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All You Need to Know About Carpal Tunnel Syndrome

carpal tunnel syndrome

The human body contains a large number of different nerves that have their own functions. In the hands of a person, the main types of nerves are present: the median and ulnar. Any injury to the nerve can lead to impaired hand movement. In this article, we will describe in detail the functions of the median nerve.

The median nerve is one of the most important in the human hand. It originates from the lateral and medial plexus. The median nerve runs from the shoulder to the flexors of the fingers and enters the palm through the carpal tunnel. Then it divides into three branches that form seven separate nerves in the fingers. This nerve is important in the shoulder joint. The median nerve is responsible for the correct function of the muscles in the thumb, index, and middle fingers. The main function of this nerve is flexion and extension of the fingers and pronation of the forearm.

 

Median nerve function:

  • Muscle atrophy in case of injury is most often expressed in the thenar area. As a result, the palm is flattened, and the adduction of the thumb makes the hand very similar to a monkey’s paw. 
  • Damage to the median nerve is a fairly common pathology caused by a complete or partial break in the nerve trunk. Closed injuries can occur due to compression of soft tissues by a foreign object. For example, a person has trauma when struck with a blunt object. Tumors, bone fragments during a fracture can also injure a nerve. Open injuries can occur if a person is cut or receives a gunshot wound to the arm.

 

Nerve tissues are very poorly regenerated with this kind of damage. Wallerian degeneration can develop very quickly; this is a process during which the nerve tissue is resorbed and replaced by cicatricial connective tissue. That is why no one can guarantee that the outcome of treatment will be favorable, and eventually, the patient gets a disability.

 

Median Nerve Damage Classes

The median nerve of the hand, depending on how much it has been damaged. It can provoke several pathologies:

  • Shake. In this case, no morphological and anatomical abnormalities are observed. Sensitivity and movement functions return within 15 minutes after injury.
  • Injury. This condition is because the anatomical continuity of the nerve trunk is preserved. But the epineural membranes are torn, and blood enters the nerve. With such damage, the motor function is restored only after a month.
  • Compression. With this pathology, the severity of the disorders is observed, and it depends on the severity and duration of the compression. Minor violations can be observed, but there are also serious cases that require only the intervention of a surgeon.
  • Partial damage manifests itself in the form of loss of individual functions. In this case, the functions are not restored; only an operation is needed.
  • A complete break in this condition, when the nerve stratifies into two separate ends – peripheral and central. If you do not take serious measures, then, in this case, the middle fragment is replaced by a small part of the scar tissue. The functions will not recover independently, muscle atrophy will increase every day, and trophic disorders are observed. Only the operation can help, but it does not always give the desired results.

Neuropathy or neuritis of the median nerve can be diagnosed at the initial stage, and if appropriate measures are taken, this pathology can be cured without any consequences. The most common median nerve problem is carpal tunnel syndrome.

carpal tunnel

Carpal Tunnel Syndrome Symptoms

It is also called median nerve compression. It is the narrow space formed by the bones of the wrist on the dorsal side and the transverse wrist ligament on the palmar side. The median nerve travels through this cavity before it splits into thin branches for the thumb, middle, and index fingers, the radial surface of the ring finger, ten flexor tendons of the fingers, and blood vessels. Carpal tunnel syndrome occurs when the median nerve is compressed as it travels through the canal and is the most common pathology in hand.

 

Compression initially manifests itself as:

  •  irritating symptoms;
  •  pain;
  •  numbness; its persistence damages the nerves, first the myelin sheaths, and then the axons;
  • the thumb, index, and middle fingers are affected; 
  • and sometimes the forearm can also be affected. 

 

Symptoms for a long time appear only at night due to immobility, venous congestion, and a progressive physiological increase in flexor muscle tone (dominant postural tone), suggesting at times increased wrist flexion. Patients usually wake up with pain and try to relieve it by adopting different hand positions:

  • people with median nerve problems are forced to shake their limbs desperately to wake up the muscles, or, in other cases, it is helpful for them to keep their hands still;
  • sometimes it helps to dip your hand in hot or cold water.

 

There is also a seasonality of pain, and discomfort occurs more often during colder months. During the day, these symptoms are not felt, but some activities, such as writing, brushing, knitting, typing on the computer, can trigger the recurrence of pain.

Over time, there is a decrease in sensitivity at the tips of the 2nd and 3rd fingers until complete anesthesia, followed by the disappearance of pain, which in this case will not be an expression of improvement. Finally, there is also a motor deficit in the control of opposite thumb movements and atrophy in advanced cases. As the disease progresses, hand function changes more and more.

