Carpal Tunnel Syndrome

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Carpal Tunnel Syndrome, called the median neuropathy of the wrist is a medical condition characterized by the compression of the median nerve, accompanied by pain, paresthesia, anesthesia and muscle weakness. Median nerve is one of the most important nerves located in the upper limb. Has complex origin, is derived from the brachial plexus and has a downward trajectory over the arm, forearm, under the carpal tunnel to the hand, where it divides into branches innervating fingers. It is the only nerve that passes under the carpal tunnel, a fibro-osseous structure located on the palmar part of the wrist. Carpal tunnel contains aside from the median nerve, nine tendons of the flexors of the fingers. Median nerve is responsible for motor and sensory innervation of the thumb and three fingers following, but not the little finger.

Carpal tunnel syndrome patients complain most often, of the weakness in the fingers, pain, numbness, tingling or even abolition of sensation in the fingers and palm (anesthesia). In some cases the pain is more intense and more diffuse, starting from the elbow and down along the forearm until the fingertips. Disorders are felt in the thumb, index finger and half finger three fourth (ring), while the little finger is not affected. A peculiarity of symptoms occurred in the carpal tunnel syndrome is the onset of night and the disappearance after shaking their hand.
Diagnosis of carpal tunnel syndrome is generally done by a neurologist. It must first conduct a discussion with the patient to understand the symptoms, which was their onset and evolution, but also to determine whether there are other systemic diseases that may be risk factors for carpal tunnel syndrome. In addition, daily activities should also be discussed, because, so many people who work a lot and keep their hand on the computer mouse excessively are complaining of symptoms suggestive of carpal tunnel syndrome. Physical examination will objectify the symptoms described by patient, the doctor performing a series of investigations and checking wrist mobility, carpal tunnel consistency, and skin sensitivity in the median nerve innervated territory. Laboratory tests will be required, mainly CBC, that will determine whether there is a systemic problem of the body, which reflect on the nerve, or if, on the contrary, the problem is only local. It can also test the median nerve itself. By conducting neurological tests will determine whether nerve stimulation are properly guided along the path or, if conduction velocity is normal or if there is, somewhere along the nerve, blockages or interruptions of the continuity.
Symptoms of moderate intensity can be treated even at home, without aggressive intervention. Sooner the patient asks for medical advice, sooner the treatment is started and the symptoms usually subside quickly, and will pass only through the application of physiokinesiotherapy measures. Preventing the progression of the disease is the first step in avoiding further complications. Experts recommend that all patients experiencing symptoms suggestive of carpal tunnel syndrome, that any time it occurs pain or paresthesia, to stop working at that time to rest his hand and to shake it a few times. If the pain is intense, may apply ice for 10-15 minutes or 1-2 times per hour localy, or analgesics with moderate action may be given, such as NSAIDs (aspirin, ibuprofen, naproxen) . They have the advantage that, besides reducing pain, can reduce the inflammation too, that is standing many times at the base of the pressure’s growth within the carpal tunnel.

Currently, there are even some medical devices similar to splints, which are specially designed to serve patients with carpal tunnel syndrome. These must be used at bedtime, and will help the wrist and hand to stay in a neutral position, also reducing the pressure and hit the median nerve. It is believed that the hand is in a neutral position when lying, or it is slightly inclined. For example, holding a glass of water on hand is a neutral position.

Patients are advised to consult their personal doctor if symptoms worsen or do not disappear after applying for 1-2 weeks of home treatment measures. Such a trend indicates a more serious condition, the syndrome in this case requiring more aggressive treatment. Often, even surgery may be considered a useful therapeutic option but to use it only when symptoms are so severe that affect the working ability of the patient and do not disappear even after 3-12 months of treatment and neurological physiokinesic enforced. Surgery involves cutting the ligament tunnel, which will significantly reduce the pressure inside, relieving symptoms by improving the management of nerve. Even if in many cases surgery significantly improved symptoms, he has not equally good results in all patients, leaving many with the feeling of paresthesia or anesthesia in the fingers, if the disease was treated in very late stages.
Scientists believe that, to prevent the recurrence of withdrawal symptoms, patients should respect, however, some basic guidelines. They can improve the overall health of the body, preventing other issues. Thus, among the specialists recommendations include both classics: avoiding smoking, maintaining a healthy weight within normal limits, adopting a healthy and balanced diet, moderate exercise daily, and the specific: avoid keeping your hand in the same position for long, having breaks more frequently if the patient works on the computer, trying to hold your hand in a neutral position, grasping and holding objects with whole hand, not fingers, shoulders relaxed when your hands are by your side, and alternating hand movements made when repeated. Fortunately, most patients who develop carpal tunnel syndrome go in time to the doctor, so the recovery treatment is helping very much, and complications rarely occur.
Article Contents
Pathophysiological mechanism
Risk Factors
Consult an expert
Laboratory investigations
Recommended drugs
Treatment at home
Other types of treatment
Complementary and Alternative Treatments


