Of Carpal Tunnel Syndrome (CTS)
Carpal Tunnel Syndrome (CTS) is the most common neuropathy and is due to compression of the median nerve at the wrist in its passage through the carpal tunnel.
What ‘the carpal tunnel?
The carpal tunnel is a tunnel in the wrist formed by the carpal bones on which is stretched the transverse carpal ligament, a fibrous band which constitutes the roof of the tunnel, entering the one hand, on the scaphoid bone and trapezium and the piriformis and hamate. This “tunnel” pass nerve tissue (median nerve), vascular and tendon (muscle flexor tendons of the fingers).
Occupational pathogenesis seems to be the most common cause for the development of carpal tunnel syndrome. Was shown to be an association with repetitive work, both in the presence and absence of the high force application. Was shown that prolonged and / or repetitive movements of flexion-extension of the wrist causing an increase in pressure within the carpal tunnel and that the repeated stretching of the nerves and tendons inside the carpal tunnel can lead to inflammation which it reduces the size of the tunnel leading to compression of the median nerve. They are in fact more, those in the manufacturing sector, electronics, textiles, food, footwear, leather goods, as well as those involved in packaging packs, cooks, and insiders public exercises. Even systemic diseases may be associated with carpal tunnel syndrome (eg. Diabetes mellitus, rheumatoid arthritis, myxedema, amyloidosis), as well as physiological conditions (pregnancy, use of oral contraceptives, menopause), trauma (previous fractures of the wrist with articular deformities) , arthritis and deforming arthrosis.
In the early stages of the disease Carpal Tunnel Syndrome is manifested by tingling, numbness or swelling of the hand, prevailing the first three fingers of the hand and part of the fourth finger (see figure), especially in the morning and / or during the night; then appears pain that radiates to the forearm, defined symptoms “irritating”. If the disease gets worse appear the fingers numb, hand strength loss, atrophy of the thenar; “Deficit” symptoms.
Because the symptoms are more pronounced at night and when you wake up?
The opinions in this respect are not unique. Likely causes are manifold: at night the pulse can stay long overflexed or hypertensive thus determining, as explained above, increased pressure within the carpal tunnel, with compression of the median nerve; the lying position may distribute body fluids with an increase of these in the upper limbs and therefore also within the carpal tunnel with consequent increase of pressure; the resting the hand will not allow drainage of fluids within the carpal tunnel.
Tingling (paresthesias) and / or pain, often radiating to the forearm, mainly at night or early morning. However it is important to perform the neurological examination and EMG (electromyography). The neurological examination evaluates the strength, the tendon reflexes, sensitivity and may involve clinical tests. The best known are the Tinel and Phalen tests but can often give a false negative or false positive and therefore it would be better not to rely too much on the result. And ‘therefore always advisable to perform an EMG test, performed using small needles to record muscle activity. cervical radiculopathy, brachial plexus, polyneuropathy in general often give rise to symptoms that mimic a Carpal Tunnel Syndrome and that only an EMG examination correctly and fully completed and can differentiate. The latter also allows you to classify the severity of the damage.
What is the evolution of the STC?
Usually without treatment or change of employment, the Carpal Tunnel Syndrome tends to worsen over the years. However in some patients it remains stationary in time. Clinical experience shows that during cold periods exacerbates the symptoms and improves during hot weather, while not modifying the severity of the disease.
Treatment of Carpal Tunnel Syndrome (CTS) can be conservative or surgical. According to the information of the American Academy of Neurology, conservative treatment is to be groped if there are deficits of strength or sensation or severe abnormalities on EMG. It ‘important, however, the patient does not operate too late, since they can persist outcomes; the patient in the conservative therapy must therefore be controlled.
Conservative therapy. Sometimes you just need to change procedures for carrying out work for an improvement. Otherwise you can use ultrasound, iontophoresis, laser, which can improve symptoms, but do not act on the cause of the syndrome (repeated and prolonged wrist flexion-extension); Nonsteroidal anti-inflammatory drugs have limited effectiveness; steroid medications, have limited effectiveness over time; infiltration, although effective on symptoms, have two major “side effects”: a proven fibrotic damage of the nerve and the risk that the patient postponements too surgery with permanent results. Splints for the wrist (splint) are effective, but little tolerate and then used only at night and therefore have no effect on the cause of the syndrome. Cuffs (type Policarpal) are new, as effectively they limit the flexion-extension of the wrist, without locking it and allow normal use of the hand (including thumb opposition) that can easily be used day and night, impacting well on the cause of the disease .
Surgical therapy. The intervention, in day-surgery, involves cutting the transverse carpal ligament (roof of carpal tunnel) through micro-incision at the wrist with microsurgical techniques, sometimes associated with neurolysis. It can be performed under local anesthesia or brachial artery, on average, with convalescence of about twenty days, during which it will have to avoid the flexo-extension movements of the wrist (open drawers, lean on the table to get up etc.), But not the fingers. The sutures are removed after 2 weeks.