Carpal tunnel

What is carpal tunnel or carpal tunnel syndrome?

The carpal tunnel is a canal located in the anterior aspect of the wrist, between the bones of the wrist and the annular ligament of the carpus. The flexor nerves of the fingers and the median nerve pass through it.

Carpal tunnel syndrome is an ailment that causes damage to the median nerve as a result of pressure inside the carpal tunnel, resulting in nerve injury.

Prognosis of the disease

Although carpal tunnel syndrome can be a disabling and painful condition, if the degree is mild, conservative treatment can be applied. On the other hand, surgery is a treatment that allows the patient to regain hand mobility effectively, usually without complications. Pain disappears and symptoms improve soon after, depending on the severity of the lesion, in 98-99% of cases. Thus, pain and paresthesias disappear, as well as nerve lesions of the palmar cutaneous branch, tenar motor branch, median nerve, ulnar nerve and common digital nerves.

Symptoms of carpal tunnel syndrome

The first symptoms of the disease are pain in the forearm and wrist, which is accompanied by cramping, cramping, numbness and tingling in the thumb, index finger, middle finger and the part of the ring finger that touches the thumb the most.

If these symptoms are not treated, atrophy of some muscles of the hand will appear later, especially in the pad under the thumb, and clumsiness when handling objects, even dropping things from the hands.

Medical tests for carpal tunnel syndrome

When the traumatology specialist suspects the existence of carpal tunnel syndrome, he will explore the sensitivity and strength of the patient’s hand, as well as the possible causes that have triggered the symptomatology.

However, to confirm the diagnosis and assess the degree to which the median nerve is affected, an electromyogram (EMG) and a nerve conduction study or NCS will be requested.

If the cause may be due to other associated diseases (mentioned below), the specialist may also request blood tests or X-rays.

What are the causes of carpal tunnel syndrome?

Many tendons and nerves pass through the carpal tunnel canal, and the median nerve, in particular, has a very tight space in the central area. If, for whatever reason, this space is further reduced, the pressure inside increases, compressing the median nerve. Although the causes may be multiple, possible associated diseases should be studied, such as:

  • Endocrinological diseases, such as acromegaly or hypothyroidism.
  • Rheumatic diseases, such as rheumatoid arthritis.
  • Depositional diseases, such as amyloidosis and mucopolysaccharidosis.
  • Tumors, such as lipoma, hemangioma and multiple myeloma.
  • Steroid or estrogenic treatments.
  • Lactation or pregnancy.
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On the other hand, it can also be related to jobs that involve repetitive manual maneuvers of the hand and wrist, as well as some local trauma (regular use of vibrating hand tools, for example).

Can it be prevented?

It is difficult to prevent carpal tunnel syndrome. It can only be prevented in cases where it is caused by repetitive movements, by trying to avoid them.

Treatments for carpal tunnel syndrome

If carpal tunnel syndrome is related to any other pathology, treatment should be coordinated with the treatment of that pathology.

Conservative treatment will usually be indicated in mild cases and if the patient is pregnant. This will consist of anti-inflammatory drugs and rest of the hand, usually with a splint during the night that keeps the hand and forearm in extension. If the patient is chronic, rehabilitation may be recommended and, if symptoms persist, corticosteroid infiltration is sometimes performed.

In more severe cases, surgery will be recommended, which is usually endoscopic and lasts a short time. It is performed under local or regional anesthesia, with a small incision in the wrist. The specialist dissects the tissues until locating the median nerve and releases it along the carpal tunnel, making a transversal cut of the annular ligament of the carpus. After surgery, the patient should hold his hand up in a sling to prevent the small wound from bleeding. However, in spite of wearing it immobilized, it is important to move the fingers a lot but not to flex the wrist. It is a grateful operation and, normally, the pain will disappear in days, as well as the rest of the symptoms.

Which specialist treats it?

The specialist who treats carpal tunnel syndrome is the orthopedic surgeon, although specialists who treat associated pathologies may also intervene.