Although it may seem that carpal tunnel syndrome is a condition that occurs only for IT developers, who work a lot on the computer and keep their hand in one position, the disease has actually a very large number of cases, often systemic, diseases, arriving to affect the functionality of the median nerve, in that it will increase pressure inside the carpal tunnel. This increased pressure causes the entire clinical picture which patient accused: tingling, pain, numbness, loss of strength in the hand. Symptoms are combined (motor and sensory) because the median nerve has a complex function. Sometimes, if the pressure is high, the median nerve may suffer along the whole trajectory, not just locally, appearing as intense pain, felt in the forearm.

Causes of carpal tunnel syndrome occurred are very numerous. The dimensions of this space are very small, and yet, through it pass nine tendons and one nerve, therefore, any change, however small and seemingly inconsequential, can cause disease.

The most common diseases that can be complicated by carpal tunnel syndrome are:
- Connective tissue diseases that cause inflammation and swelling joints or reduced blood flow to the hand. These diseases are represented by rheumatoid arthritis, gout, lupus erythematosus, but also obesity, diabetes, hypothyroidism.
- Inflammation of tendons (tenosynovitis), which will significantly reduce the space of the tunnel.
- Accumulation of fluid in the carpal tunnel (edema) can occur in pregnancy (condition characterized by fluid retention throughout the body), diabetes or rheumatoid arthritis.
- Bone injuries: fractures of the carpal bones, the distal radius or ulna, bone dislocations, osteophytosis (abnormal bony growths). These conditions can reduce space and increase the blood pressure, triggering the symptoms.
- Appearance of tumors or other mass replacement of spaces that are usually benign and are rare.
- Bleeding occurs inside the carpal tunnel.
- Burns by electrocution. They cause acute carpal tunnel syndrome.
- Amyloidosis, a disease characterized by the formation of deposits of amyloid, an abnormal protein produced by cells in the bone marrow.
- Mucopolysaccharidosis, a complex group of metabolic disorders that cause accumulation and deposition of glycosaminoglycans in cells, tissues and joints especially.
- Acromegaly, an endocrine disorder characterized by the hypersecretion of growth hormone after closure of the growth cartilage, so after the body has completed, in fact, bone development. It occurs mainly in middle-aged adults, GH-secreting pituitary tumors (growth hormone).
- Ageing and changing of the quality’s tissue at this level, it’s damage, or appearance of calcification, the excessive fibrosis, which further reduces the mobility of the tunnel and will be an important factor in increasing local pressure.
- Chronic smoking as significantly alter the quality of blood vessels and promotes the appearance ischemia.
Carpal tunnel syndrome is a condition that has a very important risk factor, the profession. In general are exposed to the appearance of this syndrome those who work a lot on the computer, those who perform physical labor in construction and working with picks, heavy vibrating machinery, with drills, those working in difficult positions, which must keep to long the arm in the same place, which should keep to long objects in the hand, and generally all those who made sudden movements of flexion and extension by hand. These professions are especially dangerous as the patient already has other conditions that predispose to carpal tunnel syndrome.

Sometimes, carpal tunnel syndrome can occur due to particular anatomical features of the patient, because some are more narrow carpal tunnels than others.
There are situations in which doctors can not determine the causes of the syndrome, the final diagnosis was “idiopathic carpal tunnel syndrome”.


The most common symptoms that patients with carpal tunnel syndrome present are numbness, tingling, weakness, pain felt in the fingers or, less commonly, in the palm. Symptoms occur most often in the hand areas that it serves the median nerve (both in terms of motor and sensory), namely the skin of the palm to the thumb, index (index finger), middle finger and half the ring finger ( half of middle finger) and nail bed of these toes. If the little finger is unaffected and the senses are kept intact is a positive sign for carpal tunnel syndrome. Little finger is innervated by another nerve, the ulnar nerve.

Symptoms of carpal tunnel syndrome can occur in both hands, but often they are more serious in one hand, compared with the other. Patients notice symptoms early in the night, and in time they occur during the day. Pain, numbness or tingling wake the patient from sleep, and prevents him going back to sleep. Symptoms appear initially that night because people tend to bend the wrist during sleep, which will further compress the median nerve.

