Carpal tunnel syndrome

Carpal tunnel syndrome

    * Introduction
    * Signs and symptoms
    * Diagnosis
    * Treatment
Carpal tunnel syndrome is a compression neuropathy of the median nerve at wrist level. It is located on the palm and is bordered by the carpal bones and flexors retinaculum previously. Inside it are found the median nerve, tendons flexors and their synovial sheath. Carpal tunnel syndrome is a collection of characteristic symptoms and signs that occur after the incarceration of the median nerve in the carpal tunnel. Common symptoms include tingling, tremor and pain on the median nerve distribution. These symptoms may or may not be accompanied by change in targets and sensitive structures innervated muscle strength of hand.
Median nerve is compressed in carpal tunnel rigid structures initially suffering demyelination followed by axonal degeneration. Sensory fibers are affected first, followed by the motor. Autonomous motor median nerve fibers may also be affected. Case syndrome is considered to be narrow carpal tunnel that causes blockage of blood flow venous pressure, edema formation and ischemic nerve.
Among the most common patients are accused of "dying the hand" or things falling from the mine without awareness, tingling and numbness. Nocturnal symptoms that awaken the patient are more specific for this syndrome, especially if the patient is relieved by moving the hand / wrist. Sensory symptoms are accompanied by a sensation of cramps in his hand to the wrist cord. This pain radiating distal palm and fingers, or more frequently extends to the proximal vertebral arm. Many people accuse the cooling sensation of the hand and skin color changes.
Carpal tunnel syndrome is associated with lack of aerobic exercise is recommended as a patient and steady state aerobics program. Using ultrasound techniques, the phonophoresis or iontophoresis with stretching exercises can benefit in some patients. Ortoza the wrist in neutral position is one of the best conservative treatment for carpal tunnel syndrome. Administration of NSAIDs and diuretics may be helpful in some patients. Patients whose condition does not improve after conservative treatment and those who initially shows severe syndrome may require surgery.
Carpal tunnel syndrome tends to be progressive over time and can lead to permanent destruction of the median nerve. We do not know if conservative therapy can stop progression. Even the syndrome recurs after surgical release for several years. Initially only 90% of moderate cases of the disease respond to conservative therapy. Secondary carpal syndrome, a disease tend to present a less favorable diagnosis from those without a background cause. Patients with normal electrophysiological studies were less favorable operational developments and more complications compared to those with abnormalities in these tests. Axonal loss in electrophysiology indicate a poor prognosis.
The pathogenesis of carpal tunnel syndrome The most common cause of carpal tunnel syndrome is chronic repetitive stress on the region and thus the median nerve. Stress can be caused by repeated unusual position of wrist flexion and extension repeated. Wrist fractures and dislocations, soft tissue injuries and abnormalities, infection, infiltrative disease, or bleeding may determine intraneurala carpal tunnel syndrome.
Anatomy of the carpal tunnel: Carpal tunnel is a fibro-osseous tunnel. Carpus consisting of the carpal bones has a concave shape bone surface is covered by the flexor retinaculum and flexors. This structure forms the floor of the carpal tunnel walls and ceiling formed rigid flexors retinaculum. Retinaculum flexors or ligament attaches to the tubercle transverse scaphoid, trapezium edge, against Hamath and ulna to pisiform bone hook. The nine tendons pass it with a sheath of synovial joint flexors. Median nerve is just below the flexors retinaculum.
Causes and risk factors for carpal tunnel syndrome: Demographic causes: old age, female, recently increased body mass index -Short stature, tomorrow dominant white race. Genetics: There is a strong family-succeptibilitate inherited characteristics associated with multiple factors: square wrist, thickened transverse ligament, short stature -Some inherited diseases are associated with carpal tunnel syndrome: diabetes, thyroid disease, hereditary neuropathy. Medical reasons: -Fracture of wrist flexion / extension wrist injuries severe acute Space-occupying lesions in the carpal tunnel: tenosynovitis, ganglions, hemorrhage, aneurysm, abnormal muscle, tumors, edema -Diabetes, myxedema, rheumatoid arthritis, menopause, recent Renal-dialysis, acromegaly, amyloidosis. Professional Grounds: -Application of extreme mechanical forces on the wrist Prolonged repetitive movement of the hand- Exposure to vibration or cold- -Use walking frames or Cirja, strollers -Pregnancy and breastfeeding Lack of aerobic exercise.