Carpal tunnel syndrome (carpal tunnel syndrome)
Carpal tunnel syndrome (or carpal tunnel syndrome) is an illness that causes pain and sensation of the upper limb in the wrist and hand. A disorder develops due to the fact that the median nerve is pinched. It stretches along the palm to the fingers, passes through the carpal tunnel. The channel itself is represented by a space in which, in addition to the median nerve, there are tendons responsible for the work of 9 fingers. The symptoms of carpal tunnel syndrome develop when the integrity of the canal is compromised. As a result of such changes, the nerve is pinched and the person experiences characteristic symptoms.
In America alone, billions of dollars are spent on treating carpal tunnel syndrome.
Some facts about carpal tunnel syndrome:
- Carpal tunnel syndrome is the most common condition associated with compression of the nerves in the hands. Surgery to treat this syndrome is considered one of the most common wrist surgeries. In America alone, 463,000 such procedures are performed every year.
- Sick leave in people with carpal tunnel syndrome is very long and is at least 31 days.
- About 50% of all cashiers who serve the population in grocery stores suffer from pathology. Most often, this position is held by women. The reason for the violation is the same type of work with your hands when scanning barcodes. Moreover, the movements are performed at high speed and are repeated many times.
- People who work at a computer develop carpal tunnel syndrome in 25% of cases.
- In women, the disease develops 2 times more often than in men.
- Carpal tunnel syndrome symptoms
- Causes of Carpal Tunnel Syndrome
- Treatment for carpal tunnel syndrome
- Alternative treatments
- Preventive actions
- Clinical researches
Carpal tunnel syndrome symptoms
The disease begins with the fact that a person begins to develop mild tingling pains. They are concentrated in the thumb, forefinger, and middle finger. Also, these areas of the brush will go numb. Symptoms are transient, but as the disease progresses, they begin to appear more often and then will be present on an ongoing basis. The intensity of pain increases all the time. Any movements of the forearm and hand become painful.
The main symptoms of carpal tunnel syndrome include:
- Numbness and tingling in the fingers, in the forearm. The little finger is not involved in the pathological process. The pain occurs not only during work, but also when a person performs normal movements: driving a car, reading a book, making a phone call. Pain often occurs at night while the person is asleep. This makes him wake up, shake his hand to relieve discomfort. Sometimes it helps, but the longer there is no professional approach to treatment, the more intense the numbness and pain will become.
- Weakness in the arms. It is also growing all the time. This leads to the fact that the person begins to drop things. The muscles that are responsible for the functioning of the thumb lose their function. Some patients indicate that they are unclenching their arm due to severe pain.
Such symptoms cannot be tolerated, you need to see a doctor. If there is no treatment, the damage to the nerve fibers and muscles will be irreversible.
Causes of Carpal Tunnel Syndrome
The main cause of the development of tunnel syndrome is the compression of the median nerve. It stretches through the carpal tunnel to the hand. This nerve is responsible for the sensitivity of the palm and fingers, with the exception of the little finger.
The thumb is also provided by this nerve.
- Any condition that causes irritation, swelling, or inflammation of the tissues surrounding the nerve can cause carpal tunnel syndrome. An example of such a disorder is a fracture of the forearm, or rheumatoid arthritis.
- Diabetes mellitus at a late stage of its development can cause tunnel syndrome.
Sometimes the disorder develops in pregnant women and in people who are overweight.
At risk are women over 50 years old, whose job responsibilities are related to the implementation of the same type of hand movements. These professions are: secretaries, assemblers, accountants, etc.
Risk factors that increase the likelihood of developing tunnel syndrome:
- Incorrect bone fusion after a fracture. As a result, the canal deforms and puts pressure on the nerve.
- Congenital anomalies in the structure of the carpal tunnel.
- Belonging to the female sex. Experts attribute this fact to the fact that women have a narrower carpal tunnel than men. Therefore, any injury to the hand will lead to the development of corresponding symptoms.
- Chronic diseases that affect nerve fibers: multiple sclerosis, diabetes mellitus, etc.
- Inflammatory diseases involving tendons and joints. Carpal tunnel syndrome often develops in people with rheumatoid arthritis.
