CARPAL TUNNEL SYNDROME

CARPAL TUNNEL

Definition Carpal tunnel syndrome is a medical condition that occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes compressed or pinched at the wrist.

Types

• Idiopathic: The most common type, accounting for 90% of cases, where the cause is unknown.
• Traumatic: Caused by injury to the wrist or hand, such as a fall or a direct blow.
• Rheumatoid arthritis: Inflammation of the joints in the wrist, leading to compression of the median nerve.
• Thyroid disorders: Swelling of the thyroid gland can compress the median nerve.
• Tumors or cysts: Growths or fluid-filled sacs can compress the median nerve.
• Fluid retention: Fluid buildup in the wrist or hand can compress the median nerve.
• Repetitive motion: Repetitive activities, such as typing or using vibrating tools, can cause compression of the median nerve.

Causes

• Repeatedly bending the wrist
• Performing repetitive movements with the wrist
• Carrying heavy objects
• Involvement in sports or activities that involve repetitive hand or wrist movements
• Certain medical conditions, such as diabetes, rheumatoid arthritis, or hypothyroidism
• Pregnancy or fluid retention

Clinical Features

• Numbness or tingling in the thumb, index, and middle fingers
• Pain or burning sensation in the hand or wrist
• Weakness or clumsiness in the hand
• Loss of sensation in the hand
• Difficulty grasping or holding objects
• Muscle atrophy in the hand

Investigations

• Tinel's sign: A test where the wrist is tapped to elicit a tingling sensation in the hand.
• Phalen's test: A test where the wrist is flexed to elicit a tingling sensation in the hand.
• Electromyography (EMG): A test that measures the electrical activity of the muscles in the hand.
• Nerve conduction study (NCS): A test that measures the speed and strength of electrical signals in the nerves.

Complications

• Permanent nerve damage
• Muscle atrophy
• Loss of sensation in the hand
• Difficulty performing daily activities

Management

• Conservative management:
  • Rest and avoid activities that aggravate the condition
  • Wrist splinting to immobilize the wrist
  • Medications to reduce inflammation and pain
  • Physical therapy to improve grip strength and range of motion
• Surgical management:
  • Release of the carpal tunnel through a surgical incision
  • Decompression of the median nerve

Homoeopathic Therapeutic Medicines

• Arnica montana: For inflammation and pain
• Rhus toxicodendron: For stiffness and pain
• Hypericum: For nerve damage and numbness
• Aconitum napellus: For pain and inflammation

Treatment

• Conservative management is usually the first line of treatment.
• Surgery is considered if conservative management fails to improve symptoms.
• In some cases, carpal tunnel syndrome can resolve on its own without treatment.

Blood supply

• The radial artery and ulnar artery supply blood to the hand and wrist.

Nerve supply

• The median nerve, which is compressed in carpal tunnel syndrome, supplies sensation to the thumb, index, and middle fingers.

Clinical Anatomy

• The carpal tunnel is a narrow passageway in the wrist through which the median nerve and tendons of the flexor muscles pass.
• The median nerve runs through the carpal tunnel and is compressed when the wrist is flexed or bent.
• The tendons of the flexor muscles also run through the carpal tunnel and can cause compression of the median nerve.