Carpal tunnel syndrome

Carpal tunnel syndrome is the most frequent neuropathy in the upper limb.
It comes from the pressure on the median nerve due to the narrowing of the carpal duct.

If there is inflammation in the transverse carpal ligament, it becomes thicker and puts pressure on the structures that are inside, for example on the median nerve.

The tenosynovitis ( inflammation of the tendon sheath) of the hand flexors can produce this condition because the tendons swell, the volume is reduced and the tunnel nerviomediano compressed.

Carpal tunnel neuropathy usually affects women three times more than men, especially women who have gone through menopause. Those who are usually most affected by carpal tunnel syndrome are between 50 and 65 years old. .
In most cases, the neuropathy is bilateral and appears along with problems in the movements of the fingers.


What is t nel Carpal? Anatom í to bones, nerves and tendons

The carpal tunnel is a duct that is found in the wrist and is also known as the carpal duct. Behind, it is surrounded by the bones of the carpus while the anterior part is composed of the transverse carpal ligament.
This ligament is born in the scaphoid bone and trapezius on one side and is inserted into the unciform bone and the pisiform.
The transverse carpal ligament has a transverse course and looks like half of a bracelet.
In the interior of the carpal tunnel are the tendons of the flexor muscles of: hand, fingers and thumb.
The median nerve and blood vessels pass through the interior of the canal together to the tendons.

What are the causes of carpal tunnel syndrome?

There are several causes for carpal tunnel syndrome although predisposition plays a fundamental role.
Normally, women who have entered menopause are the most affected because menopause influences the tendons in a negative way.
Repetitive activities, with movements of flexion and distension of the wrist and fingers at
work are the most frequent causes.
Young men who are affected by carpal tunnel syndrome have a heavy job, for example they are bricklayers.

The women affected by this disorder tend to be dressmakers, housewives, packers and workers.
The effort that women make to support the child at the time of breastfeeding can cause tendonitis in the flexors of the hand .

There are some factors that can cause carpal tunnel syndrome to develop: hyperthyroidism , pregnancy , connective tissue disorders, rheumatic diseases such as rheumatoid arthritis , diabetes mellitus, osteoarthritisand fractures of the wrist in the past.

Although there are many people who are convinced that the work in front of the computer produces carpal tunnel syndrome, the use of the mouse does not cause this disorder.


What are the traits and symptoms of carpal tunnel syndrome?

Carpal tunnel syndrome occurs slowly and gradually with tingling , a feeling of swellingand pain in the first three fingers of the hand and in the inner part of the ring.
In the first phase of the disorder, the stunning only occurs during the night and in the first hour after awakening.

If a treatment is not started, there may also be a loss of sensitivity during the day.
Neuropathy affects the thumb, index, middle and ring because they are the fingers through which the median nerve passes. If it only affects one or two fingers, we can not talk about carpal tunnel syndrome because the cause can be tendonitis.
In the advanced stages, the irritation of the median nerve produces pain in the wrist and can reach the forearm with a discomfort that resembles that which comes from the epicondylitis .
Afterwards, the muscles of the hands become weak, especially those of the thenar eminence.
Consequently, it becomes difficult to grasp objects, sew, clench the fist, etc.
The individual affected by carpal tunnel syndrome does not usually get to sleep at night and is awakened by pain and tingling.
Normally, patients with carpal tunnel syndrome have weaker tendons and are more predisposed to diseases with respect to others.
It is very common that these patients are in clinics for diseases such as ” de Quervain “, a tendon injury or because of problems in the movements of the fingers.


How is carpal tunnel neuropathy diagnosed?

Who should be consulted?
The doctor who deals with this disorder is the orthopedist.

Carpal tunnel syndrome is diagnosed through the analysis of the anamnesis and performing a clinical analysis. The doctor asks the patient questions about the symptoms and associated diseases.
You have to analyze the condition of the arm and neck to understand if the symptoms come from overload or from another disease.

This allows you to eliminate the possibility of other diseases that look like the carpal tunnel.
The specialist performs a visual and manual review of the wrist to look for other possible diseases.
Then, analyze the range of motion of the wrist and fingers and look for limitations. The doctor usually diagnoses carpal tunnel syndrome by reviewing the wrist and analyzing: stiffness , swelling and reflexes.

  • gers, it means that the test is positive.
  • Phanel maneuver : you have to keep your elbows at the same height as your shoulders, your forearms vertically and, with your fingers down, you have to join the backs of your hands, the wrists have to be bent at an angle of almost 90 degrees.

The test is positive if the feeling of numbness or tingling in the fingers increases in 1 minute.
This position causes the median nerve to extend.
In the diagnosis, the doctor has to eliminate the possibility of other diseases, especially a fracture or arthritis .
The doctor may advise that a neurologist or surgeon be consulted if the patient needs specific treatment.


What are the tests that must be done to understand that carpal tunnel syndrome is being talked about?

The radiograph of the wrist affected may be useful to rule out other causes of wrist pain, such as fractures or arthritis.

The MRI and ultrasound can teach all tissues of the wrist while not useful in the diagnosis of carpal tunnel syndrome.
The doctor may advise that blood tests be done to understand if there are other diseases associated with carpal tunnel syndrome, such as diabetes or arthritis.
The best tests to corroborate the diagnosis are:

  • EMG (electromyography) measures the small electrical discharges that occur in the muscles and teaches how serious the problem is in the nerves. You have to insert some small needles into a muscle. Electrical activity while resting and muscle contraction can show how severe the damage to the median nerve is.
  • The nerve conduction study analyzes the speed with which nerves transmit electrical signals. The doctor places two surface electrodes on the hand and wrist and sends small electric shocks. If the speed decreases in the carpal tunnel, the test is positive.