The carpal tunnel syndrome is the compression of a nerve in the wrist. It results in tingling, tingling in the hands, pain or difficulty in performing fine finger gestures. This disease is treated by medication or care in a physiotherapist, but often enough surgery is necessary.
The carpal tunnel corresponds to a precise region located inside the wrist and the hand. This canal is a kind of gutter constituted by the bones of the wrist (of the carpus) closed by a rigid ligament. Inside this canal pass the flexor tendons of the fingers and a nerve very important for the fingers: the median nerve. This allows the mobility of the thumb and the sensitivity of the first three fingers.
This problem is quite common, but fortunately, the treatments are numerous. The women are more affected than men, especially from the forties. Sometimes these symptoms turn out during pregnancy (and may fade away after).
In case of tingling, tingling, finger tenderness persisting several days, a consultation is recommended. Do not wait until you consult. Recovery will be all the better as the treatment has been implemented quickly.
Carpal Tunnel Syndrome: Causes
The cause of carpal tunnel syndrome (scc) is compression of a nerve (median nerve) in a narrow passage: just below the wrist, between the muscles of the thumb. This nerve, which descends along the arm to the hand, is very important. It ensures the sensitivity of the first three fingers (thumb, forefinger and middle finger) and controls thumb motion.
How to explain this compression? Most of the time, the cause is not known. At other times, the narrowing of the carpal tunnel can be caused by the sequelae of a wrist fracture, a cyst or inflammation of the joint.
Without being the cause, some repetitive gestures in the professional or sports setting can promote carpal tunnel syndrome. Thus, manual workers are more often concerned: workers using machines, butchers, cashiers.
In rarer cases, this syndrome may occur due to rheumatic disease, sequelae of a wrist fracture, etc.
Carpal tunnel syndrome is reported to be between 3% and 16% of the population (according to studies). This condition affects women three to five times more than men. Particularly after 40 years and during their pregnancy. The overweight, lack of exercise, hormonal disturbances, especially repetitive and tedious work with his hands, favor the occurrence of this problem. Whether computer enthusiasts are reassured, keyboard work would not be a contributing factor.
This syndrome manifests itself in symptoms such as tingling and numbness in the fingers, on one or both hands. At a later stage, pain occurs. They can be troublesome at night. A pain can rise in the arm.
Carpal tunnel syndrome is explained by compression of the median nerve at the wrist. In the most extreme cases, the nerve may be greatly altered by compression. This problem can affect both hands simultaneously, with different intensities. These symptoms are usually evolutionary.
Initially, tingling in the fingers is experienced during the night, even numbness of the hand, often painful. These symptoms can wake up in full sleep.
Tingling can then appear during the day when the hand is held still. By reading or driving, for example. Then other signs appear, indicating that the nerve is damaged. One becomes more awkward, one tends to let go of the objects. Then you feel like you have cotton or sand on your fingers. In short, the sensitivity is altered.
Last step, in the highly evolved forms, the big thumb muscle melts! And one is hampered by a total loss of sensitivity of the fingers. Hence the importance of consulting your doctor as soon as possible!
The simplest gestures of everyday life, such as dialing his cell phone, writing, driving, become painful and difficult. People with specific manual work can be severely handicapped.
The examination is of course on the sick hand or hands. For example, by performing the Tinel test: the doctor strikes with his finger or a small (medical) hammer on the fold of the wrist where the nerve passes. If you feel a discharge in the fingers, it is a sign of nerve damage.
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The Phalen test detects a sensitivity to compression. The wrist should be bent for a maximum of one minute. The test is positive in case of tingling. In addition, the doctor examines precisely the sensitivity of the fingers.
Generally the attending physician addresses the patient to a rheumatologist to confirm the diagnosis, to consider other pathologies (neurological disease, etc.), and to evaluate the severity of the syndrome.
Additional examinations are often carried out:
The electromyogram. The electrical conduction of sensory and motor nerve fibers is studied by means of electrodes. Clearly, the median nerve is electrically stimulated at various points along its path (arms, forearms, wrist) and then the speed of transmission of the message is measured by hand. Depending on the results (slower speed at the wrist, less intense message), one can thus confirm the diagnosis and measure the severity of the attack.
At the onset of the disease, when the symptoms remain bearable, no mystery: the first treatment of carpal tunnel syndrome is rest. The best is to use a splint generally during the night. It is a kind of plastic gutter that allows to immobilize hand and wrist.
On the medicines, the doctor prescribes painkillers, especially non-steroidal anti-inflammatory drugs (aspirin, ibuprofen …), tramadol which can be effective temporarily (about a month). Beware of side effects. At high doses, some of these treatments can cause stomach pain or even ulcers.
The pains do not pass? The rheumatologist may suggest infiltrations of “cortisone” (corticosteroids) at the top of the hand. A slight pain due to the injection may be experienced for 24 hours. But then, if the treatment works, it is for several months. One downside however, one cannot perform more than three infiltrations. Beyond this, there may be risks of demineralization or tendon ruptures.
To relieve pain, you can try different treatments. Physiotherapy sessions sometimes have a positive effect. Rehabilitation by slipping the nerve, cryotherapy (cold treatment), ultrasound … Physiotherapy has many techniques but generally their effectiveness remains limited in time. The homeopathy can also be used and acupuncture can be a good supplement. A few sessions will be necessary for the patient to evaluate its analgesic effect.
In advanced forms of the disease, or if other treatments have not shown efficacy, remains surgery. Generally, you do not need to be hospitalized. The procedure, carried out by a surgeon of the hand (orthopedist or plastic surgeon) lasts only fifteen minutes. Under local or regional anesthesia. You can usually arrive in the morning and come out at night.
The objective is simple: the “tunnel” in which the median nerve passes at the wrist is too tight. Just expand it. The surgeon must therefore cut the ligament which covers the median nerve along its length to clear the carpal tunnel … and thus decompress the nerve.
Two methods are possible:
The classic method which requires an incision of about four centimeters between the base of the wrist and the center of the palm.
The endoscopic technique: a tiny camera is inserted through a hole of one centimeter and a blade is then passed to cut the ligament.
Whichever method is used, it is particularly effective. Generally, if the nerve has not been altered too much, at the end of eight days, sometimes even the next day, the tingling has disappeared.
Each to his method to calm tingling or pain. Here are some tips, helpful tips to keep your hands and wrists out (tested by patients themselves).
Shake your hand, move your fingers.
Apply a hot water bottle or, on the contrary, a bag of ice (protecting the skin with a towel) or cold water on the sensitive area. The hot stimulates blood circulation and the cold tends to “anesthetize” the area by blocking nerve impulses.
If you practice a repetitive and painful task involving using your wrist, consider taking micro-breaks regularly.
Alternate, if possible, with other activities that are less traumatic for your hand.
Alter your way of doing things: use tools, and adjust the position of your wrist as best as possible for maximum comfort.