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Carpel Tunnel Syndrome

Orthopaedics Surgery in Pune

Carpal tunnel syndrome is a common condition that causes pain, numbness, tingling and weakness in the hand and wrist. It occurs when there is increased pressure within the wrist on a nerve called the median nerve. This nerve provides sensation to the thumb, index, and middle fingers, and to half of the ring finger. The small finger (the “pinky”) is typically not affected. The median nerve also provides strength to some of the muscles at the base of the thumb and index finger.

What is the carpal tunnel ?

The carpal tunnel is a narrow canal or channel in the wrist. The bottom and sides of the tunnel are formed by a semi-circle of bones called carpal bones. A strong tissue, called a ligament, forms the top of the tunnel. The median nerve and tendons pass through this narrow space. The tendons are rope-like structures that connect muscles in the forearm to bones in the hand. Tendons allow the fingers and thumb to bend and straighten. Conditions that further narrow the carpal tunnel or cause the tendons that pass through this tunnel to swell cause carpal tunnel syndrome by compressing the median nerve.

Who is at risk for carpal tunnel syndrome?

People at risk are those with jobs or activities that involve repetitive finger use, especially those associated with high force, long-term use, extreme wrist motions and vibration. However, many factors may contribute to the development of carpal tunnel syndrome. They include :

  • Heredity (smaller carpal tunnels can run in families)
  • Pregnancy
  • Hemodialysis (a process where the blood is filtered)
  • Wrist fracture and dislocation
  • Hand or wrist deformity
  • Arthritic diseases such as rheumatoid arthritis and gout
  • Thyroid gland hormone imbalance (hypothyroidism)
  • Diabetes
  • Alcoholism
  • A mass (tumor) in the carpal tunnel
  • Older age
  • Amyloid deposits

How can carpal tunnel syndrome be prevented?

Because of its many causes, carpal tunnel syndrome is difficult to prevent. Workstation changes, such as proper lighting and seating and hand/wrist placement, can help decrease some factors that can lead to carpal tunnel syndrome. Other preventive methods include:

  • Sleep with your wrists held straight.
  • Keep your wrists straight when using tools.
  • Avoid flexing (curling) and extending your wrists repeatedly.
  • Decrease repetitive/strong grasping with the wrist in a flexed position.
  • Take frequent rest breaks from repetitive activities.
  • Perform conditioning and stretching exercises before and after activities.
  • Monitor and properly treat medical conditions linked to carpal tunnel syndrome.

What are the symptoms of carpal tunnel syndrome?

Symptoms usually begin slowly and can occur at any time. Early symptoms include :

  • Numbness at night
  • Tingling and/or pain in the fingers (especially the thumb, index and middle fingers)

Common daytime symptoms can include :

  • Tingling in the fingers
  • Decreased feeling in the fingertips
  • Difficulty using the hand for small tasks, like :
    • Handling small objects
    • Grasping a steering wheel to drive
    • Holding a book to read
    • Writing
    • Using a computer keyboard

As carpal tunnel syndrome worsens, symptoms become more constant. These symptoms can include:

  • Weakness in the hand
  • Inability to perform tasks that require delicate motions (such as buttoning a shirt)
  • Dropping objects

In the most severe condition, the muscles at the base of the thumb visibly shrink in size (atrophy). As carpal tunnel syndrome worsens, symptoms become more constant. Weakness in the hand, inability to perform tasks that require delicate motions (such as buttoning a shirt), and dropping objects begin to occur. In the most severe condition, the muscles at the base of the thumb visibly shrink in size.

How is carpal tunnel syndrome diagnosed?

First, your doctor will discuss your symptoms and medical history and examine you. The tests are performed, which may include:

  • Tinel’s sign. In this test, the physician taps over the median nerve at the wrist to see if it produces a tingling sensation in the fingers.
  • Wrist flexion test (or Phalen test). In this test, the patient rests his or her elbows on a table and allows the wrist to fall forward freely. Individuals with carpal tunnel syndrome will experience numbness and tingling in the fingers within 60 seconds. The more quickly symptoms appear, the more severe the carpal tunnel syndrome.
  • X-rays. X-rays of the wrist may be ordered if there is limited wrist motion, or evidence of arthritis or trauma.
  • Electromyography (EMG) and nerve conduction studies. These studies determine how well the median nerve itself is working and how well it controls muscle movement.
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How is carpal tunnel syndrome treated?

Non-surgical treatments:

Non-surgical treatments are usually tried first. Treatment begins with wearing a wrist splint at night and taking no steroidal anti-inflammatory drugs, such as ibuprofen, to relieve pain. Cortisone injections can also be given though they provide only temporary relief of symptoms, but may provide evidence of confirmation of the diagnosis. Changes can also be made to the work station. Examples include raising or lowering the chair or the computer keyboard to bring the patient into proper alignment. Changes can be tried in the hand/wrist positions used in jobs and other activities, along with activity modification. Hand therapists can provide instruction in splinting, exercise and heat treatment, as well as ergonomic work modification.

Surgical treatments:

Surgery is recommended when carpal tunnel syndrome does not respond to non-surgical treatments or has already become severe. The goal of surgery is to increase the size of the tunnel in order to decrease pressure on the nerves and tendons that pass through the tunnel. This is done by cutting (releasing) the ligament that covers the carpal tunnel at the base of the palm. This ligament is called the transverse carpal ligament.

  • Surgery for carpal tunnel syndrome is an outpatient procedure that is usually performed under local anesthesia (you will be awake) but sedation can be added for comfort.
  • After surgery, brief discomfort lasts 24 to 72 hours. Patients often experience complete nighttime symptom relief even the night after surgery.
  • Stiches are removed 10 to 14 days after surgery. Hand and wrist use for everyday activities are gradually restored using a specific exercise program.
  • Heavier activities with the affected hand are restricted for four to six weeks. Recovery times vary depending on the patient’s age, general health, severity of carpal tunnel syndrome, and the length of time symptoms have been present. Strength and sensation continue to improve over the following year.
  • Many patients who undergo carpal tunnel release surgery achieve nearly complete relief of all symptoms. Recovery in some individuals with severe carpal tunnel syndrome may be slow and may not be complete.
  • Carpal tunnel syndrome can reoccur, but this is not common.

In K K Hospital many such cases are dealt with patient care. The surgical techniques are superiorly used to satisfy patients need. K K Hospital is easily approached from Kharadi, Chandan nagar, Wadgaon sheri, Mundhwa, Keshav nagar, Manjri, Wagholi, Logegaon, Sant nagar, Viman nagar. See Orthopaedic surgeon if you have symptoms of carpal tunnel syndrome.

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