A while ago, I went with my mother to a rehabilitation clinic and found out that she had a hand injury. At first, she felt pain and numbness in her hand when she washed dishes. Later, she decided to seek medical help because the pain had worsened to her shoulder and she could not even do her daily activities such as brushing her teeth and getting dressed. I’m sure many of you have experienced hand injuries! This phenomenon often occurs in people who use their wrists repetitively, such as mechanics, carpenters, typists, and housewives, etc. It is especially common in the habitual hand, and the symptoms are aggravated by work.
Is carpal tunnel syndrome a median nerve compression or ulnar nerve compression?
The nerves in the palm of the hand are mainly innervated by the median nerve and the ulnar nerve: the median nerve is responsible for sensation in the thumb, index finger, middle finger, and half of the ring finger, while the ulnar nerve is responsible for sensation in the other half of the ring finger and the little finger. If the median nerve is compressed, Carpal tunnel syndrome develops; compression of the ulnar nerve develops Cubital tunnel syndrome.
The 5th, 6th, 7th and 8th cervical nerves and the 1st thoracic nerve merge into the brachial nerve plexus, which is divided into the median nerve, ulnar nerve, radial nerve, etc., and is involved in the movement and sensation of the hand. The 6th and 7th cervical nerves mainly innervate the sensation of the thumb, index finger, and middle finger, and the symptoms are similar to the carpal tunnel syndrome if an attack occurs.
Today, we are going to introduce the more frequent “carpal tunnel syndrome”.
The main cause of carpal tunnel syndrome: median nerve compression
Carpal tunnel syndrome is caused by pressure on the median nerve in the wrist, resulting in pain, numbness and pins and needles in the index finger, middle finger and thumb area of the median nerve canal. The carpal tunnel is a channel formed by the fibrous tissue and the bones of the wrist. The top of the tunnel is covered by the carpal ligaments, creating a tunnel-like appearance.
Symptoms
Carpal tunnel syndrome can be divided into three major periods: early, middle, and late.
- Early symptoms include: numbness and pain in the palm of the hand, which may increase at night and temporarily decrease with shaking. Later, numbness and pain gradually appear during the day and are aggravated by repeated wrist movements.
- Middle stage symptoms include: impairment in daily behavior or movement, inability to grasp objects, numbness, painful symptoms that may even radiate to the elbow or even the shoulder.
- Late symptoms include: limited hand movement, loss of sensation, and muscle atrophy.
Ethnic group
However, as scary as it may sound, not everyone has risk factors. People with carpal tunnel syndrome include: people with repetitive wrist movements, women (3-10 times more than men), pregnant women, diabetics, people with hypothyroidism, people with rheumatoid arthritis, people with amyloidosis, and people who are overweight.
Diagnosis
But how can you tell if you have a simple muscle strain or if you already have this syndrome? The diagnosis is made clinically with a “nerve conduction test”. Neuroconduction testing uses a small electrical current to stimulate the median nerve to assess the response of the nerve and the extent of the injury. When the median nerve is compressed, the speed of conduction decreases, providing the physician with a basis for diagnosis.
Treatment
The treatment can be divided into non-surgical (conservative treatment) and surgical treatment.
Non-Surgical Treatment
- The use of the vertical wrist log: The vertical wrist log allows the wrist to be in a relaxed state and prevents excessive wrist force to reduce nerve compression in the carpal tunnel.
- Steroid use: Injections or oral administration is one of the treatment methods, mainly to reduce tissue inflammation to improve the symptoms of carpal tunnel syndrome.
- Carpal tunnel relaxation: This is done by relaxing the carpal joint, increasing the space in the carpal tunnel, and reducing median nerve compression.
- Nerve and tendon slippage treatment: mainly through wrist exercises to improve the median nerve adhesions and reduce the symptoms.
- Ultrasound therapy: Using ultrasound to raise the temperature of the muscles to reduce muscle pain and improve discomfort.
- Wax therapy: Similar to ultrasound that raises muscle temperature to reduce muscle pain and improve discomfort.
- Transcutaneous electrical nerve stimulation: The use of electrical stimulation to stimulate the secretion of endorphins to achieve pain relief.
- Vitamin B Complex: As a supplement, Vitamin B Complex has a neuroprotective effect and improves nerve pain.
Surgical Treatment
If there is already a decrease in hand function, muscle atrophy and nerve degeneration, surgery should be performed as soon as possible. The principle of surgery is to cut the transverse ligament that forms the roof of the carpal tunnel to reduce median nerve compression.
Prevention
Although small, the human hand has great potential. The hand is really a very important organ, but at the same time should be used to avoid excessive use, after a long period of use should also remember to rest, help the hand stretch. With proper rest and proper treatment, we believe that the symptoms of carpal tunnel syndrome can be improved and the adverse effects of this disease on life can be reduced.
參考資料:
- National Taiwan University Hospital
- Lin Shin Hospital
- Carpal tunnel syndrome 🔗
- Cover image from pixabay 🔗