Mild symptoms that characterize most cases of carpal tunnel syndrome occurs in hand and may have and upward trajectory, to the forearm, following median nerve distribution in this segment anatomy.
Often, symptoms include:
- Localized numbness of the hands, face palm, the patient wakes from sleep and can not go to sleep until after shaking the several times.
- Occasional pain, pinching, tingling, all similar sensation when the hands go numb. Most occur when are made movements by the type of holding the phone to the ear, driving a car or reading a newspaper.
- Paresthesia and pain that worsens as it is used the hand, and gets worse when they are made flexion movements of the hand grip.
- Sharp pain, occurring occasionally in the forearm.
- Functional immobility and impotence of the fingers, felt the morning upon awakening.
- Feeling of weakness of the hand, the impossibility of holding objects and even to grab them.
Carpal tunnel syndrome, moderate or intense, may interfere with the patient’s ability to perform daily activities. Thus, the patients can see that it becomes increasingly difficult:
- To make light movements, such as oral hygiene, to comb or to hold the fork in hand. Often, objects can escape from the hand.
- To catch objects with thumb and index, as in a forceps.
- To use your thumb when opening a jar for example, or when using a screwdriver. The syndrome developed, it can be seen as finger muscles, especially of the thumb may suffer atrophy, movements implementation will aggravate relatively easy.

If paresthesia, numbness are among the predominant symptoms, it is unlikely that the disease be carpal tunnel syndrome. Thus, regardless of the type of pain, if there is not associated paresthesia, doctor, most likely, will not put the diagnosis of carpal tunnel syndrome.
It should be noted that not all pain localized in the fingers and hand caused by carpal tunnel syndrome. There are several diseases that may have similar clinical signs, but without clinical expression of increased pressure in the carpal tunnel.

The most common diseases with similar symptoms are:
- Muscle injuries, tendinitis
- Massive carpal fractures
- Dislocated bones
- Hypothyroidism, obesity, rheumatoid arthritis, diabetes
- Arthritis or osteoarthritis located in the wrist.

Symptoms of carpal tunnel syndrome are not always very suggestive, so the syndrome can often be misdiagnosed and the patient will receive another diagnosis, as, as easily can fall in the other extreme, when the disease actually is the carpal tunnel syndrome, but it will come to be finally diagnosed. So always, symptoms will be carefully investigated in terms of laboratory findings, and will be performed nerve conduction studies to investigate the median nerve.

Pathophysiological mechanism

Carpal tunnel syndrome symptoms usually occur in time, and are aggravated by maintaining certain vicious positions, that only emphasize the increased pressure in the tunnel and median nerve compression.

Median nerve passes through the carpal tunnel, an anatomical formation is that surrounded on three sides by bone formation and transverse carpal ligament, the fourth side. Nine tendons pass through this channel and the median nerve can be easily compressed in the tunnel, tunnel dimensions or by reducing or increasing the volume of structures that it traverses, or by both mechanisms. Simple wrist flexion, 90 degrees, can easily reduce the size of the carpal tunnel.

Nerve compression passing profound the transverse carpal ligament cause hypotonia of palm thenar eminence (the most prominent just below the thumb, palm of the hand face) and of flexors of the thumb (thumb), and loss of feeling in innervation of the median nerve territory.

As compression is important and for a long time, symptoms will progressively worsen. In early stages the patient accuses a slight loss of sensation. Because patients present to the doctor on time, there are no complications of the syndrome, resolving it by applying psysiokienesiotherapy measures . In addition, if the syndrome occurs as a complication of other states, often disappears after he resolves the underlying disease or condition that goes after. For example, after pregnancy, it may disappear as quickly as it appeared. Changing hand position and relaxation can be also very useful in relieving withdrawal symptoms.
In some cases, the syndrome can cause permanent damage to the median nerve, lesions that can not be corrected even after surgery. Carpal tunnel syndrome evolving for a long time can cause:
1. Loss of hand and finger movement coordination, muscle atrophy device fingers I-IV, which greatly hindered, if not even impossible to achieve fine motion, grasping objects.
2. Median nerve injuries that will cause difficulty in using the hand. In this case most likely will be neurosurgical intervened in an attempt to recover the nerve, but this treatment will fail to improve motor and sensory function in the territory served, leaving permanent squeals.

Compared with other diseases and injuries, it seems as the tunnel carpal syndrome is one of the most common reasons for absenteeism from work.

