Carpal tunnel syndrome (CTS) or median neuropathy at the wrist is a medical condition when median nerve is compressed at the wrist. It leads to pain, paresthesias and muscle weakness in the forearm and hand. It is a form of compressive neuropathy and CTS can occur at any age.
Signs and symptoms: In most cases, CTS is due to repetitive activities along with several other possible causes. The signs and symptoms of carpal tunnel syndrome are:
1. Sensory deficit and loss over the distribution of median nerve.
2. Electrical twinge (Tinel’s sign): Tinel’s sign is a way to detect irritated nerves. .
3. Flick sign when positive is characterized by flicking of the wrist as if shaking a thermometer.
4. In longstanding cases, there will be wasting of the muscles in the thenar eminence giving it a flat appearance.
5. Tourniquet Test is positive. This is done by tying a BP cuff on the arm and inflating it. If the patient complains of paresthesias, the test is positive for carpal tunnel syndrome.
1. Spontaneous resolution with a placebo gives recovery in 50% of cases, 80% respond in short term cases.
2. Avoid extremes of flexion (bending forward) and extension (bending backward) movements over the wrist joint.
3. Eliminate the cause by avoiding repetitive trauma.
4. Avoid use of any tool which involves vibratory movements like using a drilling machine or fixing a screw with a screw driver etc.
5. Use of splints to give rest to the movements through immobilization.
6. Always avoid use of hyperextension braces.
7. Wrist and hand exercises for a brief period.
8. Local or systemic corticosteroids can be considered and an injection can be tried over the area of the carpal tunnel.
9. Consider use of systemic corticosteroids in a tapering dose namely 20 mg prednisone four times a day for 2 weeks followed by 10 mg four times a day for 2 weeks.
10. Local ultrasound therapy for 6 weeks can give relief for 6 months.
11. Nonsteroidal anti-inflammatory drugs might be helpful in combination with an antacid.
12. Surgical intervention is necessary when decompression from the pressure is the lone aim through section of the transverse ligament. This gives immediate relief in routine and simple cases. Chronic cases may get 60% relief. However, one may end up with complications like laceration of the palmar arch and injury to the branches of the median nerve.