Solutions for carpal tunnel syndrome. How to relieve pain, numbness and tingling in an affected arm

What is carpal tunnel syndrome?

Carpal tunnel syndrome is the most common cause of peripheral nerve compression in the body. It occurs as a result of irritation of the median nerve at the level of the carpal tunnel. It is an easily diagnosed condition based on typical signs and symptoms, as well as electromyography and musculoskeletal ultrasound.

The incidence of carpal tunnel syndrome is approximately 99 per 100,000 people. It affects 9% of the female population and is a pathology responsible for significant morbidity and periods of downtime at work.

Dr. Renata Chego, Medical Rehabilitation Specialist, provides more information on the causes, symptoms, and treatment of carpal tunnel syndrome.

Carpal Tunnel Syndrome: Symptoms

The symptoms of carpal tunnel syndrome appear unnoticed for several weeks or even years. The most common manifestations include:

  • sensation of tingling and tingling in the region of innervation of the median nerve, I, II and III fingers
  • nighttime pain that may worsen in the evenings, when driving a car or typing on a computer, or from prolonged or excessive flexion of the fist
  • numbness and pain during daily activities (driving a car, working at a computer, and lifting weights)
  • paresthesia at the level of the index, index and middle fingers, involving the medial region of the ring finger in the palmar region of the fist
  • nerve compression explains these sensations of burning, numbness and tingling and the distribution of symptoms in the region of innervation of the median nerve
  • after long periods, the pain becomes constant, and there is also swelling in the wrist area
  • in severe cases, atrophy of the muscles of the palms occurs with a decrease in muscle strength and limitation of hand movements

Causes of Carpal Tunnel Syndrome

There are several causes and risk factors associated with carpal tunnel syndrome, such as:

  • obesity
  • task
  • menopause
  • diabetes mellitus type 1 and 2
  • wrist injury
  • arthritis from rheumatic diseases
  • hypothyroidism
  • an important factor is also the multiple voltage of the area (for example, office work at the computer)
  • Hormonal imbalances and fluctuations are often associated with carpal tunnel syndrome.

How to Diagnose Carpal Tunnel Syndrome

Clinical tests for median nerve loading are the Tinel (carpal tunnel percussion) and Phalen (forced flexion or hyperextension of the wrist for one minute) tests, which are designed to cause or aggravate pain in the wrist area.

Diagnosis may be clinical or ultrasound, but confirmation remains the standard. electromyography (with sensitivity 85% and specificity 95%). This study also shows us the severity of the compression effect of the median nerve and may also guide therapeutic tactics.

There is good scientific evidence that shows us that Ultrasound of the musculoskeletal system it can be used as an alternative to nerve conduction studies in the diagnosis of carpal tunnel syndrome, as it is a more gentle and easily accessible procedure.

Ultrasound of the musculoskeletal system allows to determine the anatomy of the median nerve and to identify pathologies in the carpal tunnel area that may play a role in nerve compression. Ultrasonographic measurement of the median nerve region has a sensitivity of 97.9% in confirming the diagnosis.

Treatment of carpal tunnel syndrome

The therapeutic approach to carpal tunnel syndrome is becoming increasingly conservative. cases requiring surgical treatment are rarethrough easier access to medical services and accurate diagnostic tests.

Ultrasound of the musculoskeletal system is well tolerated and effective not only in the diagnosis of SBS, but also shows the severity of nerve damage, allows you to identify anatomical variations at this level. This method also helps in the treatment of CTS by ultrasound monitoring of infiltrates in the carpal tunnel or perineurally (around the nerve).

If infiltration and conservative therapy do not give the desired effect, it can be carried out under ultrasound guidance and dissection of the flexor retinaculumwhich effectively decompresses the area and brings improvement in symptoms.

Electrotherapy, physical and kinetic therapysuch as manual therapy, mobilization and massage, neuromuscular taping has proven to be as effective in the long term as surgical treatment.

Infiltrations come to the rescue and supplement therapy in cases where the pain does not go away quickly or in accordance with the patient’s expectations. You can choose corticosteroid infiltrationlong-acting anti-inflammatory agent that effectively relieves compression, reducing inflammation.

Simultaneously with infiltrates, immobilization, physiotherapy, taking painkillers and neurotrophic drugs will be recommended.

Hydrodissection of the median nerve is another ultrasound-guided procedure that, together with corticosteroid infiltration, can also be considered a diagnostic procedure.

Infiltration of own platelet-rich plasma and growth factors (PRP) or autologous serum, rich in cytokines (Sanakin), is addressed to patients of all groups and stages of the disease with STS, as well as with successful conservative therapy and with surgical indications or in the postoperative period.

These regenerative therapies have proven to be effective in relieving the pain and symptoms associated with carpal tunnel syndrome in the long term. PRP helps in axonal regeneration and restores normal median nerve function.

Treatment is individualized for each patient, determined according to risk factors, the etiology of the disease and the severity of SPC, and the patient’s expectations will always be taken into account.

Patient education and wrist hygiene after recovery are critical to prolong pain-free periods and prevent median nerve inflammation. Fixation, rest and mobilization are studied during the recovery phase, which the patient will continue at home.

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