The "carpal tunnel syndrome"

The term "carpal tunnel syndrome" refers to a series of symptoms caused by nerve compression in the carpal tunnel and was first described by Paget in 1854. It is a compressive neuropathy, defined as a mononeuropathy or radiculopathy, caused by mechanical distortion produced by a compressive force, and representing  the 90% of all trapping neuropathies. The American Academy of Orthopedics defines it as a symptomatic compressive neuropathy of the middle nerve at the level of the wrist.

Clinical features

    The main features of the syndrome include:

  • Hand pain
  • Unpleasant tingling
  • Pain or sensitivity to the distal distribution of the middle nerve (thumb, index finger, middle finger, and the radius of the ring finger)

• Reduction of grip strength and functionality  of the affected hand

Picture: Area of symptoms

 

Symptoms tend to be  worsen at night, and has been reported clumsiness during the day with activities requiring bending of the wrist. Patients often report a phenomenon called a 'flick sign' in which shaking or shaking of the  wrist , relieves them of their symptoms.

 Provocation test

  • Phalen test
  • The patient's wrists are placed in a full (but not under resistance) bending position.
  • If occurs paraesthesia in the distribution of the middle nerve within 60 seconds, the test is positive for carpal tunnel syndrome 

  • Tinel sign
  • Tinel sign can be caused by tapping lightly on the path of the patient's middle nerve in the wrist, moving from the proximal to the distal.
  • the sign is positive if the patient complains of tingling or electric shock in the middle nerve. 

· Two-point discrimination test

This test is used when severe carpal tunnel syndrome is suspected. It is not very accurate for mild carpal tunnel syndrome. To do the test, your doctor close your eyes and then uses small instruments, such as the tips of two opened paper clips, to touch two points (fairly close together) on your hand or finger. Typically, you would feel separate touches if the two points are at least 0.5 cm (0.2 in.) apart. In severe carpal tunnel syndrome, you may not be able to tell the difference between the two touches, so it may feel as though only one place is being touched.

 Risk factors 

There are  a lot of risk factors associated with this condition. The most important of these are: 

  1. Environmental risk factors
  • Extreme flexion or extension of the wrist.
  • Repetitive use of flexor muscles.
  • Exposure to vibrations.
  1. Exogenous factors
  • Pregnancy.
  • Menopause.
  • Obesity.
  • Renal failure.
  • Hypothyroidism.
  • The use of l contraceptives.
  • Syndrome heart failure.
  1. Individual factors
  • As a result of fracture of the peripheral edge of the cavity (Colles fracture)
  • Post-traumatic arthritis
  1. Neuropathic factors
  • Diabetes.
  • Alcoholism.
  • Vitamin toxicity or deficiency.
  • Exposure to toxins.

Differential diagnosis

Differential diagnosis includes conditions such as:

  • Thoracic outlet syndrome.
  • Cervical radiculopathy (especially at level A6-A7).
  • Diseases of the brachial plexus.
  • Teres pronator syndrome.
  • Neuropathy (systemic).
  • Tenosynovitis.
  • Sympathetic reflex dystrophy.

Conservative therapy

Conservative treatment is generally indicated in patients suffering from mild to moderate symptoms of the syndrome and includes

  • Anti-inflammatory drugs (NSAIDs)
  • Ultrasound
  • Vitamins B6 and B12
  • Articular mobilization of the bones
  • Exercise or chiropractic treatment;
  • Use of splints

Medial Nerve Glide Exercises

Surgical treatment

    The surgical release of the wrist tunnel should be applied to patients with symptoms that do not respond to conservative measures and in patients with severe nerve trapping, thumb atrophy or kinetic weakness. Surgical treatment is a process in which the transverse joint of the wrist is cut in order to increase the carpal tunnel space and thus reduce the intermediate pressure.


Anastasios M. Margaritis
Occupational Health& Safety Specialist.
Bsc Physiotherapy & Sports Science.
Orthopaedic Manual Therapist.
Back Mechanic Specialist.


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