 

If the median nerve is severely damaged, symptoms are felt throughout the day with:

  • a weak hand;
  • numb fingers;
  • inability to perform small movements;
  • simple daily operations such as unscrewing a lid or gripping cutlery firmly. 

The sequence of irritation and defeat is not always followed in that order. For a very long time, even years, Carpal tunnel syndrome can stop at a purely annoying level and never develop at the lesion level. There can be very long phases of remission, and there are often final remissions.

 

Carpal Tunnel Syndrome Causes 

Anything that reduces the space in the tunnel or causes an increase in the volume of what is contained in the tunnel itself can cause irritation. And over time it can lead to damage with neurological symptoms.

 

In about 80% of cases, it is bilateral; women aged 50 to 60 are more likely to suffer from hormonal changes; this is often associated with work in men.

Here are some factors that can cause tissue edema in the carpal canal:

  • Frequent repetitive movements of the wrists or prolonged stress on them
  • Performing manipulations using the hands that require effort
  • Tumor
  • Sprains, sprains, or other injuries of the wrist
  • Lack of vitamin B6 in your diet
  • Taking aromatase inhibitors (medicines used to treat breast cancer in postmenopausal women)
  • Belonging to the female sex
  • Genetic predisposition to the development of carpal tunnel syndrome
  • An increase in the contents of the tunnel or deformation is everything that forms a tunnel (an inflammatory process that affects the joints of the wrist)
  • An increase in the thickness of the flexor tendons usually occurs in certain hormonal situations, such as pregnancy and menopause
  • A similar pathology of tendons occurs more often due to a small form of immunopathy (tenovaginitis).

 

Medical conditions such as:

  • arthritis;
  • renal failure;
  • liver disease;
  • hypothyroidism (a condition in which the thyroid gland does not produce enough hormones);
  • pregnancy;
  • obesity;
  • amyloidosis (a disease in which proteins build up in your organs);
  • acromegaly (a condition in which some bones become much larger than normal).

Other causes are repetitive microtrauma, in which a conflict with the nerve occurs due to an increase in the thickness of the transverse ligament or inflammation or edema as a result of repeated or prolonged flexion, extension, or grasping, trauma (previous fractures that change the container), synovial cysts (change in content), or finally anatomical variants.

Specific pathologies can be associated with endocrine diseases, autoimmune inflammatory forms, storage diseases, hereditary forms, and root compression at a higher level.

carpal tunnel1

Carpal Tunnel Syndrome Physical Examination

Early diagnosis is essential to avoid permanent damage to the nerve fibers. A physical examination of the hands, shoulders, and neck can help determine whether the perceived symptoms are related to daily activity or illness and rule out other painful conditions that may mimic carpal tunnel syndrome. Diagnosis is simple and reliable if nocturnal numbness, numbness of the first three fingers of the hand is reported, and a difference in the pad’s sensitivity of the 4th finger. Another decisive sign, if the motor part is involved, is muscle atrophy of the outer part of the thenar eminence, together with muscle weakness in the grip of the 1-2nd finger.

 

There are also outpatient median nerve problems that your doctor can perform to mimic the symptoms of carpal tunnel syndrome.

  • Tinel’s sign. Pain can be induced or reproduced in the median nerve distribution by wrist percussion to confirm the diagnosis of carpal tunnel syndrome. A reflex hammer is commonly used, and an electric shock is triggered at the entrance to the wrist canal.
  • Phalen’s sign. The appearance of paresthesia in the fingers due to the maximum flexion of the wrist and keeping it in this position for at least one minute. This is done when the patient is asked to keep the palms unfolded for 30 seconds, keeping the elbows flexed and the forearms horizontal. This puts pressure on the median nerve of the carpal tunnel. The test is considered positive if paresthesias are radiating at the level of the first three fingers of the hand.
  • Phalen’s reverse sign. It is performed when the patient is asked to hold the back of the hand with the face for 30 seconds, keeping the elbows flexed and the forearms horizontal. This puts pressure on the median nerve of the carpal tunnel. The test is considered positive if paresthesias are radiating at the level of the first three fingers of the hand.

The range of sensitivity of Tinel’s trait is from 25 to 60%; the specificity is from 67 to 87%. The Phalen test has a sensitivity and specificity range of 40 to 80%. 

