Carpal tunnel syndrome, median compression syndrome, brachialgia paraesthetica nocturna, CTS, KTS, nerve compression syndrome, compression neuropathy of the median nerve
The Carpal tunnel syndrome describes a Nerve congestion disease of Median nerve in the area of the flexor wrist. For reasons that are often unexplained, but also due to injuries, inflammations or degenerative changes, an increase in pressure occurs in the carpal tunnel with pressure damage to the median nerve.
The damage to the nerve results in a Degeneration of the ball of the thumb muscles. It also leads to the damage Sensory disturbances in the area of the first three fingers, i.e. thumb, index and middle fingers.
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Of the Carpal tunnel represents a tunnel-like tube. It is located in the depth between the Ball of thumb muscles and the Small finger ball muscles. The median nerve runs through it. It is one of the three main nerves of the arm, which are responsible for the function of the muscles and the feeling.
The pressure on the nerves, for example as an accompanying symptom in thoracic outlet syndrome, causes pain. The pain is particularly severe at night. The clinical picture can progress further and trigger a persistent feeling of numbness, which especially extends to the thumb, index and middle fingers. If the disease remains untreated for many years, the muscles of the ball of the thumb may also decline. In this case, the thumb can no longer be forcefully opposed to the fingers.
One can differentiate between 2 basic reasons:
A definitive cause for the carpal tunnel syndrome can usually not be clearly identified. The above-mentioned and therefore known causes of carpal tunnel syndrome only make up a small proportion of all cases that occur.
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Women are very often in the field of "Menopause" affected by this condition.
Approx. 1% of all women between 40 and 60 years of age complain, at least temporarily, of symptoms that indicate carpal tunnel syndrome.
Especially the increased one Computer usecaused by the use of the keyboard and the "mouse" causes a significant increase in the area of diagnosed carpal tunnel syndromes.
Also Men can suffer from carpal tunnel syndrome Children the disease is relatively rare.
Carpal tunnel syndrome is a compression syndrome of the median nerve in the area of the wrist. This area is called the carpal tunnel. It is bounded by various bony and muscular structures and a ligament.
The said nerve runs through it, which supplies parts of the hand with motor and sensitivity. An entrapment here leads to losses and limitations of motor and sensitive functions of the hand. In order to better understand the symptoms, it is advisable to find out more about the functions and tasks of the median nerve.
This nerve supplies the first three fingers, i.e. the thumb, middle and index fingers, in parts with motor functions and the skin in this area is sensitive. In the case of sensitive care, the symptoms show a very characteristic failure pattern.On the thumb side, the nerve supplies the skin of the palm of the hand on the side of the thumb, the skin of the first three fingers and the skin of the ring finger on the thumb side. On the back of the hand, it supplies the phalanges of the first three fingers and, to a small extent, the ring finger.
In the case of a carpal tunnel syndrome, sensitive discomfort up to numbness of the skin occurs in the supply area mentioned. The severity depends on the degree of compression.
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In addition, it is more difficult to close the fist with a carpal tunnel syndrome, as the muscles are no longer properly innervated. If the symptoms are very pronounced and the compression syndrome is very advanced, the so-called “oath hand” occurs when the patient is asked to clench his fist. The thumb, index and middle finger can no longer be fully bent and are always in a stretched position. This clinical picture is very concise, but does not always correspond to reality.
Usually only the patient's motor skills and strength are limited to such an extent that he can no longer make the clench of fists so forcefully. Carrying objects or physical activities that primarily involve the thumbs are becoming increasingly difficult for those affected.
The failures just described show the full clinical picture of a median compression syndrome. At the beginning of the trapping, symptoms such as diffuse pain and abnormal sensations (falling asleep, pins and needles) occur, especially during and after the stress on the wrists. The pain primarily affects the hand, but it also radiates into the arm.
With increasing compression, the symptoms appear at night and finally during the day at rest. The insufficient supply of the muscles leads to a so-called atrophy, a muscle wasting. The ball of the thumb flattens or dimples. You can see and feel that from the outside.
As the nerve damage progresses, weakness occurs when gripping, which initially manifests itself primarily in the morning, but then also during the day. Ultimately, fine motor skills also suffer from damage to the median nerve.
At this stage of compression, the pain then decreases again, as pain fibers are also destroyed.
Read more on the topic:
The Diagnosis of carpal tunnel syndrome is done first through various tests such as the Phala-Test the Carpal Compression Test, or that Hoffmann-Tinel sign.
In order to understand the diagnostics that are used when a carpal tunnel syndrome is suspected, one must first clarify the cause:
Excessive compression of the Median nerve in the wrist, this swells up and can take the nerve impulses out of the brain no longer pass on sufficiently.