Risk Factors

Some studies suggest that carpal tunnel syndrome occurs due to overload of the trades or professions, which require repetitive movements, sometimes intense and that makes a great mechanical stress on the hand and wrist. Although not yet determined exactly which are the most dangerous professions, experts believe that if the hobby or profession requires intense use of hands, the risk of carpal tunnel syndrome is present.

Carpal tunnel syndrome can occur as a result of the combination of a profession at risk and existing medical condition.
The most important risk factors are thought to be:

- Sex: It seems that women are three times more likely to develop carpal tunnel syndrome compared with men. The women aged 40 – 60 years have the highest risk and those who are pregnant. Symptoms are more likely to present at the end of the pregnancy, as the body fluid retention is larger and swelling is increasingly important. It seems that they have increased risk and women who take oral contraceptives, menopause or who are taking hormone replacement therapy.
- Heredity: If one of the relatives had carpal tunnel syndrome, the risks are much higher.
- Profession: especially those that require more manual labor, the person who keeps the hand in the same way, the one that manipulate objects or industrial vibrating machines.
- It carries risk: smoking is one of the most frequently cited risk behaviors, because it significantly affects the blood.
- Other coexisting medical conditions: diabetes mellitus, lupus erythematosus, rheumatoid arthritis, hypothyroidism, multiple sclerosis, chronic renal failure in advanced amyloidosis.
- Obesity.
One of the most important steps in controlling symptoms of carpal tunnel syndrome is represented by maintaining a healthy weight; avoiding overweight and obesity has positive effects felt by the entire body. It is important that, if the patient realizes that certain activities at work or even some hobbies trigger the symptoms, their performance is reduced or even avoided, at least for a while. If symptoms disappear, then most certainly, that work is a risk factor for the syndrome and its continuation will surely lead to the disease’s development.

Consult an expert

Patients are advised to consult a medical or go the emergency room of a hospital, if notice the abolition of the hands’ senses, or if the driving force disappears completely.
The doctor must be notified if you experience:
- Feeling of paresthesia, numbness, tickle, weakness or pain in the fingers or hand, especially if these symptoms are recurrent and not disappear after 2 weeks of home treatment.
- Local anesthesia, with gradual evolution in time or sudden.
- Inability to perform certain movements such as grasping of the objects between thumb and forefinger.
- Escape objects from hand.
- Failure to use normal thumb.
- Problems at work because of the impossibility of the correct and appropriate use of hands and fingers.

If symptoms are mild, patients may try to treat them at home, but if they do not improve after 1-2 weeks, the safest is to contact a specialist.
Specialists who can be consulted:

In order to evaluate symptoms, to have a specialist investigation, establishing a diagnosis of certainty, and establish appropriate treatment, patients can address many types of specialists. If there is a basic condition, which may be a risk factor in the occurrence of carpal tunnel syndrome (such as diabetes, connective tissue disease, hypothyroidism), the best would be to seek first medical care for that condition. Among the first doctors you can consult is family doctor, internist or the physiokinesiotherapeut.

Subsequently, the patient may be referred for further investigation, by a:
- Orthopedics
- Neurologist or neurosurgeon
- Rheumatologists
Treatment can be done by doctors mentioned or can be left to other specialists, such as a physical therapist, or more frequently, a physician of medical recovery.

Laboratory investigations

To establishthe certainty of the diagnostic, the doctor will need to carefully investigate the patient’s condition and will perform a series of very detailed analysis and investigations. History is part of the a discussion with the patient, the physician is asking for data about symptoms and medical history.

What matters in these situations are:
- The onset of symptoms, their evolution over time, response to treatment at home.
- Worsening or improvement to the presentation to the doctor.
- Other diseases of the patient, their evolution and response to treatment given to them.
- The existence of other such episodes in the past.
- Profession, hobbies, risk factors and dangerous behaviors (alcohol, drugs, smoking).
- For women it is important to note if they are pregnant or if they take oral contraceptives or if they are at menopause.
- Medical history of thefamily (family), because of the risk that such a disease to be transmitted from one generation to another, or at least the risk of them to be higher if one of the relatives had carpal tunnel syndrome.

History will be performed simultaneously with physical examination, the doctor wanted to investigate and objectify the amendments of feeling and force that the patient presents.

The doctor will perform a series of maneuvers and tests, including:

1. Phalen maneuver
Requires a slight flexion of the wrist, then maintaining this position for as long period in which they will be waiting for symptoms. The test is recorded as positive if in 60 seconds from maintaining the wrist in flexion the numbness occurrs, and the tingling in the territory of the median nerve distribution. As sooner the symptoms appear, the more they believe the disease is more advanced.

2. Durkan test
Also called the carpal compression test and consists of applying pressure on the palm over the nerve for 30 seconds to trigger symptoms.