 

Medical Tests and Diagnostical Procedures of Median Nerve Compression

However, two non-invasive and painless tests are performed to confirm the diagnosis and establish the severity of the disease:

  • Electroneurography. That is, the study of the response of the median nerve to electrical stimuli, confirms the diagnosis. 
  • Electromyography. That is, the study of the activity of the muscles innervated by the median nerve, establishes the severity of the disease and makes it possible for the differential diagnosis between various neuropathies. In the first case, electrodes are placed on the arm and wrist, and the nerve response, such as speed, latency, and amplitude, is measured with small electric shocks. In the second, a needle is inserted into the muscles to study their activity, making it possible to establish the severity of the syndrome and exclude other pathologies.

Ultrasound and MRI can show the anatomy of the wrist, but these data are insufficient to diagnose carpal tunnel syndrome.

 

Treatment of Median Nerve Compression  

In professional medical centers, all conditions are usually created to help patients with carpal syndrome and with pain in the hands of any nature. Dealing with hand problems, specialists carry out high-quality diagnostics, establish a diagnosis, and provide qualified assistance at any stage of the disease.

 

Having decided on the tactics of treatment, orthopedic surgeons-traumatologists carry out the necessary treatment. It can be:

Conservative Medication, blockages at the pinched nerve, wrist splints
Operational Dissection of the carpal ligament with nerve decompression is also called venous drainage.

Venous blood carries blood depleted in oxygen and rich in carbon dioxide to the heart. The obstruction of venous outflow contributes to the accumulation of carbon dioxide in the organs; the use of venous drainage allows you to balance the body’s acid-base balance and facilitate the heart’s work. The leading indication for the use of this technique is the prevention of varicose veins, thrombophlebitis, reticular varicose veins, and carpal tunnel, especially in persons predisposed to these pathologies.

Surgical or surgical treatment is carried out in difficult cases at the highest professional level.

 

Correctly performed surgical intervention guarantees a complete cure for carpal tunnel syndrome and pain in the hand right on the operating table. Relapses are possible in less than 1% of cases. If the diagnosis and treatment were untimely, the patient runs the risk of serious consequences that significantly worsen the quality of life:

  • Thumb muscle hypotrophy
  • Weakness of the hand
  • Violation of the sensitivity of the fingers.
  • Self-medication for neurological problems in the arm and hands is wrong and dangerous. 

 

Having eliminated the pain syndrome with the help of analgesics, it is impossible to remove the cause of the disease. If, after physical work or any exercise, the pain in the hand and arm increases, edema has arisen, and the condition lasts more than one day, you should immediately contact a specialist. The orthopedist-traumatologist will help restore health and return to the usual rhythm of life in the shortest possible time.

Unlike drug treatment, shock wave therapy stimulates natural regenerative processes and simultaneously has an anti-inflammatory, analgesic, and decongestant effect without side effects.

The anti-inflammatory effect is enhanced when combined with laser therapy. Thanks to this, the fastest and most long-term result of the treatment of carpal tunnel syndrome is achieved.

FAQs

  • What kind of syndrome can cause irritating symptoms, pain, numbness in the hand? 

The carpal tunnel, also called median nerve compression. It is the narrow space on the wrist formed by the bones of the wrist on the dorsal side and the transverse wrist ligament (flexor retainer) on the palmar side. 

  • What does the median nerve innervate?

The median nerve innervates the ulnar flexor of the wrist and the lateral part of the deep flexor of the fingers, the adductor thumb muscle, all interosseous muscles, two worm-like muscles, the muscles of the hypotenar (the little finger elevation), the skin of the palmar surface and part of the fingers.

  • Where does the median nerve run?

It runs along the midline in the wrist in the carpal tunnel. A pinched median nerve can cause carpal tunnel syndrome, the most common cause of wrist pain.

  • What does carpal tunnel syndrome look like?

Carpal tunnel syndrome occurs when the tissue around the tendon swells, which puts pressure on the nerve. This leads to the fact that the patient begins to feel tingling in the hands, numbness in the fingers. Muscles become weak, and swelling may appear on the fingers.

  • Why is venous drainage used?

The use of venous drainage allows you to balance the acid-base balance of the body to facilitate the work of the heart. The leading indication for the use of this technique is the prevention of varicose veins, thrombophlebitis, reticular varicose veins, and tunnel syndrome, especially in persons predisposed to these pathologies.

  • How to understand that you have carpal tunnel syndrome?