The median nerve is responsible for the sensitive and motor supply of large parts of the hand responsible.
So to find out whether you have carpal tunnel syndrome, the Nerve conduction velocity of the median nerve can be measured side by side. To do this, small electrodes are stuck to the forearm and an electrical pulse is applied at the level of the Elbow set.
The measurement and side comparison with the other hand provide information about the presence of a malfunction. If - as is customary in many cases - it is not possible to compare the sides because the carpal tunnel syndrome is bilateral, you can still use Ultrasonic the Muscle and nerve box examined on the wrist.
To do this, the head of the ultrasound device is placed on the wrist and the cross-section of the arm is shown. You can see the individual in the picture Muscles, Vessels, and annoythat run at the examined location.
A comparison of the median nerve with the nearby structures allows conclusions to be drawn about possible swelling of the nerve. Ultimately, the Diagnosis of carpal tunnel syndrome of course also through the clinical examination done by examining the various symptoms, and an intense one Root cause research is operated.
For example, there are various factors that favor carpal tunnel syndrome. To Pregnancies it is through the Adjustment of the hormonal balance relatively typical of developing carpal tunnel syndrome.
But also Obesity, Trauma or Edema in the area of the wrist - if there are additional restrictions of movement and numbness in the hand - indicate a carpal tunnel syndrome. The diagnosis is not difficult to make, however. Furthermore, since no particularly unusual equipment is required for the examination, the examination can usually be carried out without prior appointment. The examination is usually completed within half an hour.
There are various clinical tests used to examine carpal tunnel syndrome:
The "Phalen test“Who named after its inventor George Phalen was named:
The patient bends his hand for a maximum of one minute in order to then check whether there are any loss of sensation in the area of the fingers.
If the Phalen test is positive, it is a sign of carpal tunnel syndrome.
Another test is the Carpal Compression Testin which the examiner applies pressure to the center of the wrist with both thumbs. After a short time, the examiner stops the application of pressure and - as with the Phalen test - any loss of feeling in the hand is determined. This depression will also be Paraesthesia called, and in everyday medical practice as "Hoffmann-Tinel sign" designated. The Hoffmann-Tinel sign is also an indication of a carpal tunnel syndrome.
The tests mentioned above are very simple and can be carried out without medical assistance, for example together with your spouse. However, if carpal tunnel syndrome is suspected, a doctor should be consulted for final diagnosis and treatment.
Although by means of a X-ray examination If the carpal tunnel syndrome cannot be diagnosed, this examination is still useful. Often one finds other diseases that are associated with the carpal tunnel syndorm (e.g. a Arthrosis of the thumb saddle joint).
A Magnetic resonance imaging (MRI) is not useful in most cases.
Only in the case of one specific suspicion of a tumor such a complex investigation makes sense.
Carpal tunnel syndrome does not always have to be operated on. Often, in the so-called early stages, the administration of vitamin B6 is sufficient. Under certain circumstances, the therapy can be additionally reinforced with a specially adapted night positioning splint.
In the event that there is no improvement in the pain in the medium term and to prevent irreversible damage to the nerves, surgery should be considered.
The decision as to whether or not an operation makes sense should be carefully considered. An experienced neurologist (neurologist = specialist in neurology) or hand surgeon can help you with this.
Read more on the subject at: Therapy of a carpal tunnel syndrome
At the Carpal tunnel syndrome there is a compression of the Nerve and blood vessels in the area of the wrist.
This compression is promoted by bending the hands, for example when grasping or lifting. At first you can still "Shake out“To get rid of the annoying tingling sensation, but in the advanced stages this hardly helps.
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If the carpal tunnel syndrome is not yet too advanced, the OP also one conservative therapy be done by immobilization. The aim is to reduce the pressure on the nerves and blood vessels in the wrist. For this purpose there are several different splint systems that splint and fix the hand. Basically differ rails and Bandages not in their function, but in their material and comfort.
Each manufacturer naturally advertises its product with different advantages, but in the end it is of course the decision of the patient himself whether he decides in favor of a bandage or a splint.
Different models can be tried on in specialist shops. It is also possible to adapt this individually. However, it must be ensured that - regardless of which type of immobilization one ultimately decides - the original purpose of the splint is not forgotten. A Fixation of the wrist is inevitably uncomfortable as it restricts the patient's physiological freedom of movement. rails have the advantage of being easy with a Velcro fastener can be removed, and the area underneath can be washed.
In addition, the solid plastic plates in the splint protect the wrist from external influences. However, there is a risk that the splint will not be worn consistently enough and that the possibility of slight removal will worsen the carpal tunnel syndrome.
