Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is a disease that develops due to the compression of the nerve as a result of increased pressure for various reasons in the space where the tendons (beam) and nerve (median nerve) are located in the wrist region. As a result of the nerve being under pressure, nerve conduction is impaired and numbness and sometimes muscle weakness occur in the first 3 fingers, which are the areas fed by the nerve. It is the most common cause of neuropathy involving the hand and arm.

Causes of Carpal Tunnel Syndrome

  1. Structurally narrow wrist canal

  2. Excess weight (obesity)

  3. Diabetes

  4. Hormonal diseases (thyroid dysfunctions)

  5. Presence of disease causing involvement of nerves (neuropathies)

  6. Vascular abnormalities

  7. Fractures and dislocations in the wrist area

  8. Rheumatoid Arthritis

  9. gouty arthritis

  10. Pregnancy (due to hormonal changes)

  11. Kidney failure

  12. Nerve sheath tumors or infections, old nerve cuts, or thickening of the nerve sheath of unknown cause

  13. Occupationally excessive use of the hand and wrist (such as housewife, carpenter, butcher, chauffeur, farming, gardening)

  14. Sports challenges (such as tennis, golf)

Carpal Tunnel Syndrome is more common in women than men. It is the most common age range, especially between the ages of 30-60.

Symptoms of Carpal Tunnel Syndrome

Carpal tunnel syndrome occurs with pain, burning, tingling and numbness or combinations of these complaints that may radiate to the elbow, arm, and even the shoulder and neck. Numbness and tingling are usually in the thumb, index finger, middle finger and ring finger. Symptoms usually occur at night; During daily activities such as driving a car, reading the newspaper and talking on the phone, symptoms may increase and affect a person’s quality of life.

In very severe cases, permanent loss of sensation may develop and muscle wasting at the base of the thumb may occur. In such cases, the movements of the thumb may be impaired, the grip may become weak and there may be difficulties in their fine grip; In the future, symptoms such as dropping small objects from their hands may be added to the complaints of patients who are not treated.

Diagnosis in Carpal Tunnel Syndrome

The patient’s history of increasing numbness and tingling in the first three fingers of his hand at night causes the suspicion of Carpal Tunnel Syndrome. In this case, the above-mentioned reasons that may cause compression of the nerve should be questioned one by one. Because in the presence of a disease that causes Carpal Tunnel Syndrome, it may be necessary to seek help from the branches that require careful inclusion of the primary disease in the treatment. The patient should also be asked if he or she has pain radiating from the neck and neck.

In the examination, maneuvers to increase the pressure in the area that caused the compression in the wrist are performed and it is evaluated whether the symptoms reappear. Careful evaluation of muscle strength is essential. Neck and neck shoulder girdle examination should be done together, and signs of a compression in the neck region should be sought in the nerves coming out of the neck. Because if the nerve is pinched both in the neck and in the wrist, treatments only to the wrist will not give satisfactory results.

Electromyography (EMG) is the most commonly used auxiliary diagnostic method in Carpal Tunnel Syndrome. In EMG, both the conduction ability and speed of the nerve and the adequacy of the muscles it feeds are determined and it is revealed whether the pressure is mild, moderate or severe. This examination also gives information about the presence of nerve compression in the neck.

In order to determine whether there is a bony structure narrowing the canal in the wrist region, soft tissues can be evaluated with direct radiographs, MR examination, and ultrasonography.

Treatments in Carpal Tunnel Syndrome

  1. Medicines: Painkillers/antirheumatic drugs, gels can be used to control pain, and antiepileptic drugs that regulate nerve conduction have recently come to the fore. Oral cortisone use is not recommended in Carpal Tunnel Syndrome.

  2. cortisone injection : Cortisone injections to the area under pressure at the wrist level will relieve the patient in a short time as it reduces edema. However, care should be taken to keep the wrist at rest for at least 3 days after cortisone application.

  3. Complementary Medicine Methods : Among these methods, very successful results can be obtained, especially with acupuncture and neural therapy. These 2 treatment methods, which do not have any side effects, are used intensively in our clinic.

Ozone therapy can provide very good contributions by increasing the antioxidant capacity of the body and regulating circulation, especially in patients with other systemic diseases (diabetes, neuropathy, vascular diseases).

  1. Exercise:In addition to the “median nerve mobilization exercises” that stretch and move the median nerve, which causes the symptoms by being compressed at the wrist level, gliding exercises to be performed on the surrounding tendons (beams) will rapidly decrease the edema in the compartment at the wrist level in Carpal Tunnel Syndrome, thereby reducing the pressure.

  2. Wrist Rest Splint : It is one of the most basic treatments in Carpal Tunnel Syndrome. It is based on the principle of reducing the pressure by immobilizing the pressure area in the wrist area. It is necessary to use the splint for 10 days day and night (as much as possible) for at least 20 days, the next 10 days only at night. It is also recommended to perform the above-mentioned exercises once a day during the use of the splint.

  3. Surgical treatment : If the patient has weakness in the thumb muscles on examination, and in the presence of severe Carpal Tunnel Syndrome in the EMG, surgical treatment is recommended for the patients. Surgery is a procedure that can be applied with open or closed methods.

Basic recommendations for prevention of Carpal Tunnel Syndrome

  1. If Carpal Tunnel Syndrome is secondary, that is, Carpal Tunnel Syndrome caused by another disease, attention should be paid to the treatment of the primary disease. For this reason, attention should be paid to keeping blood sugar properly especially in diabetes and regular follow-up in thyroid dysfunction.

  2. Wrists should not be kept bent for a long time while using a keyboard and mouse, specially designed keyboards or specially designed mouse pads with silicone backing can be used.

  3. When using the mouse, the wrist should not rest on the edge of the table, causing long-term pressure.

  4. The wrist should not be worked for long periods of time to keep the wrists in the same position. Every 45 minutes, the wrist should be rested for 5 minutes by making circular movements.

  5. Do not lift heavy loads frequently, which will tire the elbows or hands.

  6. Do not lift too much weight with the hands, activities such as handicrafts made by turning the wrist, using a screwdriver should be avoided.

  7. Regular sports should be done to keep the ligaments, joints and muscles strong, but if the hand and wrist are used in sports activities, stabilizing wristbands should be used.

  8. Being inactive for a long time can cause some structural changes and compress the nerves, so an active life should be adopted.

  9. Care should be taken not to gain weight, as the fat formed in the place where the canal passes can cause pressure on the nerves with calcification over time.

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