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Carpal Tunnel Syndrome

The median nerve is one of the main nerves that control the movements of our hands. This nerve enters the hand through a narrow tunnel in the wrist called the carpal tunnel. The tunnel is formed by small wrist bones, carpal bones, on the sides and the base. Strong ligaments, called carpal ligaments, make up the roof of the tunnel. These rigid structures limit the stretchability of the tunnel. The tunnel space is further reduced by the tendons it accommodates, called the flexor tendons.

Carpal Tunnel Syndrome

Dr Vijay Kumar Sohanlal, a senior specialist in joint replacement and orthopaedics at MGM healthcare and Mahi Clinic – Chennai, explained the details of the syndrome. He said that due to an underlying medical reason the space within the carpal tunnel gets reduced and the median nerve gets compressed. This results in anomalies along the path of the nerve.

Patients often experience numbness, tingling and pain in the thumb and fingers (except the little finger, which is not served by the nerve). The tingling sensation may extend to their arm. In severe cases, they may feel weakness in the hand making it difficult to hold things.       

Risk Factors

Several factors may lead to the condition. Mostly those working in environments involving repetitive use of hand and wrist are at a higher risk. Other factors that may impact the development of the condition are heredity, pregnancy, or other medical conditions like diabetes, arthritis, hypothyroidism.

Dislocation of the wrist or fracture may also reduce the space inside the carpal tunnel and lead to the condition. Women are more prone to the condition than men.

Diagnosis

If you have the symptoms mentioned above, you must visit an orthopaedic specialist and get yourself diagnosed. The doctor will do a physical examination of your hand to analyze the condition. They may perform the Tinsel sign test wherein the doctor taps on the nerve in the affected wrist. A tingling sensation confirms the condition.

The test is not definitive and the orthopaedic specialist may do a Phalen test and imaging tests like X-ray, MRI or an ultrasound. They may also perform an Electromyography – a test to measure the electrical activity in the median nerve.

Treatment

Carpal tunnel syndrome can be treated either surgically or non-surgically. If the condition is not severe, non-surgical treatment may be helpful. The specialist may recommend a splint to keep the wrist straight and reduce the pressure on the median nerve. Anti-inflammatory medicine is also given to control the pain and swelling. Sometimes cortisone injections may be necessary to control pain and inflammation. You may also be advised to make some changes in your lifestyle if you are into activities that may worsen the condition.

The above treatment may not be effective in severe cases. If your pain and numbness don’t subside, your doctor may recommend surgical treatment to prevent further damage.  Carpal tunnel release makes more space in the canal and releases the pressure on the median nerve. Usually, this is an outpatient operation that involves cutting the carpal ligament to create more space for the median nerve. Dr Vijay mentioned that the surgery can be performed in one of the two ways – open carpal tunnel release or endoscopic carpal tunnel release, but their purpose is the same.

Recovery

You will be under observation for some time after the operation and then discharged from the hospital on the same day. Your wrist stays bandaged or splinted for a couple of weeks. After that period, your physical therapy starts. The therapist will recommend certain exercises that will strengthen your wrist and heal it faster. Full recovery may take a couple of weeks to a couple of months.

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