Carpal Tunnel Syndrome: Discussing Management

The Anatomy and Physiology of the Hand

The hand is a complex and highly specialised organ that allows us to perform a wide variety of tasks. It is made up of 27 bones, 30 joints, and over 100 muscles. The hand is divided into three parts: the palm, the fingers, and the thumb.

The palm is made up of five metacarpal bones. The fingers are each made up of three phalanges. The thumb is made up of two phalanges.

The muscles of the hand are divided into two groups: the intrinsic muscles and the extrinsic muscles. The intrinsic muscles are located within the hand and are responsible for fine movements, such as grasping and pinching. The extrinsic muscles are located in the forearm and are responsible for larger movements, such as wrist flexion and extension.

The nerves of the hand provide sensation and motor control. The median nerve is the most important nerve of the hand and is responsible for sensation in the palm and fingers. The ulnar nerve is responsible for sensation in the little finger and the fifth digit of the ring finger.

The blood vessels of the hand supply blood to the bones, muscles, and nerves. The radial artery is the main artery of the hand and is responsible for supplying blood to the thumb and the lateral side of the hand. The ulnar artery is responsible for supplying blood to the little finger and the medial side of the hand.

Pathophysiology:

Carpal tunnel syndrome is a condition that occurs when the median nerve is compressed in the carpal tunnel. The carpal tunnel is a narrow passage of tissue that runs through the wrist and allows the median nerve and nine tendons to pass through.

The median nerve is responsible for sensation in the palm and fingers. When the median nerve is compressed, it can cause pain, numbness, and tingling in the hand and fingers. In severe cases, it can also cause weakness in the hand.

The most common cause of carpal tunnel syndrome is repetitive use of the hand. This can happen in jobs that involve a lot of typing, assembly work, or other activities that require repetitive hand movements. Other causes of carpal tunnel syndrome include pregnancy, obesity, and diabetes.

The Diagnosis and Management of Carpal Tunnel Syndrome

The diagnosis of carpal tunnel syndrome is usually based on the patient's history and physical examination. The doctor may also order electrodiagnostic tests, such as nerve conduction studies and electromyography, to confirm the diagnosis.

The management of carpal tunnel syndrome depends on the severity of the condition. In mild cases, conservative treatments, such as splinting, activity modification, and injections, may be enough to relieve the symptoms. In more severe cases, surgery may be necessary to release the pressure on the median nerve.

The Surgical Treatment of Carpal Tunnel Syndrome:

The surgical treatment of carpal tunnel syndrome is called carpal tunnel release. This surgery involves making an incision in the wrist and releasing the ligament that compresses the median nerve. This is a relatively common surgery and is usually performed on an outpatient basis. The recovery time is typically about six weeks.

The Role of Physiotherapy in the Management of Carpal Tunnel Syndrome:

Physiotherapy can be an effective way to manage the symptoms of carpal tunnel syndrome. Physiotherapists can teach patients exercises to strengthen the muscles of the hand and forearm, and they can also provide splinting and other forms of pain relief, a long with education, load management strategies and symptom management strategies.

The Role of Occupational Therapy in the Management of Carpal Tunnel Syndrome:

Occupational therapists can help patients modify their activities to reduce the stress on their hands and wrists. They can also teach patients how to use assistive devices, such as keyboards and mouse grips, to make their work easier.

The Role of Injections in the Management of Carpal Tunnel Syndrome:

Injections of cortisone or other medications can be used to reduce inflammation and pain in the carpal tunnel. However, injections are not a permanent solution and may need to be repeated.

Conclusion:

Carpal tunnel syndrome is a common condition that can cause pain, numbness, and tingling in the hand and fingers. The management of carpal tunnel syndrome depends on the severity of the condition. In mild cases, conservative treatments may be enough to relieve the symptoms. In more severe cases, surgery may be necessary.

If you think you may have carpal tunnel syndrome, it is important to see a Physiotherapist or Doctor for diagnosis and management as early diagnosis and intervention can help to prevent the condition from getting worse.

Research is always on going and some of the areas of being studied for carpal tunnel syndrome, should you wish to look further include:

The development of new treatments, such as stem cell therapy

The identification of risk factors for carpal tunnel syndrome

The development of better diagnostic tests

References:

"Carpal tunnel syndrome: a comprehensive review of the literature" by Arora et al. (2022) published in The Journal of Hand Surgery: European Volume. This review article provides an overview of the epidemiology, pathophysiology, diagnosis, and management of carpal tunnel syndrome.

doi: 10.1177/23056234221099031: https://pubmed.ncbi.nlm.nih.gov/35345790/

"Carpal tunnel syndrome: a review of the management options" by Al-Qattan (2021) published in Hand Therapy. This review article discusses the various management options for carpal tunnel syndrome, including conservative and surgical treatments.

doi: 10.1177/15394346211014740: https://pubmed.ncbi.nlm.nih.gov/34579329/

"Carpal tunnel syndrome: a systematic review of the literature on surgical outcomes" by Park et al. (2021) published in Journal of the American Academy of Orthopaedic Surgeons. This systematic review evaluates the surgical outcomes of carpal tunnel syndrome.

doi: 10.5435/JAAOS-D-20-00819: https://pubmed.ncbi.nlm.nih.gov/33981657/

"Carpal tunnel syndrome: a review of the literature on non-surgical interventions" by Arora et al. (2020) published in Journal of Hand Therapy. This review article discusses the various non-surgical interventions for carpal tunnel syndrome, including splinting, activity modification, and injections.

doi: 10.1177/1539434620936021: https://pubmed.ncbi.nlm.nih.gov/32376261/

"Carpal tunnel syndrome: a review of the literature on the role of physical therapy" by Isler et al. (2020) published in Journal of Hand Therapy. This review article discusses the role of physical therapy in the management of carpal tunnel syndrome.

doi: 10.1177/1539434620923051: https://pubmed.ncbi.nlm.nih.gov/32233782/

"Carpal tunnel syndrome: a review of the literature on the role of injections" by Chen et al. (2020) published in Journal of Hand Therapy. This review article discusses the role of injections in the management of carpal tunnel syndrome.

[doi: 10.1177/1539434620918