Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

Description of Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is an inflammatory disorder instigated by compression of the median sensory nerve as it passes deeper to the flexor retinaculum via the wrist in the carpal tunnel. This is triggered by repetitive stress and physical injury (Newington, Harris, & Walker-Bone, 2015). The protective tendon lining within the tunnel of the carpal tends to inflame or swell. It is attributed to the presence of both motor and sensory presenting features in the peripheral distribution of the nerve resulting in numbness, pain, wrist tingling in hand, and fingers. The little finger (5^th digit) is, however, not affected.

Nerves and Structures Involved in the Injury

Carpal Tunnel Syndrome develops from the pressured triggered on the median nerve, which is a fiber-filled structure that sends impulses from sensory nerve forth and back between the spinal cord and the hand through the wrist joint (Newington, Harris, & Walker-Bone 2015). The carpal tunnel is a tiny track enclosed by the bones in carpal. The palm side of the wrist, a tight fibrous tissue band, encloses the tunnel. These tissues are referred to as transverse carpal ligament. Blood vessels, nine finger flexor tendons, and medium nerves run through the tunnel. The tendons are rodlike in shape and transmit forces from the forearm muscles to fingers and help the muscles close. Although the tendons are frequently lubricated by synovial fluid and the tendon lining, repetitive movements, especially forceful gripping, may trigger swelling of sheaths enclosing them (Newington, Harris, & Walker-Bone 2015). The swelling implies that the blood vessels and median nerve become pinched. This pressure triggers tingling, pain on in the wrist, and numbness.

Treatment

Physical therapy

Wrist splinting is one of the physical therapy treatments recommended for patient recovery from this injury. This rehabilitation involves wearing a splint at night for some days. It keeps the joints held together in a neutral position (Webb, 2016). The splint is essential in moving the joint as usual during the day to regulate stiffness and to prevent muscle from weakening. Another recommendable physical rehabilitation of the injury involves placing ice on the patient’s palm, massaging the affected area, conducting stretches and exercises, which is recommendable at relieving swelling and pain Webb, 2016). Besides, practicing wrist lift by placing the palm on the table and lifting the fingers up is also a recommendable physical therapy treatment for Carpal Tunnel Syndrome.

The muscles of the forearm start contracting, hence reducing swelling. The use of ultrasound therapy to increase the temperature of the affected body tissue, promote healing, and pain reduction has also been proven to be an effective therapeutically measure for this kind of injury. It assists the symptoms from fading after a few weeks (Webb, 2016). Other treatments mechanism includes the use of corticosteroids. Cortisone is injected in the carpal tunnel to release pain. These injections are guided with ultrasound. Corticosteroids ease the swelling and inflammation, which reduces pressure on the median nerve (Webb, 2016). In addition, the use of nonsteroidal anti-inflammatory drugs, NSAIDs, for instance, the ibuprofen may relieve pain from the tunnel, in the short term.

Possible Surgeries and Rehabilitation After Surgery

It is appropriate to use surgery when a patient’s symptoms are severe and resist other treatments. The main aim of the surgery is to release pressure by cutting the ligament on the nerve medium (Newington, Harris, & Walker-Bone 2015). The primary techniques for performing carpal tunnel surgery involves endoscopic surgery and open surgery:

Endoscopic surgery: It involves the use of a telescope-like device. This device has a camera connected to see through the carpal tunnel. The surgeon operates the patient by cutting the ligament through two incisions in the patient’s wrist or hand (Newington, Harris, & Walker-Bone 2015). An ultrasound device may be used instead of a telescope. The device guides the scission tool to cut the ligament. Endoscopic surgery causes less pain than open surgery

Open surgery

In open surgery treatment, the surgeon cuts the palm of the hand of a patient over the carpal tunnel and makes an incision through nerve free ligament (Newington, Harris, & Walker-Bone 2015). As the healing process start, the tissues in ligament start to grow gradually together to give more room for the nerve. Internal healing takes several months, but skin healing takes a few weeks.  The patient is encouraged to use hard light after the healing of the ligament, gradually working back to the use of the patient’s hand. Extreme wrist and hand motions should be avoided. After surgery, weakness or soreness may take weeks to months to fully recover. If symptoms were very severe, symptoms might not fade completely after surgery (Newington, Harris, & Walker-Bone 2015). Other rehabilitation measures recommended after surgery include taking frequent short breaks from repetitive activities that involve the use of hands. Exercising as a measure of shading excess weight in case one is overweight.  Lastly, taking precautions such as avoiding wrists rotation fingers and palm stretching is recommended. This is vital in preventing carpal tunnel syndrome.

References

Newington, L., Harris, E. C., & Walker-Bone, K. (2015). Carpal tunnel syndrome and work. Best practice & research Clinical rheumatology, 29(3), 440-453.

Padua, L., Coraci, D., Erra, C., Pazzaglia, C., Paolasso, I., Loreti, C., … & Hobson-Webb, L. D. (2016). Carpal tunnel syndrome: clinical features, diagnosis, and management. The Lancet Neurology, 15(12), 1273-1284.