3. Tinel sign
It is a classic sign that the disease is characterized by nerve irritation. It is made by pinching the skin slightly above the flexors retinaculum to stimulate the emergence of a stinging sensation in the nerve territory distribution.
The patient may be asked to complete a diagram to show exactly where he feels the numbness and pain.
If the symptoms are severe, if treatment failed to improve nonsurgicaly the patient’s condition or if the diagnosis can not be accurately determined only based on information provided by history and physical examination, the doctor may perform other specialized laboratory investigations, such as:
1. EMG and Nerve conduction tests
Are important in assessing the functionality of the median nerve. Their achievement is especially recommended for patients who are candidates for surgery or those whose diagnosis can not be established otherwise. Electromyography is a technique for assessment and recording of muscle stimulation, it detects electrical potential generated in the muscle, myocytes, when these cells are resting or in active state. Nerve conduction studies are done to evaluate symptoms like tingling, numbness, muscle weakness, and power management evaluates the body’s motor and sensory nerves.

2. Radiographs
Are mainly indicated to rule out other causes that can explain symptoms such as bone injuries, fractures, bony growths located in the carpal bones, arthritis, and even tumors that extend into the carpal tunnel.
3. Ultrasound
Can provide important information on the median nerve, such as dimensions, anatomic integrity, relationship with surrounding structures. Procedure is considered inexpensive, quick and comfortable, those being just some of the reasons that has great clinical applicability. Ultrasound as a diagnostic method for carpal tunnel syndrome certainly has not yet proven, but it is useful to exclude other diseases.
4. Magnetic resonance imaging (MRI)
May reveal the existence of local edema, carpal tunnel bottlenecks and traffic problems within the carpal tunnel.

5. CBC
It is useful in assessing overall health, and is mandatory for all patients.

Currently, diagnosis of carpal tunnel syndrome is determined based on results from electrophysiological investigations. Patients with intermittent numbness of the median nerve territory distribution and who test positive at Phalen and Durkan, but who don’t have abnormal results at electrophysiological investigations, have at most an light form of carpal tunnel syndrome. If there is a predominance of pain from numbness and tingling, the disease is unlikely to be carpal tunnel syndrome, regardless of the outcome of electrophysiological testing.


The goal of treatment is to relieve carpal tunnel syndrome symptoms and restoring mobility in the wrist joint, allowing resumption of movements with the hand, and preventing disease progression and complications. If carpal tunnel syndrome is due to other diseases, is very important that they be treated fairly and the patient’s condition, balanced.
Treatment of carpal tunnel syndrome is made according to the severity of the disease, taking into account and whether there is nerve damage or other systemic diseases. Treatment options include medical measures, physiokinesiotherapeutic, and surgery.

If the patient goes to the doctor in time and the disease do not advance, it might be recommended home treatment. Thus, symptoms may subside in about 2 weeks. But if the methods recommended by experts for home treatment does not prove satisfactory, options include medication, or orthotics fitting splints or surgery.
Nonsurgical treatment

If symptoms are not severe, physicians often prefer recommending non-surgical treatment such as corticosteroid injections, placing splints, or administration of analgesic and anti-inflammatory medication.

For mild or moderate carpal tunnel syndrome, the most common therapeutic recommendations include:
- Changing the treatment of other concomitant medical conditions, and if treatment given until consultation could not balance the patient’s condition.
- Change daily activities, so there is no occupational risk factors.
- Frequent moments of relaxation between various activities, especially if they require manual work.
- Wearing a wrist orthosis with non-removable splint, especially at night, to keep his hand in a neutral position, which will limit wrist flexion so that the pressure on the nerve is not too high. Although experts believe that such devices are very useful, many patients are reluctant to use them.
- Administration of NSAIDs to relieve pain and reduce inflammation. Although studies have not yet shown the NSAIDs efficiency in carpal tunnel syndrome, patients certainly experience an improvement local pain and discomfort after administration.

Corticosteroid injections can be very effective for temporary relief of symptoms. Are not indicated in long-term treatment due to significant adverse reactions, including reduction of the immune system functionality, osteoporosis, diabetes promote iatrogenic. Generally, injections are prescribed only until it can be recommend another effective treatment.

