I have had several patients who have come to my office for a wrist problem such as carpal tunnel syndrome and are amazed when I tell them that the wrist alone is made up of 8 bones. “8 bones? Where do so many bones fit in such a small space? And yes, the wrist is a fairly complex structure, where a large number of important tendons, arteries and nerves pass through. This time we will talk about a disorder: carpal tunnel syndrome. We will tell you all about the nerve and the muscles (or rather, the tendons of the muscles) involved in the injury.
What is carpal tunnel syndrome?
The carpal tunnel is, as its name indicates, an “anatomical channel” located in the wrist region, this channel is bounded by the carpal bones at the back and the transverse carpal ligament at the front. This ligament originates from the scaphoid and trapezius , and inserts on the hook and pisiform.
A large part of the flexor muscles of the hand and fingers run through this channel called the carpal tunnel, therefore, the muscles and tendons that are responsible for flexing the hand pass through this channel located in the wrist to then some insert into the carpal bones and other tendons reach the fingers of the hand.
wrist pain What can be?
Do you have a wrist pain that does not leave you alone? Have you been unable to perform your activities of daily living such as working on the computer, showering and toileting properly, or even picking up things because pain and weakness prevent you from doing so for days? Well, the next video is for you. Here we explain the most frequent causes that may be causing pain in your wrist (ganglion or open wrist, carpal tunnel syndrome, osteoarthritis, tenosynovitis of the extensor muscles, etc.) and how to identify them.
The median nerve, which supplies the muscles of the thumb and hand, travels through this tunnel. In addition to the median nerve, we’re going to find the blood vessels and tendons that work to flex the wrist and fingers also go through the carpal tunnel.
Carpal tunnel syndrome is a pathology in which the median nerve is pinched or compressed within this tunnel.
Among these carpal tunnel structures are all the tendons of the flexor muscles of the hand, fingers, and thumb, vascular structures, and also the most important structure for which this article is concerned, the median nerve. The median nerve travels through this tunnel and innervates the muscles of the thumb and hand and part of the skin on the palm of the hand. As I explain below, it is precisely the compression due to the lack of space due to the narrowing of this channel that causes “Carpal tunnel syndrome”.
Carpal tunnel syndrome is the most common neuropathy (pathology or nerve injury) in the upper limb and consists of compression or entrapment of the median nerve as a consequence of the narrowing of the carpal tunnel, and therefore, the most common cause of back pain doll.
The thickening of the transverse carpal ligament will put pressure on the surrounding structures including the median nerve. Even a flexor tenosynovitis of the hand can cause this pathology since if the inflammation of the tendon reduces the diameter of the carpal tunnel, it strangulates the median nerve.
Neuropathy, or carpal tunnel syndrome, affects women more often than men, with a ratio of 3 to 1, particularly women in menopause. In most cases it affects people between 50 and 65 years old, in most cases it is bilateral and appears together with trigger finger.
Causes of carpal tunnel syndrome
Typically, symptoms related to median nerve pressure in the carpal tunnel are secondary to inflammation of the flexor tendons. It may be commonly associated with overuse such as repetitive activities such as excessive typing, or using a computer mouse, but there is little evidence that repetitive activity is a direct cause of this syndrome.
Mechanical problems can be a contributing factor to wrist trauma, such as sprains and the use of vibrating tools such as a demolition hammer, leading to carpal tunnel syndrome. Night pain may also be associated with thumb and hand positions. During sleep, if the wrist is held in a sustained flexed position, the median nerve can be pinched.
There are factors that will predispose to carpal tunnel syndrome. Women are three times more likely to suffer from it.
Another aspect is that some people are simply born with a narrow carpal tunnel, which makes it easy for the nerves to be compressed. Other factors such as water retention (for example, during pregnancy), an overactive pituitary gland, repeated use of vibration equipment, rheumatoid arthritis, and hypothyroidism may be important contributors to the development of tunnel syndrome. carpus Unfortunately, sometimes there is no known cause, which makes treatment difficult.
On the other hand, the peripheral nervous system is a set of nerves that are in the form of a continuous network that originates from the brachial plexus in the cervical spine. For all these reasons, it can also be related to problems that contribute to reducing the flexibility and mobility of the peripheral nervous system of the arm as a whole, cervical problems or tension in the anterior muscular chain of the arm, as well as a tendency to thoracic outlet syndrome, for tension of the pectoralis minor, or of the scalene gorge can always be associated with this pain syndrome.