Bandages however, enclose that Wrist tight, and also protect it against injuries from external influences with integrated fabric cushions. If a rigid plastic plate is too uncomfortable for splinting, a bandage is certainly a good choice. However, when choosing, it should be noted that it is not an "accessory", but a medical product that must also have a certain benefit.
Neither the bandage nor the splint should fit so tightly that pain or further numbness occurs, but it must Immobilization of the wrist is a top priority as a further worsening of the carpal tunnel syndrome can usually only be treated with an operation.
Carpal tunnel syndrome requires therapy because the nerve damage can progress further, especially if the course is severe and the compression persists for a long time.
In general, conservative therapy may be sufficient for mild compression and mild discomfort. These include gentle measures and immobilization of the hand, which can be achieved, for example, with a splint and pain relievers and anti-inflammatory drugs. If the symptoms persist or if the compression of the nerve is already well advanced, surgical treatment is necessary. There are two common surgical techniques that are used in carpal tunnel syndrome.
The procedures, complications and follow-up treatment of surgical therapy are explained in more detail below.
The carpal tunnel syndrome operation is a fairly straightforward, quick procedure and is rarely associated with complications. For this reason, the operation is usually performed under regional anesthesia so that the patient is conscious during the entire procedure, while the pain is only eliminated in the arm.
An alternative to this is a local anesthetic procedure directly on the nerve plexus that supplies the arm. This pulls through the armpit and can usually be anesthetized with the help of an ultrasound device without any problems.
On the other hand, general anesthesia is very unusual for carpal tunnel syndrome surgery and is usually used when the patient is very afraid of the procedure.
The operation can be done openly or endoscopically. With the open surgical technique, the surgeon has a direct view of the surgical field. First of all, a small skin incision is made approximately in the middle on the palmar side of the wrist. Palmar means "directed towards the palm of the hand".
The cut runs along the wrist and is about 3 cm long. The surgeon must be careful not to cut too far on the thumb side or too far on the little finger side in order not to injure important nerves. In particular, caution is advised on the little finger side, as this is where the so-called Guyon Lodge is located.
This is an anatomical area, a box, in which the important ulnar nerve is located. It supplies the muscles of the hand and the skin in a partially sensitive manner. The surgeon can in principle vary the cutting technique during the operation, so there are e.g. also the short cut technique. In the end, however, the ligament that delimits the carpal tunnel and spans the carpal bones must be cut during every operation.
This ligament is called the retinaculum musculorum flexorum. The severing of the ligament leads to an immediate relief of pressure in the carpal canal and consequently to a recovery of the compressed median nerve, provided the damage has not progressed too far. No further surgical measures on the nerve itself are necessary. This operation is a routine operation by a hand surgeon, which usually proceeds without complications.
With the endoscopic procedure, the surgeon has an indirect view of the surgical field. He sees it through the endoscope. The course of the operation is the same as in the open technique. However, this procedure seems to be more comfortable for the patients due to less scar pain. On the other hand, there may be higher complication rates.
How long the surgical treatment of carpal tunnel syndrome lasts depends on many factors. On the one hand, the doctor's approach and experience play a major role. On the other hand, the individual anatomical conditions of the patient are always important. In general, an uncomplicated carpal tunnel syndrome operation hardly takes more than a few minutes. Once the operation is complete, the patient remains in the practice for observation for some time.
So that the surgical wound can heal without complications, the wrist remains in a solid bandage or possibly even a plaster cast for the next 7 to 10 days. The thread is pulled about 8 to 14 days after the operation is completed. About 6 weeks after the operation, in most cases hardly any scar is visible.
Moving the hand is possible and recommended for the first few weeks after the operation; However, more than light stress should be avoided in favor of good wound healing.
In general, complications that can generally occur during operations, such as rebleeding and infections, are quite rare. In very rare cases a so-called algodystrophy can occur, which is characterized by severe pain. Incisions in the skin that are too small can result in complications during the operation, as the ligament to be separated (retinaculum musculorum flexorum) cannot be completely split.
In addition, the risk of complications with endoscopic procedures is higher than with the open surgical technique. But the scars heal faster here. Complicated anatomical conditions may also make it necessary to switch to an open technique during an endoscopic procedure. Overall, however, these are operations with low risks and few complications. The long-term success is also very good. Most of the patients are very satisfied or symptom-free after the procedure. The more other illnesses there are, for example diabetes, rheumatism or osteoarthritis, the worse the outcome of the operation.
Pain reliever medication can be taken if there is pain. Cooling also helps reduce swelling and pain. The hand should not be completely immobilized, but should be moved slightly to avoid joint stiffness. However, excessive strain and heavy physical activity should be avoided for the first few weeks.
