The Carpal Tunnel is an area enclosed by the wrist bones and the Carpal ligament passing through the wrist. The tendons bending the fingers pass through this space, as well as the median nerve responsible for sensation in the thumb, the pointing finger, the index finger and half of the ring finger and allowing the thumb's circular movement.
What causes the Carpal Tunnel Syndrome?
The Carpal Tunnel Syndrome is caused by pressure on the median nerve. Pressure on the median nerve may be created by direct injury of the wrist or by the development of an inflammation causing swelling, an increased pressure within the Carpal Tunnel, stiffening and pressure on the median nerve and restriction of blood supply to it.
What characterizes the Carpal Tunnel Syndrome?
The Carpal Tunnel Syndrome's characteristics arte gradual and usually start with the feeling of paresthesia of the fingers at night. When the problem intensifies the paresthesia becomes chronic and followed by pain in the back of the hand, the arm and even the shoulder and reduces the strength of the finger and palm muscles, impairing the palm's functions.
Are the reasons for the Carpal Tunnel Syndrome?
Congenial narrowing of the Carpal Tunnel
Hormonal changes such as: menopause, Diabetes Mellitus, thyroid problems, pregnancy (usually due to edemas)
Rheumatic disease such as arthritis.
Trauma (injury) of the wrist
Movement of the hand at work – repeated movement, incorrect placement of the hand (holding the computer "mouse")
How is the syndrome diagnosed?
An orthopedic examination for the signs of muscle weakness and reduced sensation.
Tinel's Sign - where knocking on the carpal tunnel area is used to check the appearance of the Carpal Tunnel Syndrome.
Phalen's Test - in which the appearance of the characteristics is checked by bending the backs on the hands towards each other for half a minute.
Electric conductive test - EMG - providing an assessment for the injury's severity though the neural conduction of the median nerve.
Treating the Carpal Tunnel Syndrome
Conservative treatment -
When the cause for the syndrome comes from pregnancy, obesity or a thyroid issue, the cause is treated leading in most cases to the syndrome's disappearance. It is possible to combine this with strengthening and stretching exercises for the area.
Rest and support of the wrist by splint for the duration of the night.
Pharmacological treatment -
Ant-inflammatory medications and steroid injections.
Surgical treatment -
Surgical treatment is performed under local anesthesia for the purpose of reducing the internal pressure in the carpal tunnel, in two methods:
Open surgery, which involves a cut, several centimeters in length, of the Carpal ligament
Endoscopic surgery, micro-invasive, in which the Carpal ligament is cut by a miniature surgical instrument inserted into the carpal tunnel through a cut 1cm in length. Recovery time is shorter after the endoscopic surgery
CTS- Carpal Tunnel Syndrom
Dr. Alon Covo