- Retention of fluid in the body, which can be observed during gestation or during menstruation. Due to the accumulation of excess water, the pressure inside the canal increases, which leads to nerve irritation. After pregnancy, carpal tunnel syndrome resolves on its own.
- Diseases associated with damage to the thyroid gland, with kidney damage. Carpal tunnel syndrome often develops in people who are overweight.
- Features of work: work with vibrating parts, work on a conveyor belt, etc. Although today there is no direct evidence that the peculiarities of working conditions directly affect the development of carpal tunnel syndrome.
As studies show, in all patients diagnosed with carpal tunnel syndrome, the volume of the canal was much smaller than in healthy women.
There is evidence that there is a relationship between long-term computer work and carpal tunnel syndrome. If a person types at high speed, then on average per hour, he presses the keyboard 12,000 times. Under the condition of an 8-hour working day, it will perform 96,000 clicks. In this case, the force applied to the keys is 225 g, that is, a load of up to 16 tons falls on the fingers per day. If a person types even faster, then this figure can reach 25 tons per day.
Typing on a computer contributes to the development of carpal tunnel syndrome. However, the incidence among such people is lower than among those who are engaged in hard physical labor. As statistics show, people who work at a computer develop carpal tunnel syndrome no more often than in 3.5% of cases. A similar incidence rate is observed among people in ordinary occupations.
The following factors may increase the likelihood of developing carpal tunnel syndrome: using a flat, high-sensitivity keyboard, prolonged use of the mouse, playing with joysticks, and fast typing.
Doctors point out that the longer a person plays computer games, the higher the likelihood of developing tunnel syndrome. The fact is that during the game people take breaks less often, and rest for their hands is extremely necessary.
To reduce the likelihood of developing the disease, you need to use an ergonomic keyboard. Despite its high cost, it keeps your hands healthy.
Diagnosing carpal tunnel syndrome boils down to the following steps:
- Taking anamnesis.
- Examination, which includes an assessment of the sensitivity of the fingers, muscle strength. The last study is carried out using a wrist dynamometer.
- Pressure on the median nerve to clarify patient complaints. In carpal tunnel syndrome, the person will indicate increased soreness.
- X-rays are given if the suspected cause of the disorder is a fracture or other bone injury.
Electromyography, which evaluates the nerve impulses that are conducted to the muscles and cause them to contract. Electrodes are inserted into the area under study to assess muscle activity during movement and at rest. The study allows you to identify tunnel syndrome if it develops due to muscle damage.
- Nerve conduction analysis. An electrical discharge is applied to the median nerve, and then the speed of its conduction along the median canal is assessed. If the impulse passes slowly, then this indicates a developing disease.
Treatment for carpal tunnel syndrome
Do not delay the start of treatment. You need to consult a doctor immediately after the first symptoms of the disease appear. Sometimes it is enough to simply normalize the load on the fingers to eliminate the symptoms of the disorder. Such people are advised to take frequent breaks from work, to stop overloading their brushes.
If it is not possible to cope with the pain, the doctor will prescribe treatment for the person. It can be reduced to wearing a splint, to taking medications, to surgery. As a rule, the prognosis is most favorable when a person suffers from pathology for less than 10 months.
If a person sought medical help on time, then it will be possible to cope with the disease without surgery.
Medicines used for tunnel syndrome:
NSAIDs: Ibuprofen, Nimesulide, Nise, Nimez, Analgin, etc. Taking these drugs can reduce the intensity of inflammation and relieve pain. However, there is no evidence that drugs from the NSAID group contribute to recovery.
Corticosteroids. Hormones can be injected directly into the median canal to quickly relieve inflammation and swelling. Inside, these drugs are not taken for carpal tunnel syndrome.
Vitamin B6 can help some patients cope with carpal tunnel syndrome, which helps the body remove water faster, reduce swelling and inflammation.
The elimination of the symptoms of the disease does not mean that the person has recovered. Therefore, in addition to taking NSAIDs, patients are advised to wear a splint. It is important to use it not only during the day, but also at night. This allows you to eliminate the pathological symptoms of the disease. The splint can be used by pregnant and lactating women.
If drug therapy does not allow coping with the disease, then the patient is referred for surgery. Its purpose is excision of the ligament that pinches the nerve.
