Carpal Tunnel Syndrome (CTS)- Its Evaluation And Treatment
What is Carpal Tunnel?
It is an about inch wide narrow passage in the wrist. The small wrist bones carpal bones form the sides and floor of the carpal tunnel. The function of carpal tunnel: it protects the Median nerve and Flexor tendon and helps inflexion of fingers and thumb.
The tunnel’s roof is the strong band of connective tissue that is called Transverse carpal ligament. One of the main nerves in the hand is median nerve which originates from the neck and passes its roots move together and runs in the single nerve form and then it supplies the arm, forearm, and hand by passing through the carpal tunnel which is present at the wrist.
Carpal Tunnel Syndrome:
When the tunnel becomes narrowed and any swelling which is around the flexor tendon then it causes the pressure to the median nerve. The tissues that cover the flexor tendon are the Synovium. And this synovium helps the lubricate, the tendon and thus is helpful for movement of fingers. And when it is inflamed then it causes numbness in the course of the nerve.
People who are at High Risk of CTS:
- People who use computer whole day and make typing
- Pregnant women
- In those people who have already diabetes and Arthritis
- People who are involved in the repetitive use of wrist like mobile use and any other case.
- Benign tumors sometimes appear at the wrist and compress the median nerve but its chances are very rare.
- Any previous fracture or injury to the wrist
- Obese people also at high risk of this CTS it is calculated that people whose BMI are >26 are at high risk of CTS than people who have BMI <20
Prevalence of CTS:
Carpal tunnel syndrome is more common in females as compared to males. The past studies show that 67% of workers of health professional had CTS. 24% of people who had the CTS are the industrial people. Hence we can say that industrial people are also at risk of developing CTS.
Signs and Symptoms:
There will be numbness and tingling sensation. As the median nerve controls the motor and sensory function and when it is compressed then this sensation appears in the index middle and radial half of the ring finger as it is the course of the median nerve.
- There will be the pain in wrist and hand
- Felling of ache and discomfort
- Gripping power will be less
- There will be the weakness in a hand
There is no reference standard for the diagnosis of carpal tunnel syndrome only the Physical test physical examination is used to diagnose the carpal tunnel syndrome. Following are the physical test which we may perform to diagnose the CTS.
It is the test which is performed by asking the patient to gently flex the wrist and then hold that position of hand if there is any problem then there will be pain and paresthesia in the distribution of the median nerve. Time which is considered is one minute but if the patient is of CTS then symptoms mostly appear within 60 seconds
It is the test in which we apply pressure to the palm over the nerve for 30 seconds. If the numbness will appear then it is the symptom of CTS. This test is also called the carpal compression test.
This test is used to detect the irritation of the median nerve and it is performed by tapping the skin over the flexor retinaculum and if there is tingling pins or needle-like sensation then the test is positive.
Hand Evaluation Test:
This test is performed by placing the hand above the head and within 2 minutes if symptoms appear then test is positive.
It is essential that there should be the difference between carpal tunnel syndrome and cervical radiculopathy because it is common that due to cervical radiculopathy there will be pain and numbness in the wrist and hand.
The medication which is used is the Corticosteroids. These are the injections which are injected in the body but it is only for the temporary relief. This is used under the local anesthesia. But it is not the permanent solution because it is only used to relieve the discomfort. It is not very effective to slow down the process of CTS. When the CTS is not treated then it will lead to
The Atrophy. The mild situation can be resolved within months but the severe condition is treated with surgery.
It is done to release the pressure from the carpal tunnel. In it transverse ligament is divided it is done earlier with tourniquet general anesthesia and local anesthesia but nowadays it is done without any anesthesia and without any tourniquet.
Physical Therapy Treatment:
Physiotherapy plays a very important role in the treatment of carpal tunnel syndrome. Because it is the non-surgical treatment one method is the Myofascial release which improves the symptoms of the carpal tunnel it takes weeks and then it will be purely managed. And ultrasound treatment which is very helpful in reducing the swelling and exercises also performed and guide for the home plan.
Here are some exercises which therapist perform and also guide the patient to do the same in the home.
1)Position the patient to the side of the table and ask the patient to place his/her hand with arm straight off to the table it will cause stretch to the wrist if there is no stretch then lower down the chest then there will be a stretch in the wrist that will reduce the symptoms of CTS.
2) ask the patient to make a fist by hand for roughly 10 to 12 seconds and then slowly extend the fingers repeat this process it will be beneficial.
3) Place your palm in front of the face so that your elbow is downward Flex the fingers of affected hand with another hand it will create stretch flex the fingers for 10 seconds and then release it.
4) Make the fist and extend the thumb and clench it tightly it will also cause stretch and this position is maintained for 10 seconds
As lifestyle play a very important role in CTS so people should be
- Stop smoking
- Low quantity in salt
- Should reduce their sedentary lifestyle
- Their BMI should be controlled
People should reduce their computer work repetitive typing increase the risk of CTS so it should be minimized and people should take the break in their work. Their ergonomics should be appropriate and if there is any other problem due to which CTS occurs then that problem should be treated first like diabetes tumors and obesity.