Carpal tunnel syndrome
Carpal tunnel syndrome is compression of the median nerve at the wrist. This nerve notably provides sensitivity to the thumb, index and middle finger, and also innervates certain thumb muscles at the motor level.
1) A BIT OF ANATOMY
The carpal tunnel is therefore an anatomical area located between the wrist bones (carpus) behind and a thick ligament in front, the anterior annular ligament.
It is through this channel that the median nerve passes, as do the various flexor tendons of the fingers.
2) What are the symptoms of carpal tunnel syndrome? What are the risk factors?
Sometimes this channel narrows. In this case, it is most often the nerve that suffers first. This is expressed by a slowed nerve impulse, and sensory symptoms such as:
- Pain in the first 3 fingers of the hand
In a second step, the attack can become motor, gradually decreasing grip strength, especially in the level of the thumb/index dart.
It is interesting to note that this type of complaint generally occurs in the second part of the night, and disappears by mobilizing the wrist and the hand. Involvement of both hands is common.
Among the main causes, we find:
- Sex: women seem to be more affected than men
- Professional causes: occupations causing overuse of the wrist increase the risk of development of this pathology
- Inflammatory causes: certain diseases such asthe synovial sheaths and narrow the canal, compressing the median
- nerve risk of development of compression of this area
The examination also finds objective signs with a difficulty in recognizing small objects with eyes closed (needle, shirt button, etc.), a reduction in muscle volume at the base of the thumb. The pressure of the median nerve or the forced flexion of the wrist causes the appearance or the accentuation of the disorders.
3) Is that bad ?
Carpal tunnel syndrome is very common in the general population. This therefore does not make it a rare and/or serious pathology.
However, if not taken care of quickly and seriously, the pain can quickly become very unpleasant and debilitating. It is therefore important to consult a health professional in the event of the appearance of the symptoms mentioned above.
4) Is surgery compulsory?
The treatment option chosen depends on the severity of the compression and the symptoms, as well as the duration of these. In order to objectify the diagnosis, certain imaging techniques such as x-rays can be used to exclude a traumatic cause or compression of cervical origin. At the same time, the electromyogram (EMG) measures the electrical impulse transmitted by the median nerve and makes it possible to evaluate any deficits, and to locate the level of compression.
Before planning a surgical intervention, a physiotherapy treatment can allow the reduction of the symptoms, then a medical treatment (night splint, infiltration, etc.).
If this fails, surgery then becomes necessary to permanently lower the pressure in the carpal tunnel and release the median nerve.
In the case of manual work, a work stoppage of 2 to 3 weeks is usual. The palmar region, the base of the thumb and the 5th finger remain sensitive to pressure for 3 to 6 months. Full strength and sensitivity return after the 6th month.
5) How is rehabilitation going?
The work with the physio will mainly focus on educating the patient on good behavior to have in daily life. The treatment will also aim to find functional amplitudes as well as a recovery of overall and analytical muscle strength.
In case of manual work, a work stoppage of 2 to 3 weeks is usual after intervention. Some areas may remain sensitive to pressure for 3 to 6 months
6) Can I continue to train?
Carpal tunnel syndrome is not an absolute emergency. The interruption of the activity is therefore not obligatory. However, in case of symptoms, consulting a professional will establish a treatment plan to avoid complications and reduce pain.
7) What can I do to speed up the process?
In order to speed up the healing process, be sure to follow the recommendations of the health professionals with whom you work.
Laziness or, on the contrary, overzealousness, will be your enemies.
Conversely, discipline, rigor, perseverance as well as a positive and voluntary state of mind will help you get back in top shape as soon as possible!
We care, U perform