Sunday, June 7, 2020

Do You have Carpal Tunnel Syndrome..Lets Find Out - Diagnose at Your Home

Carpal tunnel syndrome surgery is the most common peripheral nerve surgery done in the United states. Annually about 3,50,000 carpal tunnel release performed here. Females are slightly more affected than the males and people more than 55-60 years are the most common group.

What is Carpal tunnel syndrome?

Carpal tunnel is formed by metacarpal bones and carpal ligament or flexor retinaculum. Through this tunnel median nerve passes along with other 8 tendons and 1 muscle.

As the name suggest there is a small tunnel under the carpal ligament in our wrist joint. About 10 structures pass through this small canal including eight tendons, one muscle and one nerve that is median nerve. Whenever the size of this Cana gets compromised either with ligamental hypertrophy, tumour, bone growth etc. the median nerve gets compressed and patient develops pain. This is the mechanism how CTS develops in simple words.

Let us check out the symptoms of carpal tunnel syndrome

The most common symptoms are pain and numbness in the hand. Pain is more in the thumb index and middle finger. This is due to the typical distribution of median nerve supplying the lateral three and a half fingers and thenar aspect of the hand. Carpal tunnel patients have typical increase in pain during night. This increase in pain is due to the venous stasis which happens during the sleep. When you get up a night with severe pain some sort of a relaxing exercise can be done like repeated slow flexion- extension movements of wrist and fingers. This activity increases blood flow and helps in soothing the pain.

In severe carpal tunnel syndrome patients also can have weakness of the hand muscles which is not evident in mild cases. As you develop motor weakness of the hand it is the time to undergo surgical intervention. How to find out whether you have developed motor weakness due to CTS? You will have difficulty in flexing the proximal interphalangeal joint of the index and middle finger. Also you have abduction difficulty of the thumb.

How to diagnose carpal tunnel syndrome by yourself?

There are few tests which can be done at home to get an idea whether you having CTS or not.

1.Tinel’s sign

Tinel's sign is used to diagnose peripheral nerve compressions. Just by tapping the nerve patient feels severe pain along the distribution of the nerve.

You just stop at the centre of the wrist joint at the lower end of the palm multiple times and see whether you are getting a shop like sensation spreading through the palm to the thumb, index and middle finger.

2.Durkan compression test

This test is used to diagnose median nerve compression in carpal tunnel syndrome. Patient experiences the symptoms on prolonged compression of the nerve.

In this test you just press the same region for about 30 seconds and see whether you are experiencing the similar symptoms or any worsening of the pain. In such case it is high you might be having CTS.

3. Phalen’s test

This is used for diagnosing CTS where patient will have pain and numbness along the median nerve distribution while flexing the wrists for a prolonged time.

This is the third test to diagnose CTS. This test you have to flex your wrist as much as possible for about 60 seconds and see for any symptoms.

Medical investigations to diagnose carpal tunnel syndrome

The first test your physician would be doing is a nerve conduction study. In the early stages it will show a delay in the sensory conduction. In severe cases motor conduction will also be affected.

Ultrasound imaging is done to find out any nerve thickening or inflammation. It will be useful in cases where nerve conduction study result is inconclusive.

In conditions where any abnormal bone growth is noted and x-ray or a CT scan may be needed. In case of any nerve tumours or other joint pathologies MRI scan also might be considered.

What are the treatment options for carpal tunnel syndrome

In early cases non-surgical treatment options can be tried. these include

1. Wrist splints
2. Ultrasound therapy
3. Steroid injections
4. Exercise
5. Lifestyle modifications

Wrist splint helps in keeping the wrist in neutral position and thus improves the blood circulation and prevent venous stasis. This reduces the pain in CTS.

Wrist splints are effective particularly in early stages of CTS. Many people asks the duration of wearing wrist splints. Studies have shown that when it is worn full time it is the best. But people notice it uncomfortable during routine jobs. In such cases brace can be worn during sleep. These splints help in keeping the wrist in neutral position and this will avoid any compressive stress to the nerve.
Locally injected steroids produces significant pain relief but it is often temporary. So in severe cases steroid injection followed by wrist splints can be an option. NSAIDs are anti-inflammatory medications which reduces the pain temporarily.
Ultrasound and laser therapy shows variable results. But there is no harm in trying as there are almost no side effects.
Exercise doesn't have much effect in reducing the symptoms of CTS

Surgical management

Surgery is considered  in the following conditions
  • failed conservative treatment
  • Progressive disease
  • Muscle weakness
  • Intolerable pain and patient not willing for conservative treatment

There are two types of surgeries.
1.     Open Surgey
2.     Endoscopic Surgery
Both open and endoscopic surgery have equal efficacy in alleviating the symptoms of carpal tunnel syndrome. It is the surgeon’s familiarity and patient’s choice that decides the best approach in each patient.

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