Carpal tunnel syndrome

What is it?

The carpal tunnel, located on the front of the wrist, is an anatomical tunnel made up of a set of ligaments and bones. Through its interior, the median nerve passes which, together with the tendons, allows the hand to close and open. When the tunnel narrows, compression of the nerve occurs, which causes carpal tunnel syndrome.

Causes

There are many causes that cause the narrowing of the tunnel, causing inflammation of the anatomical structures (joints and tendons). Among them, we find bone diseases (, gout), thyroid, diabetes, bone fractures, tumors, hormonal alterations (pregnancy), etc.

It is quite common to affect workers with occupations or activities that require repetitive use of the hands and wrists (repeated hand and wrist movements, repetitive forced wrist positions) or local trauma (regular and continued use of vibrating hand tools ).

Increasing numbers of people using computers and keyboards have also led to an increase in carpal tunnel syndrome, while other occupational injuries have stabilized.

Symptoms

Symptoms tend to appear at night or during daily activities, such as driving, reading the newspaper, or typing on the computer. Initially, it is a pain in the region of the wrist and forearm, associated with a sensation of cushing (numbness), cramps (sensation of current) and tingling in the thumb, index, middle and part of the ring finger.

The later symptoms include weakness and atrophy of some muscles in the hand (especially in the pad under the thumb), as well as clumsiness when handling objects due to loss of strength. CTS can become so disabling that the person may have to stop working and not be able to perform even simple tasks.

Diagnosis

The diagnosis is based on:

• Detailed medical history: medical history, professional occupation, pain characteristics (location, radiation, relationship with manual labor, presentation schedule, dominant hand, evolution time), presence of other symptoms (numbness, tingling ...).
• Detailed physical examination: after clinical suspicion, an examination of the sensitivity and strength of the hand, as well as maneuvers that trigger the symptoms, should be carried out.

The following diagnostic tests may be performed:

• Wrist X-ray.
• and nerve conduction studies: to confirm the diagnosis and assess the degree of involvement of the median nerve, a neurophysiological study consisting of an electromyogram (EMG) and a nerve conduction study (NEC) is requested. Electromyographic studies are helpful when positive but can be negative in some patients.
• Others: blood test if there is suspicion of associated disease, X-ray of the cervical region if a cervical origin (hernia) is suspected, or chest X-ray.

Treatment

• Etiological treatment: in those cases in which an associated disease is identified, appropriate treatment must be instituted.
• Conservative treatment: in mild to moderate cases it is recommended to change habits when using the hand (postural and ergonomic measures), rest, use of a splint that keeps the wrist in a straight position (it can help reduce pressure on the nerve) , oral anti-inflammatory drugs, corticosteroid injections in the carpal tunnel and occupational rehabilitation.
• Surgical treatment: if symptoms persist despite medical treatment or if they are very serious, surgical treatment would be indicated. It consists of making an incision in the wrist and releasing the nerve along the carpal tunnel. It usually has no complications and is usually done on an outpatient basis.

Precautionary measures

In order to avoid Carpal Tunnel Syndrome it is recommended:

• Move only your fingers when typing: the wrist should always be kept straight. If the keyboard has a pad on the bottom, it is convenient to support the wrists during rest periods.
• Maintain a proper body posture: the spine should be supported against the back of the chair, the shoulders relaxed, the elbows at the sides of the body, the wrists straight and the feet flat on the floor. Work materials and screens should be at eye level so you don't have to bend your neck. Good posture is important to support nerve and circulation functions in the arm and hand region.
• Take short and frequent rest periods.
• Wearing a wrist strap at night or when working at home: it helps to keep the wrist in a neutral or straight position and favors its rest.

• It affects workers with occupations or activities that require the repetitive use of the hands and wrists
• The increase in the number of people using computers and keyboards has also led to an increase in carpal tunnel syndrome
• Preventive measures: move only your fingers when typing, maintain adequate body mechanics or take short and frequent rest periods, among others.