatient surgery without hospitalization. The operation is performed under general or regional anesthesia, by applying a special pneumatic tourniquet to the arm, in a bloodless environment and under augmentation. After the operation, the wrist is wrapped with a rest splint dressing. Surgical stitches are removed between 10-14 days of surgery. The patient is advised to use a splint and to avoid forceful work for 4 to 6 weeks.
The numbness and tingling may disappear suddenly (within 24-72 hours) after the surgery, or the recovery period may take 6-12 months depending on the nerve damage. Pain at the surgical site may persist for several weeks. It may take several months for muscle strength in the hand and wrist to return to normal. Especially in very severe cases, the symptoms of carpal tunnel syndrome may continue after surgical treatment. Postoperative physical therapy and secondary surgical interventions may be necessary.
What Can Be Done to Prevent Carpal Tunnel Syndrome?
Existing chronic diseases should be taken under control. Avoidance of work that puts excessive strain on the hands and wrists, people who use their hands and fingers excessively due to their occupation, for example, avoiding bending the wrist for a long time while using a computer and keyboard, using ergonomically designed mouse, keyboard and office equipment. Lifestyle, regular walking and swimming are very important and effective for protection from Carpal Tunnel Syndrome. One of the tissues with the heaviest metabolism in our body is our nerves. Sports, cardio exercises and swimming can also benefit the nerves in our wrist as they reduce body fat and edema, and increase blood supply to all tissues, and can create a strong protection against Carpal Tunnel Syndrome. People who do sports where the hand and wrist are actively used should protect their hands and wrists with protective splints, bandages and specially designed gloves.
One of our organs damaged by excess weight is our hands. Carpal Tunnel Syndrome is more common especially in overweight people. Therefore, care should be taken to maintain an ideal weight and diets that severely restrict B vitamins should be avoided.
There is no specific preventive exercise after Carpal Tunnel Syndrome occurs. However, there are exercises that are “specific for people at risk” to prevent the formation and progression of the disease. In order to be protected from the disease, resting the hand and wrist, which remains in the same position for a long time during the day, at regular intervals, relieving the joints by performing circular exercises, nerve stretching, nerve shifting and tendon shifting exercises can be beneficial.
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