Carpal tunnel syndrome

Sinonimi: Carpal Tunnel Syndrome

Carpal tunnel syndrome develops because of the pressure to the nerve (N. Medianus) in the carpal region (the wrist). Patient feels it as pain and tingling in the first 3 fingers of the hand.

Problems with the cervical spine can produce similar symptoms

Reason for developing is unknown.

What we do know is:

• That the basis of the disease lies in the reduction of the space in the carpal tunnel, caused by inflammation, with resulting pressure to the N. Medianus
• That in a certain number of patients there is a hereditary component (in 1 out of every 4 patients there was a previous occurrence in the family)
• That it happens more frequently after fractures to the wrist, as well as with patients with rheumatoid arthritis.
• That it often accompanies: pregnancy, obesity, thyroid function reduction, diabetes, menopause and all conditions that result in swelling in the wrist areas
• That all growths (tumors and cysts) in the area of the carpal tunnel can trigger this condition.
• That it develops more frequently in persons that daily use their hands with great stress

• “Tingling” in the fingertips
  The first sign of developing this disease is a “tingling” sensation in the fingertips. Usually these symptoms first appear in the index finger and the middle finger. But in principle, it can appear in the thumb, index, middle and the inside half of the ring finger.
• Pain
  Pain can appear in the fingers, the hand, but it can be transferred along the forearm and, rarely, even up to the shoulder.
• “Numbness” of the fingers
  Over time, a loss of sensation in the fingertips develops, in the first to the half of the fourth finger.
• “Weakness” of the hand
  If the disease lasts longer, for months or years, a loss of muscle mass in the palm develops, in the tenar region (thumb region), and there is a following loss of hand strength.
• Clumsiness
  Loss of functionality develops in a certain number of patients, so they can no longer perform even medium complexity manual labor (sometimes not even being able to bring a glass of water to their mouth).
• Dryness of the skin of the fingers and the palm
  A loss of function in the sweat glands develops in the region innervated by N. Medianus, followed by dryness of the skin.

Symptoms often occur in both hands. Pain is more pronounced during night, and some of the patients even have sleep disorders. Pain becomes permanent over time. Temporary help is provided by a change of position of the hand and forearm, i.e. lifting them above the level of the heart.

In most cases, a detailed clinical examination with some test to detect the aforementioned symptoms is enough, In all cases when the hardship persists for months or when it’s reappearing, an EMNG nerve function test is necessary

All clinical tests are performed by a physician.

• Tinel’s sign test
  Forearm with the palm facing upwards is resting on a surface. The examiner slightly taps the place where the N. Medianus enter the carpal tunnel with his finger. Tinel’s sign is positive if the patient feels a slight electric “shock” towards the fingers, tingling or an exacerbation of pain .
• Phalen’s sign test
  Both hands are flexed at the wrists, and are touching themselves with their backs (upper or dorsal) sides. Upper arms and forearms are level with the shoulders. Phalen’s sign is positive if there is an increase in tingling or pain in the fingers, or a sensation of slight electric shock during 30 seconds in this position.
• o Reverse Phalen’s sign test
  Both hands are flexed at the wrists, and are touching with their palms. Upper arms and forearms are level with the shoulders. Reverse Phalen’s sign is positive if there is an increase in tingling or pain in the fingers, or a sensation of slight electric shock during 30 seconds in this position.

CTS that hasn’t been timely detected and treated can develop a picture of tenar muscle mass loss (hypotrophy) with loss of agility and hand strength.

In all cases when the hardships appear for the first time, the following treatment should be done

• Ease the stress to the hand in which the signs of the disease are starting
• If necessary, take mild analgesics, for pain management.
• If obesity is present, reduce the weight, If there are signs of arthritis present, take measures in treating it.

After the problems subside, undergo exercises to prevent CTS from developing. In a large number of cases, CTS goes away without any treatment, and never reappears.

• Hand immobilization
  Immobilizing the hand at the wrist during the day or at night only is the first option in treating the first signs of CTS. Immobilization is kept on for several weeks, and is completely successful in 1/3 of the patients.
• Injection treatment
  Injections of steroids can prove to be useful in some cases, for their anti-inflammatory effects. The value and performance of this kind of treatment is still under evaluation. In any case, during the first months of the first CTS signs appearing, and after immobilization, this treatment can be worthwhile.

The basic surgical indication principle is the following:

• o If the symptoms persist for many months, and a tenar muscle mass loss is evident,
• If previous treatments were ineffective, and the hardships increase .

The essence of a surgical treatment is in “releasing” or opening the carpal canal, in fact, the ligament that closes it. It’s a procedure done by:

• Incision and “release” of the carpal ligament
• Endoscopis “release” of the carpal ligament.

Both procedures are done under local anesthesia, possible complications like infection are extremely rare, as well as nerve damage. After both procedures, recovery is needed, with resting the hand for a few weeks.

In certain cases, other things can be useful: diuretics, vitamin B6, ultrasound and magnetic therapy and various exercises.