Carpal tunnel syndrome

Content

Introduction

There carpal tunnel syndrome it is a peripheral neuropathy that can generate tingling, numbness and pain in the hand and arm; it is due to the compression of the median nerve that runs along the arm and reaches the fingers passing through a narrow canal (the carpal tunnel) present at the wrist. The anatomy of the wrist, health problems and repetitive hand movements they can contribute to the onset of carpal tunnel syndrome. As it worsens over time in most cases, it is important to diagnose (diagnose) and treat it as soon as possible.

Symptoms

The disorders (symptoms) caused by carpal tunnel syndrome usually occur gradually and intermittently; if you sleep with your wrist bent, they can get worse at night. The most common ailments include:

  • tingling and numbness in the fingers of the but no, mainly the thumb, index finger, middle finger and ring finger are affected. The disorder may also be associated with pain; sometimes, you may feel an electric shock in your fingers. a prolonged time, for example the steering wheel of the car, the telephone or the newspaper; pain and tingling may spread down the arm towards the shoulder
  • weakness and numbness of the hand, weakness of the thumb flexor muscle controlled by the median nerve; a weaker grip and reduced finger sensitivity can cause objects to fall

In the initial stages, the ailments can be alleviated with simple measures such as wearing a brace (wrist brace) or avoiding certain movements. However, continued pressure on the median nerve can damage the nerve and worsen the disorders.

In some cases, surgery is required in order to prevent permanent nerve damage.

Causes

Any stimulus that compresses or irritates the median nerve in the carpal tunnel space can cause carpal tunnel syndrome.

The wrist fracture can narrow the carpal tunnel and irritate the nerve, as can the swelling and inflammation that can arise in people with rheumatoid arthritis. In most cases, there is no single cause.

The risk factors associated with carpal tunnel syndrome are different:

  • anatomical factors, fracture or dislocation of the wrist, or arthritis that deforms the small bones of the wrist, can alter the space within the carpal tunnel and compress the median nerve. People with a smaller carpal tunnel are more likely to develop this disorder. Carpal tunnel syndrome is more common in women, possibly because the carpal tunnel is smaller in women than in men
  • diseases that damage the nervesSome chronic diseases, such as diabetes, increase the risk of nerve damage, including the median nerve
  • inflammatory diseases, diseases characterized by inflammation, such as rheumatoid arthritis, can alter the lining of the wrist tendons and compress the median nerve
  • changes in body fluids, fluid retention can increase the pressure within the carpal tunnel, causing irritation of the median nerve. This is common during pregnancy. Carpal tunnel syndrome associated with pregnancy generally disappears at the end of pregnancy.
  • other medical conditions, some conditions, such as menopause, obesity, thyroid disease and kidney failure can increase the likelihood of developing carpal tunnel syndrome

It is possible that working with instruments that vibrate or require prolonged or repetitive flexion of the wrist will generate harmful pressure on the median nerve or worsen pre-existing nerve damage. However, the scientific evidence regarding this is conflicting and these factors have not been identified as direct causes of carpal tunnel syndrome.

Diagnosis

Your doctor can ascertain (diagnose) carpal tunnel syndrome based on reported complaints (symptoms), any pre-existing medical conditions, and by examining the hands, arms, shoulders and neck. He may also order further investigations such as:

  • x-ray of the hands, to rule out other causes of hand pain, such as osteoarthritis or fractures
  • electromyography, an examination that involves inserting a small needle into specific muscles of the hand to measure their electrical activity when they contract and relax. This test can identify muscle damage caused by compression of the median nerve and rule out other diseases
  • laboratory analysis, to investigate associated diseases

Treatment and therapy

Carpal tunnel syndrome can be treated as soon as symptoms appear in various ways:

  • applying a wrist brace at night, in order to stabilize it and prevent the nerve from undergoing pressure
  • avoiding or reducing any activity that engages the wrist, with bends or tight grips
  • taking anti-inflammatory drugs, useful in the short term to reduce inflammation and pain
  • practicing specific hand exercises, stretching (lengthening) or strengthening, to try to relieve ailments

It is good to seek medical attention if the complaints worsen or persist.If wearing a wrist brace has not worked, your doctor may prescribe an injection of corticosteroids (cortisone) directly into the wrist to reduce swelling around the nerve. If the disturbances are intense and come to severely limit daily activities, the family doctor may prescribe a specialist visit to evaluate the possibility of a surgical intervention which, by releasing the median nerve from compression, usually resolves the problem definitively.

Bibliography

Mayo Clinic. Carpal tunnel syndrome (English)

Orthoinfo. Carpal tunnel syndrome (English)

NHS. Carpal tunnel Syndrome (English)

National Institutes of Health (NIH), National Institute of Neurological Disorders and Stroke. Carpal Tunnel Syndrome Fact Sheet (English)

In-depth link

Italian Association of Peripheral Neuropathies (AINP) Onlus

National Association of People with Rheumatological and Rare Diseases (APMAR). Carpal tunnel syndrome

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