Carpal tunnel syndrome (CTS) is a medical condition that occurs when the median nerve travelling through the wrist, gets compressed. Pain becomes intense during night and may extend up the arm. CTS is observed to affect more women than men.
3D Medical Animation still of Carpal Tunnel Syndrome at the carpal tunnel
Some people may improve without any specific treatment over a year, but if pressure on the median nerve continues, it can inhibit its gliding, leading to its damage and, therefore, worsening of the symptoms.
Cause
The causes of carpal tunnel syndrome are mostly unknown, but some common risk factors include- repetitive wrist work, arthritis, obesity, hormonal changes during pregnancy, diabetes, trauma. Certain extrinsic factors that are likely to exert pressure from outside the tunnel and cause CTS are- benign tumors or lipomas, improperly formed blood vessels, etc.
Pathophysiology
When the carpal tunnel, located at the base of the palm, becomes narrow, it results in CTS. Flexor tendons and the median nerve pass through the tunnel; synovium lubricates the tendons and allows easy movement of the fingers. Repetitive flexion and extension in the wrist significantly increases the fluid pressure in the tunnel through thickening of the synovial tissue that lines the tendons within the carpal tunnel. Swelling of the synovium ultimately puts pressure on the median nerve resulting in pain, numbness, tingling, and weakness in the hand.
Treatment
Carpal tunnel syndrome, for most people, gradually worsens over time without some form of treatment. That’s why it is important to be evaluated and diagnosed early on to slow or stop the progression of the disease.
The American Academy of Orthopedic Surgeons recommends a course of nonsurgical therapies to be implemented for a few weeks before surgery is considered.
1. Non-surgical methods
- Splints/ Braces
Splints or braces can be used, especially at night, to keep the wrist from bending. A rigid splint can keep the wrist in a neutral position. Current recommendations, however, generally don't suggest immobilizing braces, but instead focus on activity modification and non-steroidal anti-inflammatory drugs as initial therapy.
- Corticosteroids
Corticosteroid is a powerful anti-inflammatory agent that can be injected into the carpal tunnel to temporarily calm the symptoms. The therapy buys time for the patient to develop a long-term strategy that fits their lifestyle. The use of ultrasound while performing the injection leads to faster resolution of CTS symptoms. The injections are done under local anesthesia.
2. Surgical Methods
Surgery is recommended when there is constant numbness and muscle weakness. The surgical procedure performed for carpal tunnel syndrome is called a "carpal tunnel release." There are two different surgical techniques for doing this, but the goal of both is to relieve pressure on the median nerve by cutting the transverse carpal ligament that forms the roof of the tunnel. This increases the size of the tunnel and decreases pressure on the median nerve.
Conclusion
Joint and nerve pain in the hands are common complaints in the modern technological world or laptops and tactile technology. Many of these issues can be addressed through changes in lifestyle. However, when pain extends to the level of CTS it can be debilitating. Early recognition and attention can help significantly.
Disclaimer: The information in no way constitutes, or should be construed as medical advice. Nor is the above article an endorsement of any research findings discussed in the article an endorsement for any of the source publications.
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