Contents
Carpal tunnel syndrome (or tunnel syndrome) is a disease that is expressed by pain and deterioration in the sensitivity of the upper limb in the area of the hand and wrist. 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 canal itself is represented by a space in which, in addition to the median nerve, there are tendons responsible for the work of 9 fingers. Symptoms of carpal tunnel syndrome develop when the integrity of the canal is compromised. As a result of such changes, the nerve is compressed and the person experiences characteristic symptoms.
In America alone, billions of dollars are spent on the treatment of carpal tunnel syndrome.
Some facts about carpal tunnel syndrome:
Carpal tunnel syndrome is the most common condition that is associated with nerve compression in the hands. The operation performed to treat this syndrome is considered one of the most common interventions on the wrist. In America alone, 463 of these procedures are performed each year.
Sick leave for 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 of these positions are held by women. The reason for the violation is the same type of work with hands when scanning barcodes. Moreover, the movements are performed at high speed and repeated many times.
In people who work at a computer, carpal tunnel syndrome develops in 25% of cases.
In women, the disease develops 2 times more often than in men.
Symptoms of Carpal Tunnel Syndrome
The disease begins with the fact that a person begins to experience mild pain in the form of tingling. They are concentrated in the thumb, index and middle fingers. Also, these areas of the brush will become numb. Symptoms are transient, but as the disease progresses, they begin to occur more often, and then will be present on an ongoing basis. The intensity of the pain is increasing all the time. Painful are any movements of the forearm and hand.
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. Pain occurs not only during work, but also when a person performs normal movements: driving a car, reading a book, making phone calls. Often the pain occurs at night when a person is sleeping. This makes him wake up, shake his hand to relieve discomfort. Sometimes this helps, but the longer there is no professional approach to treatment, the more intense the numbness and pain will become.
Weakness of the hands. It also grows all the time. This leads to the fact that a person begins to drop things. The muscles that are responsible for the work of the thumb lose their function. Some patients indicate that they open their hand due to severe pain.
Tolerate such symptoms can not be, you need to consult a doctor. If treatment is absent, then damage to nerve fibers and muscles will be irreversible.
Causes of Carpal Tunnel Syndrome
The main cause of carpal tunnel syndrome is compression of the median nerve. It extends 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 work of 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 to develop. 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 carpal tunnel syndrome.
Sometimes the disorder develops in pregnant women and in overweight people.
Risk Factors
At risk are women over 50 years old, whose job responsibilities are related to the performance of the same type of hand movements. Such professions are: secretaries, collectors, accountants, etc.
Risk factors that increase the likelihood of developing carpal tunnel syndrome:
Incorrect fusion of bones after a fracture. As a result, the channel is deformed and puts pressure on the nerve.
Congenital anomalies in the structure of the carpal tunnel.
Belonging to the female gender. Experts attribute this fact to the fact that in women the carpal tunnel is narrower than in men. Therefore, any injury to the hand will lead to the development of appropriate symptoms.
Diseases of a chronic course that affect the nerve fibers: multiple sclerosis, diabetes mellitus, etc.
Inflammatory diseases affecting the tendons and joints. Carpal tunnel syndrome often develops in people with rheumatoid arthritis.
Fluid retention in the body, which can occur during childbearing or during menstruation. Due to the accumulation of excess water, the pressure inside the channel increases, which leads to irritation of the nerve. After pregnancy, carpal tunnel syndrome goes away on its own.
Diseases associated with damage to the thyroid gland, with damage to the kidneys. Carpal tunnel syndrome often develops in people who are overweight.
Features of work activity: work with vibrating parts, work on a conveyor, etc. Although today there is no direct evidence that the features of working conditions directly affect the development of carpal tunnel syndrome.
Studies show that in all patients diagnosed with carpal tunnel syndrome, the volume of the canal was much less than in healthy women.
Computer work
There is evidence that there is a relationship between prolonged computer use and carpal tunnel syndrome. If a person types at high speed, then on average per hour, he presses the keyboard 12 times. Under the condition of an 000-hour working day, he will perform 8 clicks. At the same time, the applied force to the keys is 96 g, that is, a load of up to 000 tons is placed on the fingers per day. If a person prints even faster, then this figure can reach 225 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 heavy physical labor. As statistics show, in people working at a computer, carpal tunnel syndrome develops no more often than in 3,5% of cases. A similar incidence can be traced among people of ordinary professions.
The following factors may increase the likelihood of developing carpal tunnel syndrome: use of a flat, highly responsive keyboard, prolonged use of the mouse, playing with joysticks, high typing speed.