Surgery is usually recommended when other therapies prove ineffective in controlling symptoms and preventing progression of the disease, but also when there are signs that suggest an important lesion of the median nerve. For many of the patients presenting late to the doctor, surgery is the only effective therapeutic option. During the surgical procedure the transverse carpal ligament section will be the only element that separates the carpal tunnel anatomy on which we can intervene. This ligament runs along the wrist and forms in fact, carpal tunnel’s ceiling. After the intervention and division, it allows the tunnel’s elements to spoil, which will greatly reduce the pressure inside. The procedure is performed according to the experience of each surgeon, currently there are several types of intervention. All have in common incision plamar face or wrist, cutting the transverse ligament and rapid discharge of the patient. Procedures can be achieved by classical technique, the open or endoscopic surgery, the incision is smaller in these cases.

Results of surgery are usually very good or good, depending on how advanced the disease actually was. Data indicates that over 70% of patients operated declare very satisfied with the results of surgical treatment and that over 90% can resume their daily activities and return to work. There are some cases where surgery may not relieve numbness and pain if the nerve is damaged. Such a prognosis less favorable is recorded in development of the diseases with long, untreated evolution, or diseases that complicate carpain tunnel syndrome, such as diabetes, obesity, hypothyroidism. Poor results can occur in patients, alcoholics, smokers, those who do not comply with postsurgical recommendations and resume their activities as soon as strenuous.
Whatever type of intervention chosen, recovery is usually rapid, and the scar that remains is aesthetic.

Recommended drugs

Drug treatment is a symptomatic treatment that can relieve pain and inflammation. By reducing inflammation can be treated and other complaints of the patient, general condition is improving significantly. It should be noted that drug therapy should not be used long term. If symptoms persist or if they worsen even after 2-4 weeks of treatment properly applied, more likely the condition is more serious, and therapy should be reconsidered.

Therapeutic alternatives include NSAIDs and glucocorticoids (administered in local intra-articular injection, or, less commonly, oral). Moderate analgesics such as paracetamol, can be administered, but their effectiveness is minimal if there is an inflammatory component of the syndrome, because they don’t have anti-inflammatory properties.

NSAIDs are widely used drugs, which patients and can buy without a prescription, and are effective in controlling pain and inflammation signs. Because it can significantly reduce inflammation, NSAIDs are effective only in cases of carpal tunnel syndrome occurring in inflammation (whether it is inflammation of a tendon from the tunnel – tendinitis, whether it is a systemic inflammation, such as the collagen diseases). Yet studies have demonstrated the effectiveness of NSAIDs in particular carpal tunnel syndrome, but the truth is that many patients describe a major improvement in symptoms, at least for a while. The recommended NSAIDs are aspirin, ibuprofen or naproxen. Unfortunately, these medications are gastric irritants, experts recommending that their administration is accompanied by a stomach protector, in order to avoid occurrence of dyspepsia. Administration of NSAIDs may worsen asthma in patients diagnosed with this condition, requiring modification in regimen. Often will recommend anti-inflammatory steroids.
Glucocorticoids are substances having similar NSAIDs, but their use is significantly reduced due to systemic adverse reactions. Prednisone is a corticosteroid that can be taken orally. In intra-articular injections is used mainly cortisone. In some cases of carpal tunnel syndrome has proven effective and vitamin B12 (metilcobalamina).

Drug treatment should always be used in combination with other measures to relieve pain and inflammation. Corticosteroids are second-line drugs and are not recommended until after the NSAIDs, and local application of ice, or wearing braces, ware proved ineffective. They are given only a short period, while the doctor tries to find other therapeutic options less dangerous to overall health. Although glucocorticoids are effective in relieving local symptoms, they have a negative impact on the body. Important adverse reactions are those that limit as much clinical use of pharmaceuticals as good acting. Intra-articular administration seems to be more effective than the oral, but none has beneficial effects on long-term. The most important adverse effects of glucocorticoids include immunosuppression, hyperglycemia, obesity, muscle loss, cataracts, glaucoma, euphoric mood, psychosis, osteoporosis.


Most patients with carpal tunnel syndrome are treated by surgery. Because symptoms are very disturbing and impede the daily activities, patients are presented in time to the doctor. The most important reasons to get in some situations to surgery are the patient’s failure to go the hospital (for whatever reason) or misdiagnosis of the case. Because symptoms of carpal tunnel syndrome can be very complex and not specific, sometimes doctors can consider another diagnosis and therefore, will provide another treatment.

Timing of treatment properly, for whatever reason, can eventually lead to the need for reconstructive surgery. Thus, surgery is under discussion when:
1. Symptoms do not improve after applying for a long time nonsurgicul treatment. Generally, the doctor prefers to wait 3-12 months, and the patient is recommended physiotherapy techniques, drugs, measures at home. If they do not influence in any way thesyndrome, then surgery may be considered an alternative.
2. Symptoms are severe and restrict daily activities, the patient losing his ability to coordinate movements, can not grasp objects, they can not hold and has no force in hand.
3. Symptoms affect patient quality of life in all aspects, including disrupts sleep.
4. There is laboratory evidence that the median nerve is damaged, or the risk of future injury is imminent if there is no intervention. Often, once damaged, the median nerve can not recover, and permanent sequel occurr.

