All You Need to Know About 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 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;
- 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
- 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:
- renal failure;
- liver disease;
- hypothyroidism (a condition in which the thyroid gland does not produce enough hormones);
- 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 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.
- 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:
- Increased tingling sensation
- Numbness in the fingers, mainly in the thumb, index, and middle
- Hand weakness
- Inability to hold even light objects in your hand
- Muscle disorders
- The appearance of pain
- Reflex unclenching of the fingers.
- What to do with carpal tunnel syndrome?
Exercises to prevent tunnel syndrome:
- Squeeze your fingers into a fist and also unclench strongly.
- Clench your fists and rotate first in one direction, then in the opposite direction.
- Pressing your palms together, spread your elbows to the sides, taking a position like a prayer.