The carpal tunnel is a canal or corridor on the anterior or flexor side of the wrist, located between the wrist bones and the annular carpal ligament, through which the flexor tendons of the fingers and the median nerve pass.
Carpal tunnel syndrome is a disease that causes damage to the median nerve. If there is, for whatever reason, an increase in pressure within that carpal tunnel, an injury to said nerve can occur.
Mild cases may progress favourably with carpal tunnel syndrome treatment in Delhi by immobilization of the wrist or with an injection of corticosteroids. In more advanced cases, the solution is always surgical, freeing the nerve trapped in the carpal tunnel.
Virtually all patients experience very satisfactory improvement with surgical treatment.
What are the usual symptoms?
Initially, most patients complain of pain in the wrist and forearm region, associating the feeling of cushioning, cramps and tingling in the thumb, index, middle and part of the ring finger. These symptoms are typically nocturnal and/or postural.
Subsequently, if left untreated, weakness and atrophy of some muscles of the hand will appear (especially in eminence tenar or pad under the thumb), as well as clumsiness when handling objects.
The most common symptoms are:
- Pain in wrist and forearm.
- Cramps and tingling in fingers.
What are the causes?
There are so many tendons that cross this channel that the median nerve has a very fair space in its central area.
If for any reason this space decreases even more, then the pressure inside it increases, making the median nerve compressed. There are multiple causes that can cause this compression of the nerve, although on many occasions no associated disease is identified, and there are also a few family cases.
It can be associated with endocrinological diseases (hypothyroidism or acromegaly), rheumatic diseases (rheumatoid arthritis), deposit diseases (amyloidosis, mucopolysaccharidosis), tumors (multiple myeloma, hemangioma, lipoma), steroid or estrogenic treatment and pregnancy or breastfeeding…
It is quite common for it to be related to occupations or activities involving repetitive manual manoeuvres (repeated hand and wrist movements, repetitive forced wrist positions) or local trauma (regular and continued use of vibrating hand tools).
What is your prognosis?
It is an operation that usually has no complications. After surgery, the pain disappears in days, and the rest of the symptoms improve in a short time, depending on the severity of the injury.
The results obtained vary in the different series, with the following being the most extensive and with the largest number of patients:
- Improvement of pain and paresthesias: open (98%), endoscopic (99%).
- Satisfaction with the technique: open (84%), endoscopic (89%).
- Earlier return to work with endoscopy.
- The overall rate of complications of endoscopy: 1.8% on about 17,000 procedures (varies with different techniques).
- Endoscopic nerve lesions (palmar cutaneous branch, tenar motor branch, common digital nerves, median nerve, ulnar nerve): 0.8%.
How is it diagnosed?
After clinical suspicion, an examination of the sensitivity and strength of the hand should be carried out, as well as manoeuvres that trigger the symptoms.
To confirm the diagnosis and assess the degree of involvement of the median nerve (mild, moderate or severe), a neurophysiological study consisting of an electromyogram (EMG) and a nerve conduction study (NEC) is usually requested.
Carpal tunnel syndrome can be associated with endocrinological, rheumatic diseases, estrogen treatment, pregnancy, some tumors, etc.; that is why if there is a suspicion of these diseases, the diagnosis can be complemented with analytical or imaging tests that help find the cause.
What is the Carpal Tunnel Syndrome Treatment in Delhi?
- Conservative treatment
- Endoscopic carpal tunnel surgery
In those cases, in which an associated disease is identified, adequate treatment must be instituted.
Conservative treatment
It is indicated in mild cases, with lack of atrophy of the tenar eminence, or pregnancy. These patients may respond to anti-inflammatory drugs (steroids or non-steroids) and rest of the hand with a nocturnal dorsal splint that includes the hand and forearm.
In chronic cases, occupational rehabilitation is also useful. If symptoms persist, local corticosteroid infiltration may be performed.
Surgery
The opening of the carpal tunnel is one of the methods of surgical treatment. Surgical intervention is recommended for those patients whose symptoms do not go away within six months or more.
The operation of opening the carpal canal is to separate the bundles of connective tissue that surround the wrist, in order to reduce pressure on the median nerve. The operation is performed by the neurosurgeon in Delhi under local anaesthesia and does not require a long hospital stay. Note that there are two types of surgical intervention:
- open-access surgery, in which an incision is made up to 5 cm, after which the ligament intersects in order to increase the volume of the carpal canal;
- endoscopic intervention, in which two incisions are made up to 1.5 cm long on the palm and wrist, after which a video camera is inserted, tissues are examined and the wrist ligament is dissected. This type of intervention is most effective, characterized by a quick recovery period and the absence of large postoperative scars.
Physical exercise
For patients whose symptoms of the disease are mild, physical exercises that are aimed at stretching and strengthening the hand may be useful. Note that the exercises should be carried out only under the supervision of a qualified physiotherapist or rehabilitologist, otherwise they can aggravate the situation.