Carpal Tunnel Syndrome
The carpal tunnel is a small narrow tunnel located at the level of the wrist. Some carpal bones and the transverse carpal ligament delimit the tunnel. The median nerve travels from the forearm to the hand passing through this tunnel. This nerve controls the sensation of the palmar face of the first 3 fingers and the muscles of the base of the thumb. The tendons of the flexors of the fingers also pass through this tunnel. When the tissues around the tendons of the flexors become irritated and swollen, this can cause pressure on the median nerve, causing carpal tunnel syndrome. The median nerve may also be irritated or compressed by certain muscles as it passes through the arm, particularly in the pronator round muscle.
Presentation of carpal tunnel
- Numbness, tingling and pain in the hand (median nerve area).
- Sensation of electric shock in the first 3 fingers (from the thumb).
- Strange sensation can irradiate into the arm and shoulder.
- Symptoms are very common at night.
- The carpal tunnel can be anatomically smaller inherited.
- Over-use of the hand and forearm causing adhesions in the soft tissues (muscles, ligaments) compressing the median nerve.
- Hormonal changes (eg pregnancy)
- Some medical conditions, such as diabetes, rheumatoide arthritis and certain thyroid disorders.
- Following diagnosis, changes in activities associated with the condition.
- Treatment of Active Release Techniques (ART) or Graston to break the adhesions at structures that can compress the median nerve.
- Treatment of neurocryotherapy to decrease inflammation and edema at the level of the carpal tunnel.
- Stretching and rehabilitation exercises.
- Use of a night orthosis to keep the wrist in neutral position.
- Use of NSAIDs (anti-inflammatory) as needed and injection of cortisone.
- Decompression surgery may be necessary in some cases refractory to conservative treatment.
- In many cases, the conservative approach will provide a cure for the condition in a few weeks or months.
- In severe cases, even following surgery, symptoms may reappear and a second surgery may be necessary.