Symptoms of Carpal Tunnel Syndrome
As carpal tunnel syndrome is a compression of a nerve, the symptoms are neurological in nature. They include numbness, tingling, burning, pain, and weakness in the region invaded by the terminal branches of the median nerve in the palm of the hand. The median nerve is responsible for sensation and muscle activity in the front of the thumb, index finger, and half of the ring finger, so symptoms occur in these areas. With the most significant cases, atrophy of the muscles of the ball of the thumb (called the thenar eminence) may appear. Weakness can also affect the pincer grip between the thumb and index finger.
In the first stage of carpal tunnel syndrome it is only numbness or numbness at night and during the first hour after waking up, this progresses to loss of sensation during the day.
Nerve involvement includes the thumb, index, middle and ring fingers, since they are innervated by branches of the median nerve. If only one or two of these fingers are affected, it is not possible to speak of carpal tunnel syndrome, and the cause must be sought elsewhere.
In advanced stages of carpal tunnel syndrome, irritation of the median nerve causes pain in the wrist and forearm.
Over time it becomes difficult to grasp objects, sew, make a fist and there is a weakening of the muscles of the hand, and of the thenar eminence in particular. The affected person may have difficulty sleeping at night and may wake up with pain and tingling.
Diagnosis of Carpal Tunnel Syndrome
Due to the neurological nature of carpal tunnel syndrome, it is possible for symptoms to arise from other causes, including the cervical spine and even the elbow. If you have symptoms that extend beyond your hand and wrist, insist that your physical therapist do a thorough evaluation to determine the true source of your symptoms.
A number of tests used to help diagnose carpal tunnel include the Phalen test. It consists of a maneuver in which the backs of the hands are pushed against each other with the fingers pointing downwards and is held for one minute. If carpal tunnel symptoms recur, the test is positive.
Another test is called the Tinnel test which involves tapping the base of the wrist in the carpal tunnel to see if the median nerve is irritated. A positive test is the reproduction of pain or neurological symptoms.
One of the most common diagnostic tests to help determine the origin of the symptoms is a nerve conduction test, in addition to this, an electromyogram can be performed to determine if the musculature innervated by the compressed nerve has become affected. These results are discussed before surgery and should be thoroughly evaluated.
Carpel Tunnel Syndrome Treatment
As inflammation of local tendons can contribute to carpal tunnel symptoms, reduction of inflammation is a goal of pharmacological treatment. In addition to medications, the use of ice therapy can help reduce local swelling. Due to the neurological nature of carpal tunnel, if the use of ice increases local pain and tingling, minimize ice time from 10 minutes to 5 minutes.
The main thing for the treatment of symptoms is the limitation of aggravating activities. If writing is the main aggravating factor, the use of ergonomic writing aids will minimize stress on the nerve. Using a keyboard cushion improves the angle of the wrist. The grip between the thumb and index finger can become weak, so the use of writing instruments with a larger diameter can be helpful.
In cases of severe pain and specifically if symptoms occur at night, the use of the wrist splint is recommended. The splint helps keep the wrist in a neutral position, preventing compression of the tunnel.
Physical therapy treatment for carpal tunnel syndrome may include electrotherapy, soft tissue massage, and exercise and stretching. The goals of physiotherapy are to improve soft tissue mobility, nerve flexibility to reduce nerve entrapment, and restore and stimulate muscle strength.
Recommended exercises for carpal tunnel syndrome
In this section we give you a series of exercises and useful recommendations to complement the individualized physiotherapy treatment adapted to each person.
Carpal tunnel syndrome is the most common neuropathy in the upper limb and occurs due to compression of the median nerve at the level of the carpal tunnel. The causes of this pathology are varied, it can appear due to repetitive movements, trauma, genetics, among others.
Its symptoms are pain, tingling, numbness and weakness throughout the region innervated by the nerve. These symptoms could be due to other causes, so a detailed evaluation should be done to determine if the symptoms really are due to carpal tunnel syndrome or come from another source.
To treat the carpal tunnel we have two ways: conservative treatment (physiotherapy) and surgical treatment. Conservative treatment has proven to be effective in cases with mild and moderate symptoms, but in severe cases, surgical treatment is the best option.