Surgical procedures for carpal tunnel syndrome are for reducing the pressure inside the carpal tunnel and therefore the pressure on the median nerve. This is achieved by intervening on the transverse carpal ligament and section it. Cutting will widen the narrow space that includes nine tendons and median nerve. Another advantage of this type of surgery is that, if carpal tunnel syndrome arose by a mass replacement of existing space, the tumor can be removed on this occasion.
In convalescence, until the area heals completely, it is best for the patient to avoid performing certain activities that may constitute risk factors for recurrence of symptoms and therefore the relapse syndrome.


Surgical options

Classical surgical procedure involves cutting (cutting) the transverse carpal ligament, which will translate to improving clinical symptoms due to reduced pressure wrist. Currently there are several surgical procedures, each surgeon prefers the one that can perform better and that he thinks, given his personal experience, the safest and most effective.

The most used are:

1. Open surgery, the classical method
It is a widely used technique, was first described to address carpal tunnel syndrome, surgeons prefer it because it allows direct access and visualization of the whole area. Shout ligament can be observed in full and thus can more accurately determine where cutting should be done. The incision is usually made from palm of hand or wrist exactly. Being a full and deep incision, local tissue architecture and integrity is more impaired, and recovery take longer. Scar, although still small, some patients may be perceived as unsightly, especially if it is a generalized tendency to keloid formation. Incision does not exceed, most times, 3-5cm.
2. Endoscopic method
Calls for a very small incisions (not exceeding 2-3cm) on the wrist (uniportala technique) or wrist and palm (biportala technique). Despite the small size of the incision, it can enter the entire instruments and endoscope, which allows the surgeon to view anatomical parts. The procedure was introduced more recently, in the early 90s, but increasingly ground gaining. Patient discomfort is minimal, and the tissues are less affected than the classical method. Recovery is also faster and the scar is much smaller. As was observed that the risk of reintervention for final resolution of the syndrome is greater after achieving endoscopic technique compared with the classic.
Currently, surgeons choose to perform interventions as simple and they make a minimal incision. The advantages are for the patient, that will not have large scar, and also the doctor himself, as this is allowed to spare as much tissue and facial region. In addition, the risks of iatrogenic harm, by instruments and surgical technique, the median nerve is greatly reduced. These procedures are announced very promising, but until now few studies have been conducted to demonstrate their superiority compared with conventional procedures. 
Surgery is the one that solves most often the symptoms. But it is considered a backup treatment and should only be recommended to the patients whose disease is very evolved or those whose syndrome appeared by local tumor processes, degenerative or traumatic. Before surgery, the patient will be made a series of tests to determine with accuracy the state of the median nerve (the nerve impulse driving tests, electromyogram). Results after surgery are better as the patient had changes of the median nerve, objectified by these tests.
Surgery is not a therapeutic alternative for pregnant women unless symptoms become unbearable. The syndrome often will go away after task completion, along with all edema resorption characteristic of this period.
There are many systemic disorders, chronic, which may complicate, if not properly balanced by treatment, with carpal tunnel syndrome. Therefore, patients who are diagnosed with diabetes, hypothyroidism, rheumatoid arthritis, lupus erythematosus, amyloidosis, must first discuss new symptoms with the doctor who treats the disease in question, and then consult a specialist to address carpal tunnel syndrome .
The decision to use the classic or endoscopic surgical technique depends mainly on experience in developing medical interventions, but also the diseas’s severity and causes of the syndrome. Endoscopic technique, although preferred by patients because of very small scars and minimal discomfort they associate, is not suitable for all, the surgeon being the one who appreciates what to do and how.

Home treatment

Home treatment is indicated for patients who have mild symptoms that do not require aggressive specialist treatment. Home treatment can relieve pain and prevent further injuries, or even completely remove the symptoms if the patient addresses the doctor as soon as syndrome makes its presence felt.
The most important recommendations regarding home treatment include:
- Stop activity, regardless of its nature, if appear painful or numbness symptoms.
- Local application of ice for 10 to 5 minutes once, or twice an hour, in order to ameliorate pain and reduce local inflammation.
- Administration of anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin, which can treat both pain and inflammation. It can manage and paracetamol (acetaminophen), but it does not influence inflammation, only reduce painful symptoms.
- Wearing a wrist braces can prevent increased pressure in the carpal tunnel during the night (and beyond) and can hold your hand in a neutral position.
- Making of exercise, but only during times when no symptoms clinically manifest. They can improve strength and flexibility but locally.

