Carpal Tunnel Syndrome (CTS)
What is Carpal Tunnel Syndrome
The term carpal tunnel syndrome was first described by Sir James Paget in the year 1883.
This is the most common entrapment neuropathy (compression neurological problem) of the upper extremity. The median nerve gets entrapped in the narrow tunnel formed between the carpal bones and the transverse carpal ligament present on the front of our wrist.
Etiology:
The dominant hand is more commonly affected. Acute trauma to the wrist may lead to carpal tunnel syndrome.
Individuals with relatively square wrists may develop idiopathic (unknown cause) CTS. Congenital defects, like bony protrusion or anomalous extension of muscles, can narrow the carpal tunnel and make it more susceptible to Carpal tunnel syndrome.
This condition may be associated with many other conditions that make the median nerve more susceptible to compression within the carpal tunnel-like malaligned wrist fractures, rheumatoid arthritis, thoracic outlet syndrome, ganglion cyst, Paget’s bone disease, pregnancy, diabetes, hypothyroidism, etc.
Individuals involved in repeated wrist flexion and abnormal wrist positions while working are more prone to develop this condition like butches, haircutters, drivers, line workers, typists, gardeners, carpenters, etc.
The condition has a high incidence rate in females on oral contraceptives, pregnancy, menopause, and gynecological surgeries.
Signs/ Symptoms
CTS occurs 3 times more frequently in females than in males.
Intermittent or persistent numbness and tingling (Paresthesia) in the outer three and a half fingers (patient reports feeling of “hands going to sleep”)
The Paresthesia, at times, is severe enough to radiate the pain till arm and shoulder level. Night sleep may be disturbed in such patients because of nocturnal pain and tingling.
Sympathetic disturbances, such as excessive sweating and edema in the hands may result from vasomotor disturbance.
Motor involvement (muscles affection): weakness of the intrinsic thenar muscles supplied by the median nerve gives rise to the tendency of dropping things, difficulty in tasks like unscrewing, opening bottle caps, turning keys.
Examination:
There is a sensory loss in the distribution of the median nerve, often involving the volar pad of the index finger.
Muscular weakness is noted, mainly of opponens pollicis and abductor pollicis brevis muscles. In severe cases, thenar muscle atrophy may be noticed.
Special tests like Phalen’s maneuver or reverse Phalen’s maneuver are excellent diagnostic tests.
Tinel’s sign can be elicited by gently tapping at the wrist over the median nerve.
Treatment:
The condition can be quite effectively managed conservatively by proper physiotherapy treatment in Dwarka. We at our esteemed establishment, Pain-Free Physiotherapy Clinic (Physiotherapist in Dwarka, New Delhi) have successfully treated several cases of CTS.
If conservative treatment doesn’t work, which is possible in certain resistant cases of CTS, surgical release of the tunnel can be performed.
