Carpal tunnel syndrome Discussion
Carpal tunnel syndrome is the effect of abnormal pressure on the median
nerve. It can result in a variety of problems, including pain, tingling,
numbness, swelling, weakness or clumsiness of the fingers and thumb. Tendon
swelling and tendinitis results from a person's own tendency to collect
fluid around their tendons and joints. This may be aggravated by repetitive
or strenuous activities, but there is no scientific evidence that such
activities cause the problem. When the lining around the tendons swells,
the pressure cuts off the blood supply to the nerve. Scar tissue may form
around the nerve from repeated episodes of pressure. Nerve damage is
suspected when any symptoms occur regularly during the day. Electrical
nerve study evaluation is indicated in selected cases if there is a
question of other nerve compression syndromes, metabolic neuropathy, or
nerve damage. Otherwise, management options are based on history and
physical examination. In mild cases with tolerable symptoms and no evidence
of nerve damage, conservative management is indicated. Nonoperative options
include antiinflammatory medication, vitamin B6, wrist splints while
sleeping, and cortisone injection into the carpal tunnel. Risk Factors for
failure of conservative management include age greater than 50, constant
paresthesias, symptoms greater than 10 months, trigger digits, Phalen's
test positive in less than 30 seconds, or any sign of nerve damage. Surgery
is indicated for patients who have failed conservative management or have
evidence of nerve damage. Additionally, patients with mild current symptoms
who are having other surgery on the same hand should be strongly considered
for carpal tunnel release to avoid the difficult problem of acute carpal
tunnel syndrome in the postoperative period. The longer the nerve is
irritated, the less likely it is to have a full recovery. Conservative
treatment has the risk of progressive nerve damage from prolonged
compression, as well as increasing the chance of developing reflex
sympathetic dystrophy. The main surgical risks are persistence of numbness
due to damage that has already occurred to the nerve or from a secondary
site of compression, soreness of the palm (pillar pain), as well as the
risks of surgery.
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