Once the operation has taken place, the patient remains in the practice for observation, for example to rule out any side effects of the anesthesia. Since the effect of anesthesia can last for up to a few hours, depending on the type of anesthesia selected, it is not recommended to go home alone or even to drive afterwards. In addition, unproblematic healing of the surgical wound is only guaranteed if the hand is spared for the next 7-10 days, so that for this reason, too, independent driving is not advisable for the time after the surgery.
As with all procedures, scarring can occur.In addition, there may be a reduction in strength in the first six months after the operation. In the rarest of cases, there is a possibility that an algodystrophy will develop. This algodystrophy includes both motor and sensory disorders.
Read more on the topic: Carpal tunnel syndrome surgery
Homeopathic healing approaches exclude conventional medical treatment for carpal tunnel syndrome per se. Often, patients are advised against surgery and are advised to use alternative methods such as massage, acupuncture and treatment by a chiropractor.
In general, there is nothing wrong with massages, and acupuncture or treatment by a chiropractor can alleviate the symptoms. However, it is questionable whether such methods are really effective, especially in the case of advanced compression of the nerve. You cannot permanently eliminate the cause of the compression, namely the bottleneck in the carpal tunnel.
In addition, homeopathic remedies, which are produced on a plant basis and are available in the form of globules, drops or ointments, are used in homeopathy. The agents Arnica D4, Ruta D4 and Hekla lava D4 are recommended. There is also a complex remedy called Traumeel®. This is available both as an ointment and in the form of tablets.
Read more on the topic: Traumeel S tablets
In order to be able to make a detailed diagnosis, it is important that the patient explains all his complaints to the doctor. Also the questions about the comorbidities, such as Diabetes mellitus ("Diabetes"), Thyroid malfunction or gone through Fractures in the wrists are important.
In the course of the disease, it is not just the nightly pain and abnormal sensations. The symptoms also appear increasingly during the day. In this regard, patients often report "clumsiness" and sudden "weakness" of the hand. The sensitivity of the skin on the thumb, index, middle and ring fingers is increasingly reduced.
In the subsequent stages, the ball of the thumb may be lost.
Fortunately, the complete loss of feeling on the skin in the hand is very rare these days.
The Gender distribution is about 75: 25 (female: male), mostly the primary working hand is affected. In the majority of cases, both hands are affected. This does not mean that carpal tunnel syndrome has to appear in both hands at the same time. In the other hand, the disease often takes years to develop.
During pregnancy, a woman's body is special hormonal situation exposed. Especially in the last one Trimester (Third) pregnancy the body stores more water. The stored water causes the body tissues to swell and especially it at anatomical bottlenecks to compressions of structures such as Nerves can come. The carpal tunnel is such an anatomical constriction.
This results in compression of the median nerve and the typical symptoms of a Carpal tunnel syndrome. Pain in the affected hand dominates, which can radiate into the arm and is particularly excruciating at night. As a result, a lack of sleep and nocturnal restlessness. Also feel especially the middle finger and index finger numb on.
How should carpal tunnel syndrome be treated during pregnancy? In principle, unnecessary interventions should be avoided during pregnancy. The carpal tunnel syndrome, however, can be thanked modern anesthetic procedures also operate during pregnancy.
However, it does not necessarily make sense to do this. In most cases, the syndrome resolves once the cause disappears. It means that after birth and maybe of the Lactation in about 50% of those affected, the symptoms completely subside. You should therefore try to wait for the birth. Especially with nocturnal pain one can Night storage rail be worn.
This is intended to alleviate the symptoms so that the pregnant woman can sleep again as symptom-free as possible. The rail leads to one Pressure relief in the carpal tunnel.
Most of all, waiting for the operation prevents one infection during pregnancy in front. Even if the risk is very low, the operation can lead to an infection, the treatment of which can then be made considerably more difficult by the pregnancy. This is because not all drugs may be given during pregnancy, i.e. they are contraindicated. After weaning, an operation can in principle be carried out at any time. However, it should be ensured that someone has the first 2-3 weeks after the operation Infant care takes over.
This includes, above all, changing diapers and bathing the child. During these activities, the fresh surgical wound can possibly be contaminated with germs. This causes inflammation and infection. This should be avoided in any case.
Carpal tunnel syndrome is a "nerve entrapment" of the hand. If you look at the hand at the level of the wrist, you can see a wide band that stretches between the balls of the thumb and little finger, directly above the wrist. This band is the roof of a canal, namely the carpal tunnel. an important hand nerve - the median nerve. In the case of carpal tunnel syndrome, this channel is exactly too narrow. This puts pressure on the median nerve.
