Pain and tingling in the hand, carpal tunnel syndrome

Health Mello22 July 25, 2016 0 8
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The carpal tunnel syndrome is the most common nerve constriction that occurs there. The result is a compression of the median nerve in the hand which makes for pain and tingling. What structures are exactly in hand, how this herniation is caused, how it is diagnosed and what treatments are available?

Anatomy


 To understand how complaints arise, it is important to know what structures there are in the hand and wrist. In the poor run various nerves and one of them is called the median nerve. In case of entrapment of this nerve rise to the classical symptoms such as carpal tunnel syndrome. The median nerve provides feeling the palm with the thumb, index finger, middle finger and part of the ring finger. On the back of hand even only the fingertips do with it, the rest of the hand is innervated by other nerves. These n. median nerve in the wrist runs through a tunnel type of it, also known as the carpal tunnel. This tunnel is formed by a solid sheet of connective tissue called the ligamentum carpi transversum. Ligament stands for connective tissue, carpi stands for hand and transverse means that it runs across. Together with the median nerve pass through the carpal tunnel even more structures such as blood vessels and muscle tendons.

Clinic


 Symptoms include a painful, deaf and / or tingling in the palm which often goes to the thumb, index finger, middle finger and part of the ring finger. The back side of the hand is unaffected, except for the tips of the fingers described. In some cases, it radiates into the forearm and even the upper arms. The route that is making the pain in the arm on the inside. The symptoms are most prominent in the night and they often wake up from here. By waving the hand, or reduce the symptoms disappear again temporarily. Often people experience with CTS awkwardness and his actions when typing and writing difficult.
With a long-standing compression of the nerve also occurs power loss. The median nerve is responsible for activities of the innervation of two thumb muscles. The movement with the thumb of the hand is moved away is provided by the musculus abductor pollicis. If the thumb is put on the little finger, including the musculus opponens pollicis is active. Due to reduced power and control in these muscles, people often let things fall out of this hand. Over time, it can be seen that the thumb of this hand muscles have decreased in size and mass, this is called duimmuisatrofie. It is very different for each person how the symptoms are present and to what extent.

Causes

It is still not clear why some people in the carpal tunnel creates a constriction of the median nerve. It is more common among certain professionals such as chefs and painters, probably because they repeatedly make the same movements. It is not hereditary, but can occur in the family as she example, sit in the same work branch. When certain disorders CTS also more common, though this is rare. This is the case in rheumatoid arthritis, hypothyroidism, acromegaly, diabetes mellitus, trauma, dialysis patients with a shunt in the forearm or a tumor.

Research

There are several tests to confirm the diagnosis of CTS. When the neurological examination of the test and the test of Phalen Tinel can be performed. In the test of Phalen, the hand in the wrist bent 90 degrees with the palm facing the lower arm. Researcher holds this position for one minute. If the same symptoms occur within that minute, that's a clue to CTS. At the trial of Tinel knocks the investigator with his / her finger significantly on the transverse ligament carpi. Also in this case that the test is positive if the generating his complaints.
Sometimes it is necessary to do additional research, because the diagnosis can not yet been set on the basis of the clinic. In that case, is frequently chosen for an EMG. This stands for electromyography and hereby is measured how much time an impulse to go through a nerve. This is compared to the duration of other nerves. Because of the blockade in the carpal tunnel, the n. medianus delayed conduction tones compared onbeknelde nerves. Depending on the suspected cause may still place additional studies, such as X-ray or blood test.

Treatment


On the basis of the complaints and the outcome of the EMG will determine the severity of the CTS is. Depending on the severity will be chosen appropriate treatment. In a slight variation is also often selected a plaster splint at night. Here, the brace pushes the hand in a light-stretched state, so that space is created in the carpal tunnel. Sometimes there may also be chosen for a local injection of steroids. If symptoms persist despite previous treatment or if there is duimmuisatrofie, then surgery is needed. It is by the plastic surgeon or neurosurgeon ligament carpi transversum by taken under a local anesthetic.
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