The main symptoms are:

  1. Increased tingling sensation
  2. Numbness in the fingers, mainly in the thumb, index, and middle
  3. Hand weakness
  4. Inability to hold even light objects in your hand
  5. Muscle disorders
  6. The appearance of pain
  7. Reflex unclenching of the fingers.
  •  What to do with carpal tunnel syndrome?

Exercises to prevent tunnel syndrome:

  1. Squeeze your fingers into a fist and also unclench strongly.
  2. Clench your fists and rotate first in one direction, then in the opposite direction.
  3. Pressing your palms together, spread your elbows to the sides, taking a position like a prayer.

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Daneisha Johnson
Daneisha Johnson
22:20 19 May 22
Dr. Askari was very kind and explained everything so I could understand. The other staff were nice as well. I would... have gave 5 stars but I was a little taken aback when I checked in and had to pay 600.00 upfront. I think that should have been discussed in a appointment confirmation call or email just so I could have been prepared.read more
Jean Cooper
Jean Cooper
16:54 29 Apr 22
I love the office staff they are friendly and very helpful. Dr. JODIE is very caring and understanding to your needs... and wants to help you. I will go back. would recommend Dr. Dr. Jodie to other Patients in a heart beat. The team works well together.read more
Linda M
Linda M
19:40 02 Apr 22
I was obviously stressed, needing to see a neurologist. The staff was so patient and Dr. Ansari was so kind. At one... point he told me to relax, we have time, when I was relaying my history of my condition. That helped ease my stress. I have seen 3 other neurologists and he was the only one who performed any assessment tests on my cognitive and physical skills. At one point I couldn't complete two assessments and got upset and cried. I was told, it's OK. That's why you're here. I was truly impressed, and super pleased with the whole experience!read more
Leslie Durham
Leslie Durham
15:05 01 Apr 22
I've been coming here for about 5 years. The staff are ALWAYS friendly and knowledgeable. The Doctors are the absolute... best!! Jodie Moore is always in such a great mood which is a plus when you are already stressed. Highly recommendedread more
Monica Del Bosque
Monica Del Bosque
14:13 25 Mar 22
Since my first post my thoughts have changed here. It's unfortunate. My doctor and PA were great, but the office staff... is horrible. They never call you back when they say they will, they misinform you, they cause you too much stress wondering what's going on, they don't keep you posted. They never answer the phone. At this point I've left four messages in the last week, and I have sent three messages. Twice from their portal and one direct email. No response. My appointment is on Monday morning at 8:30am, no confirmation on my insurance and what's going on. What the heck is going on, this is ridiculous!I've given up... the stress her office staff has put me through is just not worth it. You can do so much better, please clean house, either change out your office staff, or find a way for them to be more efficient please. You have to do something. This is not how you want to run your practice. It leaves a very bad impression on your business.read more
Ron Buckholz
Ron Buckholz
23:32 23 Mar 22
I was actually pleasantly surprised with this visit! It took me a long time to get the appointment scheduled because no... one answers your phones EVER! After a month, I finally got in, and your staff was warm, friendly, and I was totally impressed! I feel like you will take care of my needs!read more
Steve Nabavi
Steve Nabavi
16:28 16 Mar 22
It was a nice visit. Happy staff doing all they can do to comfort the patients in a very calming environment. You ask... me they are earned a big gold star on the fridge. My only complaint they didn't give me any cookies.read more
Katie Lewis
Katie Lewis
16:10 10 Feb 22
Had very positive appointments with Jodie and Dr. Sheth for my migraine care. Jodie was so fast with the injections and... has so much valuable info. I started to feel light headed during checkout and the staff was SO helpful—giving me a chair, water, and taking me into a private room until I felt better. Highly recommend this practice for migraine patients, they know what they’re doing!!read more
Joshua Martinez
Joshua Martinez
16:02 10 Dec 21
I was scheduled to be checked and just want to say that the staff was fantastic. They were kind and helpful. I was... asked many questions related to what was going on and not once did I feel as though I was being brushed off. The front desk staff was especially great in assisting me. I'm scheduled to go back for a mri and am glad that I'll be going there.read more
Isabel Ivy
Isabel Ivy
21:42 03 Nov 21
I had such a good experience with Lone Star Neurology, Brent my MRI Tech was so awesome and made sure I was very... comfortable during the appointment. He gave me ear plugs, a pillow, leg support and blanket, easiest MRI ever lol 🤣 My 72 hour EEG nurse Amanda was also so awesome. She made sure I was take care of over the 3 days and took her time with the electrodes to make sure it was comfortable for me! Paige was also a huge help in answering all my questions when it came to my test results, and letting me know her honest opinions about how I should go forth with my treatment.read more
