Wrist canal syndrome (Carpal Tunnel syndrome)
How does nerve compression develop in the wrist?
What are the causes of nerve compression?
What are complaints?
Inspection and examinations
How is the treatment done?
How does nerve compression develop in the wrist?
If you suffer from complaints such as numbness in the fingers, pain, spasm in the middle of the hand, numbness by waking up at night and trying to eliminate matting, you have started to read the right place.
It is a tunnel problem called carpal tunnel syndrome. It is a disease that puts pressure on the median nerve and weakens the hand muscles and causes numbness in the hand.
The nerves that go to our hand like an electric cable pass through some tunnels to protect them from movement in the joints. There is a band-like ligament called the 'transverse (horizontal) carpal ligament' that forms the wall of this tunnel. If this ligament thickens and its flexibility decreases, it will start to put pressure on the nerve just below it. Or, swelling in the surrounding soft tissues that narrows this tunnel also increases the pressure on the nerve.
What are the causes of nerve compression?
• repetitive crafts: this syndrome occurs early in hand-intensive situations such as keyboard use, knitting, painting, graphics, ceramics.
• genetics: in some families the carpal tunnel size may be lower than normal. In such cases, the use of the hand in forced, repetitive jobs reveals this syndrome.
• systemic diseases: common in patients with hypothyroidism, diabetes, rheumatoid arthritis, vitamin deficiencies.
• Pregnancy: Swelling caused by hormonal changes can trigger carpal tunnel syndrome.
• Hand and wrist position: Prolonged work in excessive wrist positions can trigger this syndrome.
Complaints: 1.2.3 first. There will be slight numbness and temporary numbness in the fingers. These numbness increases gradually and weakness begins. Complaints may be prolonged from handing to dropping the plate. The chubby place (thenar atrophy) on the palm of the hand extending to the thumb gradually begins to wrinkle.
• Felting, tingling, burning sensations and pain in the thumb, index finger, middle and ring fingers
Sudden shocks such as electric shock to the thumb, martyrdom finger, middle finger
Pain and unpleasant sensations extending to the forearm and shoulder
• drop items from the hand
• waking up with numbness at night: since most people sleep with bent wrists, this position triggers the symptoms of karpla tunnel syndrome.
Examinations:
In the examination, the extent of numbness and loss of strength and the severity of muscle wasting, if any, are investigated.
Electrophysiological tests are performed
With nerve conduction tests, the speed at which messages pass through the nerve is measured; this gives us information about the gravity of the situation.
EMG (electromyography): measures the electrical activity in the muscles. We try to understand the extent of muscle loss.
With ultrasound, MRI and x-rays, we can see conditions such as tumors that may rarely occur in the carpal tunnel.
Treatment:
As a result of EMG and examination, we evaluate the nerve compression at 3 degrees:
Light, Medium, and Heavy.
• Medical treatment is applied to a mild nerve compression.
• Medium: it is the group that will benefit most from the surgery. The hand regains its former performance in operations performed without muscle loss.
• Severe: surgery is also necessary in this group, but the hand is not expected to regain its former performance as the muscles are now damaged; the situation is prevented from getting worse.
Medical Treatment:
• Night splint: When worn at night, it prevents bending of the ankle and prevents pressure on the nerve. It can also be used during the day when there are complaints. ATTENTION! Commercially available splints keep the wrist in a slightly bent upward position; This position may cause further stretching of the nerve and increased complaints. We need to remove the bendable support aluminum of the wristband, bend it and make it flat and keep the wrist in this position while sleeping.
• Medicines: Anti-inflammatory drugs such as ibuprofen can reduce edema.
• Activity limitation: it is helpful to restrict repetitive movements and the hand to stand and work in the same positions for a long time.
• Nerve shift exercises: Exercises that try to increase the movement rate of the median nerve in the carpal tunnel can relieve the compression in the early periods.
Steroid injections: Cortisone injections reduce the complaints in patients who are not able to have surgery or in some cases for a certain period of time because they are strong edema remover. usually the effects are not permanent.
Surgical treatment:
The transverse carpal ligament is loosened to relieve the increased pressure exerted on the nerve in the carpal tunnel. There are different techniques; but the goal is the same. Generally, the patient is discharged on the same day. It can also be performed under local anesthesia with adrenaline and anesthetic mixtures, and regional 'RIVA' anesthesia that allows the use of tourniquet to see the carpal tunnel more clearly bloodless or a short general anesthesia can be performed. The duration of the operation is approximately 25 minutes. It is not necessary to stay in the hospital. Keeping your hand up for 2 days after the operation ensures less edema. You can do light work after surgery. It is recommended that you do not carry containers that carry hot material until the force is restored. There is a low risk of bleeding, infection and damage to the nerve tissue in every surgery. Even though the wound is small, the transverse carpal ligament is a large ligament and sensitivity passes around the 3rd week. A mild tenderness in the palm of the hand can last for several months. Recovery is slow in the nerve tissue, if there is weakness before the operation, the pinch strength and grip strength are restored only between 6-12 months.