Causes and risk factors
Most of the cases of carpel tunnel syndrome is due to some unknown causes. The carpel tunnel provides a passage way for various tendons, thickening or other swelling of these tendons can lead to narrowing of the space thus compressing the median nerve. Any trauma, fall blow or injury which causes fracture of the wrist bones can also evoke compression or damage to the median nerve. Various endocrine disorders and musculoskeletal diseases also lead to carpel tunnel syndrome. The common ones are Rheumatoid arthritis, osteoarthritis, Acromegaly, Myxoedema etc.
Clinical presentation:
Complaints come up gradually. Unilateral or bilateral affection can be seen. Pain , weakness of hands are the characteristic features. The patient comes up with complaints of tingling, numbness or discomfort in the thumb, index and middle fingers. Patient experiences difficulty in carrying out fine movement. In carpel tunnel syndrome the complaints are aggravated at night, as most of the people sleep with wrist flexed which evokes pain. In cases where initiation of treatment is neglected it results in wasting of the muscles at the base of the thumb. The patient’s experiences loss of sensation of heat and cold in the affected area.
Investigations:
Diagnosis is done of the basis of the symptoms narrated by the patient and the physical examination is carried out by the orthopedic doctor. Certain specific physical test (Tinel test, the phalen test) which evokes symptoms of carpel tunnel syndrome are carried out by the doctor. Electro diagnostic tests are also carried out for confirming the diagnosis. Nerve conduction study and electromyography is done. Ultrasound imaging reveals impaired median nerve echo’s. Routine blood test, ray, specialized blood profiles can help to reveal the underlying causes.MRI can also be done.
Treatment:
Rest, application of ice packs for swelling are the important measures to be adopted.Strenous activities which will worsen the complaints should be avoided. The wrist joint must be supported by splint. Pain relieving medicines are advised to allay the pain.Corticosteoird injections are given. Vitamin B6 supplements have found to be effective in carpel tunnel syndrome. In spite of conservative method the symptoms lasts for 6 months then surgical intervention is required. Open release surgery or endoscopic surgery can be done. A gradual rehabilitation by physiotherapy is further advised which will help to improve the range and mobility of the joint and strengthen the muscles. Certain preventive measures which needs to be adopted are taking frequent breaks,
Use correct postures, use gloves which will keep the hand warm and flexible. . Certain yoga exercises can also be helpful in relieving the pain and strengthening the muscles after recovery.
Other modes of treatment:
Acupuncture which is the science of insertion of fine needles on the certain stimulating spots on the body has proved to be effective in managing the pain of carpel tunnel syndrome.
Recent update:
Various researches by The National Institute of Neurological Disorders and Stroke (NINDS), a part of the National Institutes of Health are going on for studying the biomechanical stresses and the factors which give rise to long standing neuropathies which will help for better understanding of the diseases and to adopt better treatment plans.
