Carpal Tunnel Syndrome

October 15, 2018 | By | Reply READ MORE...

Carpal Tunnel syndrome is caused by irritation of the median nerve in the carpal tunnel. Carpal tunnel is a narrow space between the carpal bones and the transverse carpal ligament (flexor retinaculum). It causes tingling, numbness and pain in the fingers and hand.

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CAUSED BY:

Some of the CAUSES are :

  • Occupational or repetitive overuse e.g. laptop typing ,washing clothes, making dough, handy work ,baking and cooking
  • Endocrine disorders such as Hypothyroidism, Menopause, Pregnancy in which there is water retention.
  • Metabolic cause like Gout.
  • Rheumatoid arthritis or wrist osteoarthritis.
  • Wrist fracture / dislocation.
  • Space occupying lesion in the carpal tunnel e.g. mass (tumor).

SYMPTOMS:

Three main symptoms which are commonly seen in CTS are:

  • Pain
  • Tingling
  • Numbness

These symptoms primarily occur in the thumb, index, middle fingers and half of ring finger which is supplied by median nerve. Initially the common and the first complain is symptoms at night time. Many people have the habit of sleeping with the wrist curled, which induces the symptoms and they got awake from sleep. They feel better by shaking the hands.

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As the condition progresses, symptoms are often noticed during the daytime also. Usual complain is:

  • tingling
  • reduced feeling in the hands and fingers
  • occasional shock like sensation occurs.
  • The pain sometimes radiate to the forearm and up to the shoulder
  • Functionally complains are difficulty in holding small objects, decreased grip strength and difficulty in performing fine movements e.g. buttoning a shirt.
  • The person complains of difficulty in doing things like opening a bottle, typing on keyboard, grasping a steering wheel to drive, writing, etc.
  • Over a period of time the muscles of the palm (thenar and hypothenar muscles) reduce in their bulk
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TREATMENT:

Initial treatment aims to relieve the symptoms by reducing the pressure induced on the median nerve.

Bracing or splinting: They help to keep the wrist in the position that prevents pressure on the nerve. These can be used during the night time and also be used during activities that induce the symptoms, like typing.

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Activity modification and patient education: Take breaks if there are repetitive sustained activities involved in your work. Correct postures are taught to the person. Also ergonomic modification and postural correction is taught.

Cold compression: Ice application helps to reduce the symptoms however direct application to the skin should be avoided.

Nerve gliding exercises: There are exercises which helps to glide the nerve within the carpal tunnel smoothly. These exercises helps to relieve the symptom.

Mobilization technique: In case of restricted joint mobility mobilize the carpal bones for increased carpal tunnel space.

Pain relieving modalities: Ultrasound usually helps reducing the inflammation and TENS can be used in reducing the pain in case of pain going to the forearm, shoulder.

Medicines: Usually the medicines such as NSAIDS help as prescribed by the physician.

Improving the muscle performance: Initially muscle setting exercises are done. Further exercises are done to increase the strength and endurance of the muscle to help perform the functional activities smoothly.

 

Sometimes if the symptoms are severe, then steroid injections are advised. If the conservative management is not effective and symptoms are severe,surgery can be recommended by the physician e.g. carpal tunnel release surgery.

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