Carpal tunnel syndrome is one of the most common diseases of the wrist area. It consists in compression of the median nerve in the region of the so-called carpal tunnel. In a broad sense, carpal tunnel syndrome occurs if the condition for reducing its size or increasing the volume of tissues inside it is observed.
Carpal tunnel syndrome occurs under any conditions leading to a decrease in its size or an increase in the tissues inside it, which leads to compression of the median nerve. Causes of carpal tunnel syndrome include:
- Injury to the wrist area, which leads to swelling of the tissues in it, the occurrence of hematomas.
- A fracture of the bones in the wrist area is most often a fracture of the radius.
- Arthritis of the wrist joint.
- Tumors in the carpal canal.
- Inflammation in the area of the synovial sheaths of the tendons of the flexor muscles.
- Pregnancy, with all this, there is a tendency to swelling of soft tissues.
- Diabetes mellitus, which is manifested by pathology of peripheral nerves – neuropathy.
- Decreased thyroid function.
With compression of the median nerve, there is a violation of the blood supply to its outer shell and even a complete cessation of blood circulation in it. There is ischemia. In the beginning, only the superficial parts of the nerve are affected. But with prolonged ischemia, the lesion also affects the deep layers of the nervous tissue. As a result, scar tissue forms in the nerve. This causes pain and numbness in the fingers.
Manifestations of carpal tunnel syndrome are traditionally bright. This is accompanied by intermittent or constant numbness in the fingers (and palms), tingling and pain, which are noticeably worse at night. Patients wake up more than once at night due to pain, they are forced to move and knead stiff and “stiff” fingers, and lower their hands down.
In the morning, there is an increase in these symptoms. During the day, patients experience gradual relief, but even after short overloads, deterioration begins again. Over time, the discomfort gets worse. Sometimes the pain can radiate up to the shoulder. Numbness first captures one or two fingers, then spreads to all the others, sometimes including the little finger. When raising the arm up, the pain intensifies, which is associated with a deterioration in blood flow.
On examination, you can notice some cyanosis and pasty swelling. When feeling in the palm area, pain is determined.
Diagnosis of carpal tunnel syndrome is mainly based on diagnostic tests. They consist in the artificial induction of ischemia of the median nerve and further evaluation of the manifestations.
A certain role in the diagnosis of this pathology can be played by radiography, in the case when this syndrome is a consequence of a fracture of the bones of the forearm. In addition, magnetic resonance imaging is performed.
In patients with a mild course of the disease, in whom symptoms have appeared recently or are expressed inconsistently, conservative therapy is successfully used, which consists in taking anti-inflammatory drugs and fixing the hand with a splint bandage for the night, which prevents its flexion. However, in many cases, the symptoms of the disease recur again. In this case, surgical treatment is indicated. Surgery is the method of choice (best known) for classic carpal tunnel syndrome. Usually, 80-90% of patients completely get rid of the symptoms of the disease after dissection of the transverse carpal ligament, which takes part in the formation of the carpal tunnel. In some cases, neurolysis is performed during the operation – excision of scarred and altered tissues within the nerve, as well as partial excision of the tendon sheaths.