Leslie Luce
Leslie Luce
17:37 20 Oct 21
The professionalism and want to help attitude of this office was present from the moment I contacted them. The follow... up and follow through as well as their willingness to find a way to schedule my dad was above and beyond. We visited two offices in the same day with the same experience. I am appreciative of this—we spend a lot of time with doctors and this was top notch start to finish.read more
robert Parker
robert Parker
16:38 16 Apr 21
I love going to this office. The staff is friendly and helpful. The doctor is great. I am getting the best... neurological tests and treatment I have ever had. The only reason I did not give them a 5 star rating is because it is impossible to reach a live person at the office to reschedule appointments. Every time I have tried to get through to the office it says all people are busy and I am sent to a voicemail. If they could get their phone answering fixed, I would give them a strong 5 stars.read more
MaryAnn Hornbaker
MaryAnn Hornbaker
00:26 25 Feb 21
Dr. Harney is an excellent Dr. I found him friendly , personable and thorough. I evidently am an unusual case. ... Therefore he spent a Hugh amount of time educating me. He even gave me literature to further explain my condition and how to follow up. This is something you rarely get from your doctors. So I am more than please with my doctor and his staff.read more
Roger Arguello
Roger Arguello
03:05 29 Jan 21
Always courteous, professional. The staff is very friendly and always work with you to find the best appointment time.... The care team has been great. Always taking the time to listen to your concerns and to find the best treatment.read more
Margaret Rowland
Margaret Rowland
01:12 27 Jan 21
I have been a patient at Lone Star Neurology for several years. Now both my adult daughters also are patients there. I... love Jodie. She is always so prompt whether it is a teleamed call are a visit in the office. She takes the time to explain everything to me and answers all my questions. I am so blessed to have Jodie as my doctor.read more
Susan Miller
Susan Miller
03:01 13 Jan 21
My husband had an accident 5 years ago and Lone Star Neurology has been such a blessing to us with my husbands care.... Jodie Moore is his provider and she is amazing! Jodie is very knowledgeable, caring, and thorough. She takes her time with you, making sure your needs are met and she is happy to answer any questions you may have. Lone Star Neurology’s patients are very lucky to have Jodie providing their care. Thank you Lone Star Neurology and especially Jodie for everything you have done for us. Jodie, you are the best!read more
Windalyn C
Windalyn C
01:32 09 Jan 21
Jodie is wonderful. She is very caring and knowledgeable. I have been to over a dozen neurologists, and none were able... to help me as much as they have here. Thanks!read more
Katie Kordel
Katie Kordel
00:40 09 Jan 21
Jodi Moore, nurse practitioner, is amazing. I have suffered from frequent, debilitating headaches for almost 20 years.... She has provided the best proactive and responsive care I have ever received. My quality of life has been greatly improved by her caring approach and tenacity in finding solutions.read more
Ellie Natsis
Ellie Natsis
15:41 07 Jan 21
I have had the best experience at this neurologist's office! For over a year I have been receiving iv treatments here... each month and my nurse, Bobbie is beyond wonderful!! She's so attentive, knowledgeable, caring, and detail oriented. She makes an otherwise uncomfortable experience much more pleasant and definitely puts me at ease! She also helps me with my insurance,ordering this specialty medication and dealing with the ordering process which is no easy feat.Needless to say, she goes above a beyond in every way and I'm so grateful to this office and to Bobbie for all they do for me!read more
Matt Morris
Matt Morris
15:39 07 Jan 21
Let me start by saying that I have been coming here for years. Due to my autoimmune disease, I am in this office... once every three weeks for multiple hours at a time. The office is very clean and the staff very friendly. My only complaint would be there communication via phone. They aren't the best at responding if you leave a voicemail and expect a call back. I understand that this is prob just due to the sheer number of alls they receive daily. What I can say I like the best about the office are the people. Bobby who handles my infusions is great. I never have any issues with her setting up my infusions. She is very quick to reply to messages sent via text and if she were to leave then my whole opinion of the office may change. I also enjoy people like Matt, Lauren, and Jodi. I appreciate all that they do for me and without this team I'm not sure I would be as happy as I am to visit the office as frequently as I have to. Please ensure that these folks are recognized as they are what makes my visit to this office so tolerable :).read more
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