What is carpal tunnel syndrome?
The carpal tunnel is a narrow, rigid passage made up of the ligament and bones at the base of the hand, just before the wrist. Inside it passes the median nerve and tendons. Sometimes, the enlargement of the tendons or other conditions that create swelling narrow the tunnel and cause the median nerve to be compressed. The consequence is pain and a feeling of weakness or numbness in the hand and wrist, which expand towards the arm. Although pain may indicate other pathologies, carpal tunnel syndrome is the best known and most famous of the neuropathies, i.e. pathologies in which the peripheral nerves of the human body are compressed or suffer trauma.
Symptoms usually manifest gradually, with frequent burning, tingling or feeling of numbness mixed with itching in the palm of the hand and fingers, especially in the thumb, index and middle fingers. This happens especially at night.
When the symptoms worsen, you may feel an annoying tingling during the day, the pain then also extends to the forearm and there is a loss of sensation in the fingers and a loss of strength in the hand, making even the lightest daily actions, almost impossible to carry out.
Compression and / or irritation of the median nerve within the carpal tunnel leading to Carpal Tunnel Syndrome (CTS) can have different causes and each of them must be meticulously studied by professionals before proceeding with the treatment. Some of them are:
- Inflammation of the tendons and tendon sheaths of the flexor muscles (tenosynovitis); this is often due to excessive use of the hand in repetitive manual labor activities, such as in the case of pianists, computer workers, workers using pneumatic hammers or other instruments with vibrations on the palm, etc .;
- thickening of the transverse carpal ligament;
- systemic pathologies affecting peripheral nerves or formation of peripheral edema: diabetes mellitus, kidney failure and fluid retention in body tissues, hypothyroidism;
- wrist or carpal fractures, with residual osteoarticular deformity and not fully healed;
- hereditary predisposition to the syndrome;
- hormonal factors (women are especially at risk of CTS, particularly if pregnant or of perimenopausal age, probably due to an increased progesterone / estrogen ratio which affects water retention).
The treatment of carpal tunnel syndrome varies according to the severity and duration of the symptoms: in fact, when the symptoms are moderate, bearable and present for a few months, the therapeutic approach to the condition is conservative (conservative therapy); vice versa, when the manifestations are intense and such as to negatively affect daily life for more than 6-10 months, the therapy classically indicated by doctors is surgical.
Conservative therapy is indicated when the symptoms of carpal tunnel syndrome are mild, bearable and have been in existence for a few months.
If appropriate and timely, this therapeutic approach can be of enormous benefit to the patient.
Conservative treatments for carpal tunnel syndrome include:
- The use of a wrist brace. The use of this brace is provided especially at night, to prevent the wrist from assuming positions that worsen the pain, tingling and numbness.
- Rest of the wrist joint. Avoiding all those activities that evoke pain at the wrist joint is, especially at the beginning of therapy, essential for improving the general symptom picture. The resumption of the various interrupted activities must take place gradually.
- Applying ice to the wrist. Ice has an important anti-inflammatory effect, which many underestimate.
- Physiotherapy and therapeutic exercise. There are some stretching and mobility exercises of the wrist that help to alleviate the tension in the tendons passing through the carpal tunnel
- Taking a non-steroidal anti-inflammatory drug (NSAID). NSAIDs are medicines that help relieve pain and inflammation.
- Local injection of a corticosteroid. Corticosteroids are powerful anti-inflammatory drugs. Injecting them into the wrist can drastically relieve pain; however, like NSAIDs, their effects are temporary.
Surgical therapy is indicated when the symptoms of carpal tunnel syndrome are intense, unbearable and present for more than 6-10 months; this therapeutic approach, moreover, is also used when conservative treatment has proved completely ineffective.
Surgery for carpal tunnel syndrome is outpatient and essentially involves the decompression of the suffering median nerve through an enlargement of the carpal tunnel.
There are two surgical techniques that allow to perform the aforementioned intervention: the classic surgical technique (or “open surgery”) and the arthroscopic technique (or arthroscopy); the first option involves an incision of several centimeters at the level of the wrist, while the second option is limited to small incisions whose purpose is to allow the insertion of a camera and the surgical instruments necessary for decompression.
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