The operation can take place in 2 ways:
- Using endoscopic equipment. To dissect the ligament, use a special device equipped with a video camera. It is injected into the median canal, after making a small incision on the skin. This operation is a low-traumatic one; after it, no scars or scars remain on the skin. The procedure itself is characterized by minimal pain and a quick recovery period.
- Open type operation. In this case, the doctor makes a longitudinal incision in the palm, then excises the ligament that puts pressure on the median nerve. The rehabilitation period will not be as short as with endoscopic surgery. However, the doctor gets the opportunity to dissect the ligament throughout its entire area, which is an advantage of open surgery.
Possible complications that can develop after surgery include: infection in a wound, scar formation on the skin, nerve damage, and vascular damage. Endoscopic surgery is associated with a lower risk of complications, but the effect of both procedures is almost equal.
Dissection of the ligament located in the carpal tunnel is one of the most common and easy procedures. However, the likelihood of recurrence of tunnel syndrome symptoms remains high. It occurs in about 57% of patients, 3 years after the intervention. In this case, relapses most often occur in people who have undergone an intervention using endoscopic equipment.
After the stitches are placed, the ligament begins to grow together. However, the space of the median canal increases, so there will be no more pressure on the nerve.
Within 24 hours after the procedure, a person will be able to move their fingers. It will be possible to lift and hold objects no earlier than 1.5 months after the intervention.
Full restoration of hand function occurs in about six months. A person begins to control hand movements well, can return to work.
After 1.5 months after the procedure, the patient is shown physiotherapy. He is also recommended massage, therapeutic exercises, stretching.
At home, you need to follow the following guidelines:
- You need to take breaks from work. Resting your hands is important.
- From time to time, you should do gymnastics for the arms, knead the hands and palms, rotate the limbs in different directions.
- To reduce pain, you can take drugs from the NSAID group, such as Ibuprofen or Naproxen.
- A splint should be worn on your hand during a night's rest, it should not be too tight or too weak.
- You should not put your hands under your head while sleeping, as this increases the pressure on the nerve.
- If you cannot cope with the pathological symptoms, then you need to consult a doctor.
Video: Doctor-neurologist M. M. Sperling (Novosibirsk) on his medical video channel "Doctor Sperling", in a lecture "carpal tunnel syndrome" talks about what this syndrome is and how to treat pain in this syndrome:
Sometimes alternative methods help to enhance the effect of conservative treatment and minimize the risk of developing carpal tunnel syndrome, including:
Yoga classes, which allow you to work out all the joints and ligaments, increase muscle strength.
Manual therapy. Some methods of manual therapy can have a positive effect in the treatment of patients with tunnel syndrome.
Ultrasound therapy. Thanks to this treatment, the body temperature rises at the local level, this helps to reduce pain and speed up the restoration of damaged tissues. A course of treatment lasting 14 days can significantly reduce the symptoms of the disease.
Preventive measures that are aimed at preventing the development of carpal tunnel syndrome:
Controlling the applied force. Do not press the keys too hard unless the keyboard requires it. The softer the movements, the lower the likelihood of developing the disease.
Regular rest. Hands need breaks. During such pauses, you can do exercises, do stretching.
Control of movements. Do not bend or straighten your hands too much. The longer they are relaxed, the better.
Posture control. If a person sits and stands with an even straight back, does not bend the spine, then the nerves are not pinched, which means that their conduction does not suffer.
Temperature control. In order to prevent hypothermia of the hand, you need to dress for the weather, wear mittens or gloves.
To date, scientists are looking for effective methods that would prevent the development of tunnel syndrome in humans, for example:
- The University of Washington is studying a method of treating tunnel syndrome using magnetic resonance waves. It is given to patients with mild to moderate disease.
- At the University of California at Los Angeles, they are studying protective bracelets that should be worn by all people who work with vibration equipment. This bracelet absorbs vibrations, but does not affect limb mobility.
It is possible that in the coming years there will be fewer people suffering from carpal tunnel syndrome.
Author of the article: Kaplan Alexander Sergeevich | Orthopedist
Education: diploma in the specialty "General Medicine" received in 2009 at the Medical Academy. I. M. Sechenov. In 2012 completed postgraduate studies in Traumatology and Orthopedics at the City Clinical Hospital named after Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.