What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is a term used to describe a series of symptoms and findings that occur as a result of one of the three main nerves in the hand, the median nerve, being compressed under pressure in the wrist canal at the level of the wrist. Carpal tunnel syndrome is the most commonly diagnosed peripheral nerve compression syndrome, and carpal tunnel syndrome surgery is the most commonly performed hand surgery in the world.
What Causes Carpal Tunnel Syndrome?
As the median nerve moves from the wrist to the hand, it passes through the wrist canal (carpal tunnel). The compression occurs in this tunnel. Any reason that increases the pressure in the carpal tunnel will leave the median nerve compressed, leading to the manifestation of carpal tunnel syndrome symptoms.
In most cases of carpal tunnel syndrome, a clear cause cannot be identified.
Some situations where a cause can be detected:
Fractures at the level of the wrist.
Masses occupying the tunnel
Connective tissue diseases such as rheumatoid arthritis,
In conditions such as pregnancy, tuberculosis, or goiter (hypothyroidism), accumulation in the body like fluid increases the pressure in natural tunnels in the body such as the carpal tunnel. This leads to nerve compression in the wrist.
What are the Symptoms of Carpal Tunnel Syndrome?
The most common symptoms of carpal tunnel syndrome are numbness, pain, and in advanced cases, loss of sensation in the half of the thumb, index finger, middle finger, and ring finger in the region corresponding to the distribution of the median nerve in the hand.
The region corresponding to the distribution of the median nerve in the hand is shown in yellow. When there is nerve compression in the wrist with carpal tunnel syndrome, numbness, pain, and loss of sensation occur in the inside of the palm, thumb, index finger, middle finger, and half of the ring finger.
The leading feature of these symptoms is that they appear or increase at night and wake up the patient. Pain spreads from the wrist and forearm to the elbow in some patients. In cases where the nerve is severely compressed in advanced stages of the disease, pain, loss of strength and dexterity in the palm of the hand, and a noticeable muscle weakness in the region behind the first finger of the palm of the hand are revealed.
Who Is Most Commonly Affected by Carpal Tunnel Syndrome?
Carpal tunnel syndrome is most commonly seen in women between the ages of 40-70 and is generally bilateral. But it also occurs in men. At the first visit, about 50% of patients have complaints in both hands or in the majority of patients with unilateral complaints, complaints emerge in the opposite side in later stages.
How Is the Diagnosis of Carpal Tunnel Syndrome Made?
The diagnosis of carpal tunnel syndrome is a clinical diagnosis made based on the patient's history and physical examination. Two simple examination methods are very important in the diagnosis of carpal tunnel syndrome.
These are the Tinel and Phalen tests, which carry the purpose of revealing the symptoms by putting pressure on them. In the Tinel test, the nerve is tapped with a finger on the potential compression area of the nerve. If the patient perceives a tingling sensation or electric shock spreading to the region that provides sensation in the nerve, it means the test is positive.
In the Phalen test, the median nerve pressure is increased by bending the wrist as much as possible and holding the wrist in the same position for one minute. If the patient's complaints, such as numbness, tingling, and pain in the hand and fingers, are revealed in this way, the test is considered positive.
There are some examination methods available to confirm the clinical diagnosis of carpal tunnel syndrome or to assist in the differential diagnosis. The standard examination method for carpal tunnel syndrome is electrodiagnostic examinations consisting of nerve conduction studies and needle electromyography (EMG). These examinations measure the electrical conduction power of nerves, thus determining whether there is a compression in the nerve and, if so, at what level. It is important to determine the level of compression in the nerve because the median nerve can sometimes be compressed higher up in the wrist and the treatment of such different compressions is different.
How Is Carpal Tunnel Syndrome Treated?
Non-surgical Methods
The purpose of non-surgical methods is to reduce or eliminate the causes of increased nerve pressure.
Some non-surgical treatment options are:
Using wrist splint.
Cortisol injection under ultrasound in the carpal tunnel.
How Is Carpal Tunnel Surgery Performed?
The treatment of carpal tunnel syndrome is surgical, which involves loosening the median nerve and freeing the tissues that cause compression. The surgery is performed with a 3-4 cm incision located just below the wrist. It can be done with regional or general anesthesia.
Immediately after the surgery, all symptoms are gone in all patients and they are significantly relieved. People who used to wake up every night due to pain and numbness in their hand can start sleeping comfortably the night of the surgery.
Factors that affect the result of the surgery include the patient's age, the duration of the disease history, and the severity of the symptoms before the surgery. If the cell death in the nerve due to compression cannot be improved with non-surgical methods after the diagnosis of carpal tunnel syndrome, surgery should be performed as soon as possible. With the progression of the patient's age, especially after the age of 65, the improvement in symptoms and hand function may decrease. However, a significant improvement in clinical symptoms and hand function is seen even in elderly patients over 70 years old, and almost all of them are very satisfied with the results. Therefore, regardless of age and disease stage, surgical treatment should not be avoided in patients with carpal tunnel syndrome.