Other Treatments

Other therapeutic options for relieving symptoms of carpal tunnel syndrome include:
1. Physiotherapy
It can be very useful. Recovery methods used may include hydrotherapy, stretching exercises, massage. This can be done by a doctor or medical rehabilitation by a physical therapist. Ultrasound may also be included in these procedures. It uses sound to create heat, it reduces pain in soft tissues, especially tendons. Hydrotherapy involves immersing the wrist in warm water for 3 minutes, then in cold water for proper 3 minutes. This particular type, called contrast hydrotherapy can improve blood flow through the wrist.

2. Wearing wrist orthoses
In some cases, wearing these orthotics and relaxing hand treatment recommendations can be only the doctor deems appropriate. The fastest the patient presents to the doctor the easier treatment will be if it is diagnosed in an early stage. Wrist orthoses prevent flexion at night, which will minimize pressure being put on the median nerve. There are braces that can be worn only at night, and orthotics for the day, more flexible. Their efficiency is most effective when worn under medical advice, even if initially may seem uncomfortable. Patients with intens symptoms and advanced carpal tunnel syndrome may require professional reorientation, also those who underwent surgery for correction of the tunnel. The benefits are twofold reorientation for patients with carpal tunnel syndrome: relieving symptoms and preventing relapses.

Complementary and Alternative Treatments

These therapeutic measures can help the patient, because they reduce numbness, pain and tingling. The main such methods are:
1. Acupuncture: seems to be one of the recommended alternative treatment methods for carpal tunnel syndrome. Scientists have shown that this method is very effective in relieving symptoms, especially pain, in over 28 diseases, including PCOS.
2. Yoga and other relaxation techniques can improve the pain felt in joints and some muscles. Yoga positions are especially recommended for TLS stretching, toning and balance and can significantly improve the health of patients with carpal tunnel syndrome.
3. Dietary supplementation with vitamin B6 may improve symptoms. However, vitamin B6 should be administered carefully because excessive doses can cause neuropathy. Patients are advised to consult first with the doctor before they take supplements of vitamin B6.
4. Chiropractic or joint manipulations were effective but unproven, even though many patients report an improvement in the joints, especially wrist.
5. Electrical stimulation, magnetotherapy and laser therapy have not very effective results, and clinical trials don’t recommend them with confidence yet.


Scientists believe that carpal tunnel syndrome can be prevented, because his appearance is correlated with the achievement of certain business activities or existence of chronic disease background. Therefore, among the most important recommendations aimed at prevention of occurrence of the syndrome are to maintain a good health, avoiding smoking, excessive alcohol consumption, maintaining the optimal weights, treating coexisting diseases, and avoid overtraining hands.
Other recommendations include:
- Conduct exercises to promote flexibility of the hand, joint to enforce their muscle power.
- Termination of activity whenever there is a localized discomfort, numbness, pain or tingling in the wrist.
- Making moves to distribute evenly the pressure over the hand and increase pressure only to the wrist.
- Changing the hand with which is preferred to do certain shares whenever it begins to be felt. Hand-stretched to allow you time to rest.
- Maintaining a good posture at work. Avoid pushing your shoulders in front because in this position the nerves in the cervical region are compressed.
- Avoid excessive salt intake, a factor that favors the appearance of edema and can thus lead to the onset of the syndrome.
- Wearing a wrist braces as recommended by the doctor, even if initially it does not seem very comfortable, as it will greatly reduce the pressure being put on the wrist.
- Keeping hands warm, especially if the patient works in the cold. If you can not control the temperature at work, most useful would be wearing gloves (even without fingers) to heat the palm and wrist.

If you notice that certain activities performed at work will produce symptoms suggestive of carpal tunnel syndrome, try telling the supervisor so that you, for a while, avoid them. If symptoms disappear, it is for sure that the activity was in fact an important risk factor for the occurrence in time of carpal tunnel syndrome. In this case you can communicate your problem to the chief, asking him to give you other tasks that do not include long-standing use of hands in a certain position. Your GP or company doctor or occupational health doctor can take notice and may recommend other more appropriate activities.

In the daily activities and even a hobby, it is necessary to avoid movements that increase pressure in the carpal tunnel. Repeated movements, or conversely, those in what the hand is immobilized for a long time, should be avoided whenever possible.



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