Carpal Tunnel Syndrome

Diah Rahmi

Carpal tunnel syndrome is a nerve compression syndrome where the median nerve gets

compressed at the wrists

What is carpal tunnel?

Causes

Causes of carpal tunnel syndromeThe most common cause of carpal

tunnel syndrome is idiopathic (which means that the exact aetiology is unknown).

• In general, anything that crowds, irritates or compresses the median nerve in the carpal tunnel space can lead to carpal tunnel syndrome.

Anything that aggravates and inflames the tendons can cause carpal tunnel syndrome,

including repetitive hand movements,

pregnancy and arthritis.

Sign and Symptom

• Numbness Pins and needles Pain, particularly at night • Darting pains from the wrist • Radiated or referred pain into the arm and shoulder• Weakness of the hand and Decreased grip strength • The little finger and half of the ring finger are unaffected• Swollen fingers• Inability to differentiate between hot and cold by

touch

atrophy of the thenar muscle

Test for Carpal Tunnel Syndrome

A common test for nerve entrapment is

Tinel’s sign. Tapping or ‘percussing’ is performed on the surface of the skin along the nerve pathway over the suspected area of the lesion. If this produces a tingling sensation then the test is positive.

Treatment

Non-steroidal anti-inflammatory drugs, such as :

• Aspirin and ibuprofen can manage carpal tunnel syndrome symptoms that have been present for a short time.

• Corticosteroids can be injected directly into the wrist to provide relief to persons with mild symptoms

Exercise for Carpal Tunnel Syndrome

• Straighten both wrists and relax fingers.• Make a tight fist with both hands.• Then bend both wrists down while keeping

the fist. • Hold for a count of 5.• Straighten both wrists and relax fingers,

for a count of 5.• Repeat 10 times.

Non SurgicalOrthoses

The following orthoses help manage the carpal tunnel syndrome pain:

– Wrist hand orthosis – Thumb spica splint– Cock-up wrist splint

Orthotics goals– Decrease pain and swelling– Prevent deformity progression– Prevent Movement

– By restrict flexion movement of wrist

– Main objective is to position wrist in neutral but preferably slight extension to get pressure off of median nerve

– Static low profile wrist supports often used to position wrist accordingly

Surgical Options

Endoscopic surgery

Carpal tunnel release surgery

Surgical

Cut The Ligament (Flexor Retinaculum)

Surgery is one treatment option for carpel tunnel syndrome. The surgeon makes an incision (cut) less than 5 cm long in your palm, and perhaps into the wrist as well, to expose the transverse carpal ligament. The surgeon then cuts the ligament to reduce pressure on the underlying median nerve. The incision in the palm is sutured (sewn) closed

• Surgery is usually successful. In some cases it does not completely relieve the numbness and pain in the fingers or hand. This may be the case if there has been permanent nerve damage caused by long-standing carpal tunnel syndrome or by other health problems such as diabetes.

Complications from surgery

• Although complications are possible with any surgery, your doctor will take steps to minimize the risks. The most common complications of carpal tunnel release surgery include:

• Bleeding• Infection• Nerve aggravation or injury

Risk factors of carpal tunnel syndrome*

1-Alterations in the balance of body fluids. Certain conditions such as pregnancy, obesity, thyroid hormone disorders and kidney failure, can affect the level of fluids in your body.

Fluid retention common during pregnancy, for example may increase the pressure within your carpal tunnel, irritating the median nerve. Carpal tunnel syndrome associated with pregnancy generally resolves on its own after the pregnancy is over.

2-Nerve-damaging conditions. Some chronic illnesses,

such as diabetes and alcoholism, increase your risk of nerve damage, including damage to your median

nerve.3-Inflammatory conditions. inflammation, such as rheumatoid arthritis or an infection, can affect the tendons in your wrist, exerting pressure on your median nerve.4-Anatomic factors. A wrist fracture or dislocation that alters the space within the carpal tunnel can create extraneous pressure on the median nerve.

Activity

Reference

• http://www.repetitive-strain.com/ctsindex.html.

• http://www.selfcare4rsi.com/carpal-tunnel-syndrome-anatomy.html.

• http://www.carpal-tunnel-symptoms.com/anatomy-of-the-carpal-tunnel.html

• https://www.ncbi.nlm.nih.gov/labs/articles/23798040/