Carpal tunnel syndrome initially manifests as intermittent numbness and pain in the fingers. Then the ailments worsen and they do not let us sleep at night. If an orthopedic surgeon recommends wrist surgery, do not defend yourself against it, because it is the best way to treat carpal tunnel syndrome. Learn more about the symptoms, treatment, and rehabilitation for carpal tunnel syndrome.

What is carpal tunnel syndrome?

Carpal tunnel syndrome( ZCN ) is a disorder of the median nerve function following chronic compression. In over 90 percent. cases, there is idiopathic carpal tunnel syndrome, i.e. for an unknown reason.

Its development is favored by overloading the hand with repeated activities. It can be laying bricks, working with a conveyor belt in a factory, hitting a computer keyboard for many hours, but also homework, strenuous cycling or playing an instrument.

In the remaining few percent, the cause of illness may be, among others :

  • poorly healed wrist fractures or sprains,
  • degenerative changes,
  • hormonal disorders.

Women get sick three times more often than men. The complaints usually concern the dominant hand.

Symptoms of carpal tunnel syndrome: numbness and pain in the fingers

Carpal tunnel syndrome may be suspected if pain and numbness in the fingers (thumb, index, middle and ring fingers) awake you from sleep. This is rare in the beginning of the first stage of the disease. After that, the discomfort reappears many times over the course of the night, and the pain radiates to the forearm and even the shoulder.

In the second stage, numbness and pain also occur during the day, especially during exercise (e.g. driving a car or cycling). This is accompanied by a deterioration in manual dexterity in activities requiring precision, such as sewing, peeling vegetables, and applying makeup.

In the third stage of carpal tunnel syndrome, the earlier symptoms worsen and muscle atrophy occurs. To some people, however, it may seem that the disease is resolving, as the painful numbness of the fingers at night sometimes becomes less troublesome. Meanwhile, it is a signal of deepening degenerative changes in the median nerve.

See also: Exercises for the wrists will help eliminate pain

How does carpal tunnel syndrome develop?

The carpal tunnel is a tunnel bounded at the bottom and on the sides by bones, and at the top by the transverse ligament of the wrist. Inside there are quite tightly "stuffed" median nerve and tendons of the flexor muscles of the fingers.

In the most common idiopathic form of SCN it becomes too tight due to inflammatory changes - swelling and thickening of the sheaths covering the tendons and hypertrophy of the transverse ligament. The result is pressure on the nerve fibers (not so much the nerve is pinched as the arteries that nourish it). Due to ischemia, degenerative changes occur.

After the pressure has ceased, proper blood circulation is restored and the median nerve is regenerated.It is completely destroyed only in neglected cases, when the patient decides to undergo treatment too late.

Important

Why is repetitive movement bad?

It is believed that the constant movement of tendons in the carpal tunnel irritates the transverse ligament, causing it to overgrow. Repeated movement also irritates the tendons themselves, resulting in their thickening. As a result, the space in the canal is significantly reduced and the blood vessels in the canal and the nerve itself are compressed.

Diagnosis of carpal tunnel syndrome

An interview and clinical tests are generally sufficient. They consist in checking manual dexterity and feeling in the fingers. The patient will not be able to perform certain activities, discomfort will appear when the hand is in a certain position, e.g. with its maximum flexion in the wrist (Phalen's test).

She will also have sensory disturbances in her fingers. For example, touching two needles that are more than 5-7 mm apart will be interpreted by a he althy person as two pricks, and a sufferer with advanced CTS, even when the needles are 1-1.5 cm away, will feel one prick.

Occasionally, electromyography (EMG) is needed to test the speed of nerve conduction, and ultrasound to show deformation, thickening of the transverse ligament and tendons.

Carpal tunnel syndrome - conservative treatment

If the patient goes to the orthopedist in the early stages of the disease, non-surgical treatment may be enough. It consists in a short-term immobilization of the hand in an orthosis in order to eliminate swelling and inflammation of the tendons, taking non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy with the use of iontophoresis, ultrasounds or TENS currents.

Sometimes steroids are administered to the wrist canal to eliminate the conditioninflammatory, but also destroy tissues, in this case overgrown tendon sheaths.

Carpal tunnel surgery

When there is no improvement or the symptoms recur, the orthopedic surgeon will recommend a procedure consisting in increasing the space in the wrist canal by cutting the transverse ligament. It is true that it heals for up to 3 months, but it is prolonged and the pressure does not return.

The operation is performed using the open method or endoscopy. In the first case, the cut is made at the base of the hand. It can be quite long (2-4 cm) when there is a need to extend the procedure (e.g. to remove inflammatory granulation tissue), or short (1-1.5 cm), if only the ligament is cut.

In the latter case, the operation takes only a few minutes. Narcosis in both cases is unnecessary. Local anesthesia or anesthesia is used - the patient is put to sleep for a few minutes (intravenous injection).

It is better not to postpone the operation, because it may lead to irreversible damage to the median nerve and loss of feeling in the hand.

The operation performed with a less invasive endoscopic method (a mini camera connected to a knife is inserted through a small incision). Convalescence after this procedure is shorter because the incision is made on the underside of the wrist, which is associated with less tissue damage. The wound heals faster, the scar is less painful, and simple, light activities such as eating or dressing can be performed the day after the procedure.

Rehabilitation after cutting the ligament is not needed. The time it takes to return to work depends on the method and profession used. It ranges from 4 weeks for office work to over 2 months for heavy physical work. In fact, after a month, you can decide for yourself which activities are prohibited. If there is pain, you have to give it up for a while.

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Spine, bones, joints