Doctors point out that the longer a person plays computer games, the more likely he is to develop carpal tunnel syndrome. The fact is that during the game people take breaks less often, and resting their hands is extremely necessary.
To reduce the likelihood of developing a disease, you need to use an ergonomic keyboard. Despite its high cost, it allows you to keep your hands healthy.
Diagnostics
Diagnosis of carpal tunnel syndrome is reduced to the following steps:
History taking.
Inspection, which includes an assessment of the sensitivity of the fingers, muscle strength. The last study is carried out using a hand dynamometer.
Pressure on the median nerve with clarification of the patient’s complaints. With carpal tunnel syndrome, a person will indicate an increase in soreness.
X-rays are prescribed if the suspected cause of the disorder is a fracture or other bone injury.
Electromyography, which allows you to evaluate the nerve impulses conducted to the muscles and causing them to contract. Electrodes are inserted into the area under study, which assess muscle activity during movement and at rest. The study allows you to identify carpal tunnel syndrome if it develops due to muscle damage.
Nerve conduction analysis. An electric discharge is applied to the median nerve, and then the speed of its conduction through the median canal is estimated. If the impulse passes slowly, then this indicates a developing disease.
Treatment of carpal tunnel syndrome
You should not delay the start of treatment. You should consult a doctor immediately after the first symptoms of the disease appear. Sometimes it is enough just to normalize the load on the fingers to eliminate the symptoms of the disorder. Such people are recommended to take frequent breaks in work, stop overloading the brushes.
If it is not possible to cope with the pain, the doctor will prescribe a treatment for the person. It can be reduced to wearing a splint, to taking medication, to surgery. As a rule, the prognosis is as favorable as possible when a person suffers from pathology for less than 10 months.
What does the doctor prescribe?
If a person seeks medical help in time, then it will be possible to cope with the disease without surgical intervention.
Drugs that are used for carpal tunnel syndrome:
NSAIDs: helps to reduce the intensity of inflammation and relieve pain.
Corticosteroids. Hormonal drugs can be injected directly into the median canal, which allows you to quickly get rid of inflammation and swelling. Inside, these drugs for carpal tunnel syndrome are not taken.
Some patients can cope with carpal tunnel syndrome by taking vitamin B6, 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 tire can be used by pregnant and lactating women.
Operation
If drug therapy does not allow to cope with the disease, then the patient is referred for surgery. Its purpose is to excise the ligament that compresses the nerve.
The operation can take place in 2 ways:
using endoscopic equipment. To cut the ligament, a special device equipped with a video camera is used. It is inserted into the median canal, after making a small incision on the skin. This operation is low-traumatic, after which no scars or scars remain on the skin. The procedure itself is characterized by minimal pain and a quick recovery period.
open operation. In this case, the doctor makes a longitudinal incision in the palm of your hand, then cuts out the ligament that puts pressure on the median nerve. The rehabilitation period will not be as short as with endoscopic intervention. However, the doctor gets the opportunity to dissect the ligament throughout its entire area, which is a plus of an open type operation.
Possible complications that may develop after surgery include: infection in the wound, scar formation on the skin, nerve damage, vascular damage. Endoscopic surgery is associated with a lower risk of complications, but the effect of both procedures is almost equivalent.
Dissection of the ligament located in the carpal tunnel is one of the most common and easy operations. However, the likelihood of recurrence of symptoms of carpal tunnel remains high. It occurs in approximately 57% of patients, 3 years after the intervention. At the same time, relapses most often occur in people who have undergone an intervention using endoscopic equipment.
Rehabilitation
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 his fingers. It will be possible to lift and hold objects no earlier than 1,5 months after the intervention.
A full restoration of the function of the hand occurs in about six months. A person begins to control hand movements well, can return to work.
1,5 months after the procedure, the patient is shown physiotherapy. He is also recommended massage, therapeutic exercises, stretching.
What can you do at home?
At home, you need to follow the following recommendations:
You need to take breaks at work. It is important to give your hands a rest.
From time to time, you should do gymnastics for the hands, knead the hands and palms, rotate the limbs in different directions.
To reduce pain, you can take drugs from the NSAID group.
During the night’s rest, a splint should be put on the arm, it should not be too tight or too weak.
Do not put your hands under your head during sleep, as this increases pressure on the nerve.
If you can not cope with the pathological symptoms, then you need to consult a doctor.
Video: Neurologist M.M. Shperling (Novosibirsk) on his medical video channel “Doctor Shperling”, in the lecture “carpal tunnel syndrome” talks about what kind of syndrome it is and how to treat pain in this syndrome: