Pain, Numbness in Hands: Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is a picture that occurs as a result of compression of a nerve called “median nerve” at the wrist level. The patient may present with pain, numbness, tingling, and even loss of dexterity in the hand. Complaints may wake the patient, especially at night. In the daytime, it can cause unbearable pain during working hours.

First, let’s get to know this “median nerve”. The median nerve is a nerve that passes through our wrist region and provides skin sensation of the first 3 fingers of our hand and half of the 4th finger (ring finger). In addition, it provides nutrition to the muscles that perform many movements of the thumb, which has a very important role in hand functions. This nerve reaches the hand by passing through the wrist region between the beams going to the fingers. If it is under pressure in this region, if there is a disturbance in its conduction, the disease called Carpal Tunnel Syndrome develops.

Why is this nerve under pressure? The first thing that comes to mind is extreme use cases. Pressure changes in the area where the nerve passes in the up and down movements of the wrist cause the nerve to be under pressure. Those who have to use their wrists a lot and those who work in jobs that force the hands are at risk. It is especially common in computer workers, cooks, those who have to write constantly, and those who use their hands and wrists a lot, such as weaving and handwork.

Another important reason is hormonal reasons. The most striking example of this is pregnancy. Edema (water collection) in soft tissues due to hormonal reasons during pregnancy causes the nerve to be under pressure in the area where it passes. Apart from this, hormonal factors such as hypothyroidism (underactive goiter gland), menopause can also cause this disease.

In addition to hormonal factors, metabolic disorders can also cause conduction disorders in the median nerve. In diabetes, chronic kidney failure, some substances accumulated in the nerve sheath, and due to treatments such as chemotherapy, nerve conduction is impaired and Carpal Tunnel Syndrome may occur.

Fractures, dislocations and soft tissue injuries involving the wrist area are another factor. Sometimes, the formation of the fusion tissue towards the region where the nerve passes in the fracture healing, the misalignment of the bones in this region, and the increased scar tissue that develops during the soft tissue healing can cause the nerve to be compressed in the region where it passes.

In inflammatory rheumatic diseases involving the wrist (such as Rheumatoid Arthritis), swelling in the joints and beams in the wrist region can cause pressure on the nerve.

Although the causes are listed like this, it is common that no cause can be found, and this picture is called idiopathic (unknown cause) Carpal Tunnel Syndrome, and most of the tables fall into this group.

Carpal Tunnel Syndrome is detected in approximately 2% of the population, it is more common in women than in men, and 40-60 years are the most common ages. It is relatively more common in the dominant hand (left-handed people, right-handed people, etc.).

Edema increases with inactivity in the wrist canal and patients wake up with numbness in their hands, especially at night. Feeling relieved by waking up at night and shaking hands is a fairly typical symptom. Patients with pain radiating to the hand, forearm and even to the upper parts of the elbow can be seen. Incompetence can be seen in tasks such as buttoning, which require fine dexterity, which is a sign of advanced disease.

When making the diagnosis, maneuvers that increase the pressure in the area where the nerve passes from the wrist are performed and it is checked whether the symptoms occur. Neck, shoulder, elbow, wrist examination should be done carefully and other possible causes should be excluded. Neurological examination of the arm and hand should be done carefully and it should be determined whether there is weakness in the muscles fed by the nerve. Because if there is weakness in these muscles (partial paralysis), the patient should be operated immediately and the pressure in the area where the nerve passes should be reduced and the nerve should be released. Otherwise, the weakness may be permanent. Permanent weakness is important as it will cause serious impairment in the patient’s hand skills. Loss of sensation in the skin area fed by the nerve should also be evaluated well. Because the decrease in the sensation of the first 3 fingers may also cause loss of skill, the risk of injuring the hand increases because the patient does not feel well.

The most valuable diagnostic method is EMG (electroneuromyography). Patients with moderate and severe involvement in this examination should be carefully evaluated in terms of surgery. As we mentioned above, it is important to protect the patient from possible loss of dexterity in severe involvement and loss of muscle strength. If the patient does not need surgery, the treatment is started by resting the wrist. A device that stabilizes the wrist (wrist rest splint) should be used for at least 3 weeks. In half of these 3 weeks, the splint should be used both day and night, and only at night in the other half. In addition, treatment combinations consisting of physical therapy methods, local ozone or cortisone applications, neural therapy, acupuncture, electroacupuncture, median nerve stretching exercises, and beam shifting exercises also provide very good results.

In addition to all these treatment efforts, some precautions should be taken to prevent the median nerve and the region it is in from being under pressure in daily life. For example, computer workers or people who do fine work with their hands 3-5 minutes after 30 minutes of work. He should rest, make gentle circular movements on his wrist, and make exercises to open his hands into fists. Using ergonomic models of computer keyboards, supported mousepads can also be added to the working hardware. Using a wrist splint while working will prevent improper wrist movement. Those who work with hand tools should thicken the handles of the tools, work with different tools to change the holding and movement pattern.

Those with hormonal disease should ensure that their hormone levels are normal with careful follow-up.

I hope this information has helped you in controlling the disease if you have Carpal Tunnel Syndrome.

I wish you to stay healthy.

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