Carpal Tunnel Syndrome
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Carpal Tunnel Syndrome
Carpal Tunnel Syndrome ( CTS ) is a nerve compression disorder. The Median nerve passes into the Hand through the Carpal Tunnel. This is an inflexible structure made up of Carpal bones and a band of tissue that stretches across the front of the wrist. In addition to the nerve, blood vessels and tendons pass through this tunnel. If any swelling occurs in this region the nerve and the other structures become compressed. Common signs of Median nerve compression at the wrist include:-
Pins & Needles and/or numbness,
typically to the thumb, index and middle fingers
( half of the ring finger may also be involved)
Pain to the same area
Symptoms worse at night
Wasting of the muscle belly at the base of the thumb
A thorough history is usually required.Provocative tests include tapping on the wrist to see if any tingling or similar symptoms are experienced in the hand or fingers. Another test involves allowing
the hands to flop forward at the wrists into a fully flexed position. This may elicit pins and needles numbness or pain to the fingers. These 3 things may be sufficient for the physician to confidently rule in or out Carpal Tunnel Syndrome.
An EMG is a test that is frequently carried out to confirm the diagnosis. This is a test for electrical conduction along the length on nerves and identifies sites of entrapment.
A diagnosis of CTS does not necessarily mean surgery. As for all conditions,there are many opinions about what helps.Preferred conservative ( non-operative) treatment for CTS is wearing a wrist cock up splint, such as this custom made one, around the clock and completing tendon gliding exercises approximately 3 times a day. Contrast baths are also completed 1 or 2 times a day. For people
such as office workers it is important to analyze their work environment to identify poor ergonomics. Sometime MD's will give a shot of cortisone to the wrist and therapists will sometimes try ultrasound.
Conservative treatment of CTS has varying results ( as does the surgery).There may be dramatic changes within one day, particularly with night symptoms, but others take longer and some obtain no relief at all. Factors which suggest a poor out come for both operative and non operative treatment include:-
1 A long history of symptoms i.e.. several years
2 Muscle wasting to the base of the thumb ( thenar muscles)
For those patients who's symptoms have not resolved with conservative treatment there may be few other options than surgery.
Open or Arthroscopic?
It depend on who you ask!
Post Surgical Treatment
Not all patients who undergo a release will need therapy. For those who do, treatment usually involves restoring a full range of motion, decreasing hypersensitivity to the scar, decreasing swelling and restoring strength.