Dr. Rahul Gupta : Neuro , Brain & Spine Surgeon in Fortis Hospital
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Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

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Carpal Tunnel Syndrome is common condition that causes pain, numbness, and tingling in the hand and fore arm. The condition occurs when one of the major nerves to the hand – the medium nerve – is squeezed or compressed as it travels through the wait.In most patients, carpal tunnel syndrome gets worse over time, so early diagnosis and treatment are important .Early on, Symptoms can often be relived with simple measures like wearing a wrist splint or avoiding certain activities and medication.If pressure on the median nerve continues, however, it can lead to nerve damage and neurological defects. To prevent permanent damage, surgery to take pressure off the median nerve may be recommended for some patients.

Anatomy:
The Carpel tunnel is a narrow passageway in the wrist, about an inch wide.The floor and sides of the tunnel are formed by small wrist bones called carpal bones.

Carpal Tunnel Anatomy:
The carpal Tunnel protects the median nerve and flexor tendons that bend the fingers and thumb. The roof of the tunnel is a strong band of connective tissue called the transverse carpal ligament, because these boundaries are very rigid, the carpal tunnel has little capacity to “stretch” or increase in size.

The median nerve is one of main nerves in the hand. It originates as a group of nerves roots in the neck. These roots come together to form a single nerve in the arm.The median nerve goes down the arm and forearm, passes through the carpal tunnel at the wrist and goes into the hand.  The nerve provides feeing in thumb and index, middle and ring fingers. The nerve also controls the muscles around the base of the thumb.

The nine tendons that bend the fingers and thumb also travel through the carpal tunnel, these tendons are called flexor tendons.

Risk Factors for Carpal Tunnel Syndrome Include:

  • Heredity
  • Repetitive hand use
  • Hand and wrist position
  • Pregnancy
  • Health Conditions
Symptoms

Symptoms of carpal tunnel syndrome may include:

  • Numbness, tingling, burning and pain – primarily in the thumb and index, middle and ring fingers
  • Occasional shock –like sensations that radiate to the thumb and index, middle and ring fingers
  • Pain or tingling that may travel up the forearm toward the shoulder
  • Weakness and clumsiness in the hand – this may make it difficult to performs fine movements such as buttoning your clothes.
  • Dropping things – due to weakness, numbness or a loss of proprioception (awareness of where your hand in the space)

In most cases, the symptoms of carpal tunnel syndrome begin gradually without a specific injury. Many patients find that their symptoms come and go a first. However, as the condition worsens, symptoms may occur more frequently or may persist for longer periods of time.Night time symptoms are very common. Because many people sleep with their wrists bent, symptoms may awaken you from sleep. During the day, symptoms often occur when holding something for a prolonged period of time with the wrist bent forward or backward, such as when using a phone driving or reading a book.Many patients find that moving or shaking their hands helps relieve their symptoms.

Physical Examination:

Electrophysiological tests:

  • Nerve Conductions studies.
  • Electromyogram (EMG)
  • Ultrasound
  • X-rays
  • Magnetic Resonance Imaging Scans(MRI)

Treatment:
Although it is a gradual process, for most people Carpal Tunnel Syndrome will worsen over time without some form of treatment. For this reason,it is important to be evaluated and diagnosed by your doctor early stages. It may be possible to slow or stop the progression of the disease.

Nonsurgical Treatment
If diagnosed and treated early, the symptoms of carpal tunnel syndrome can often be relieved without surgery. If your diagnosis is uncertain or if your symptoms are mild, your doctor will recommend nonsurgical treatment first.

Nonsurgical Treatments may include:
Bracing or splinting. Wearing a brace or splint at night will keep you from bending your wrist while you sleep. Keeping your wrist in a straight or neutral position reduces pressure on the nerve in the carpal tunnel. It may also help to wear a splint during the day when doing activities that aggravate your symptoms.

Medicines:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Gabapentin/ Pregabalin
  • Calcium & Vitamin Supplementation
  • Activity Changes
  • Nerve gliding exercises
  • Steroid Injections

Surgical Treatment
If nonsurgical treatment does not relieve your symptoms after a period of time, your doctor may recommend surgery.The decision whether to have surgery is based on the severity of your symptoms – how much pain and numbness you are having in your hand. In long-standing cases with constant numbness and wasting of your thumb muscles, surgery may be recommended to prevent irreversible damage.

Surgical Procedure
The surgical procedure performed for carpal tunnel syndrome is called a “Carpal Tunnel Release.” There are two different surgical techniques for doing this, but the goal of both is to relieve pressure on your median nerve by cutting the ligament that forms the roof of the tunnel. This increases the size of the tunnel and decreases pressure on the median nerve.

Recovery
Immediately following surgery, you will be encouraged to elevate your hand Carpal Tunnel Release Surgery You should expect some pain, selling, and stiffness after your procedure. Miner soreness in your palm may last for several weeks.Grip and pinch strength usually return by about two months after surgery. If the condition of your median nerve was poor before surgery, however, grip and pinch strength may not improve for about six to 12 months. Recovery may not upper if the ligament is not cut completely and patient may need surgery again.

You may have to wear a splint or wrist brace for several weeks you will however, we allowed to use your hand for light activities, taking care to avoid significant discomfort driving self-care activities and light lifting and gripping may be permit soon after surgery.

Dr. Rahul Gupta has more than ten years of neurosurgery. He was trained at Govt Medical College, Rohtak and PGIMER, Chandigarh and worked as faculty member in the department of Neurosurgery at PGIMER, Chandigarh and GB Pant Hospital, New Delhi. He has presented many papers in national and international conferences and has also published about 40 articles in reputed national and international scientific journals. He was awarded with Prestigious Sugita Scholarship at Nagoya University of Medical Science, Japan in 2011. Dr Rahul was trained for use of Fluorescence (5-ALA) in malignant glioma surgery at Graz, Austria and for functional neurosurgery at Amsterdam, Holland. He is a member and active participant in many neurological societies.

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