Carpal Tunnel Syndrome or CTS is a neurological conditions in which median nerve get compress at the wrist due to overuse of wrist which cause inflammation of flexor tendon at wrist joint. Swelling of flexor tendon cause compression of media nerve which leads to Carpal Tunnel Syndrome.
Carpal tunnel is the fibro-osseous canal formed between three carpal bones (Scaphoid, Trapezoid and Hamate) and the transverse carpal ligament. Median Nerve and Eight tendons of the digital flexors and flexor pollicis longus pass through this 2-2.5 cm tunnel. Therefore any bony or soft-tissue pathology precipitates compression forces over the median nerve passing through the tunnel.
Aeiology:-
1). Occupational overuse of the wrist joint, e.g. computer keyboards and mouse.
2). Malunited Colles Fracture, Rheumatoid Arthritis or Osteoarthritis.
3). Ganglia or Haematoma at the wrist.
4). Connective tissue disorder (amyloidosis).
5). Endocrine disorder such as Diebetes mellitus, hypothyroidism, myxoedema, acromegaly and menopause.
6). Metabolic cause such as gout.
7). Pregnancy.
Clinical Features:-
1). Vasomotor symptoms such as swelling, cold, dry and shiny skin.
2). Pain and discomfort at the wrist during movements or even at rest.
3). Burning, aching, warmth and paraesthesia in the hand and wrist in the distribution of the median nerve (relieved by shaking hand).
4). Motor weakness of opponens pollicis and flexor pollicis brevis.
5). Loss of true opposition.
6). Late-stage muscular atrophy – thenar muscles of the hand.
Special test to diagnose:-
1). Phalen’s test
2). Reverse Phalen’s test
3). Tourniquet sign
4). Vibratory test
5). Bilateral arm percussion test
Treatment:-
1). A simple splint that block movement at the wrist is adequate to avoid compression stretches to the carpal tunnel.
2). Nonseroidal anti-inflammatory drugs (NSAIDs) are used.
3). Local ultrasonic exposure may be used.
4). Pain-free, relaxed, passive or speedy active movements are encouraged in the pain-free range by removing the splint.
5). Cryotherapy or TENS over the palmar aspect of the wrist may be tried.
6). Local corticosteroid injection may be given only after confirming the absence of sensary deficit.
7). Surgical release of median nerve may have to be undertaken by division of the carpal flexor retinaculum and transverse ligament either by open surgery or by endoscopic surgery.