CARPAL TUNNEL SYNDROME

Carpal tunnel syndrome(CTS) is a collection of characteristic symptoms and signs that occurs following compression of the median nerve within the carpal tunnel. CTS has an incidence of about 1-3 cases per 1000 subjects per year and prevalence of approximately 50 cases per 1000 subjects in the general population.

But before going forward with our discussion let us get some basic idea about the anatomy of flexor retinaculum(transverse carpal ligament).

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FLEXOR RETINACULUM:

  • Also known as transverse carpal ligament.
  • It is basically a fibrous band which is present on the palmar aspect of hand near the wrist.
  • It arches over the carpal bones of hands covering them and forming carpal tunnel.
  • It forms the roof of carpal tunnel.
  • Median nerve and tendons of muscle which flex the hand pass under this.
  • In CTS, one of the tendon or tissues in the carpal tunnel is inflamed,swollen or becomes fibrotic and puts pressure on the median nerve.Thus causing numbness,tingling and weakness of hand.

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Causes:

  • Majority of the cases are idiopathic(cause unknown).
  • However,it may be associated with:

        1)diabetes

        2)thyroid disease

        3)alcoholism

        4)amyloidosis

        5)inflammatory arthritis

        6)pregnancy

       7)obesity

History of patient:

  • Patients presents with tingling and infrequent numbness of radial three and a half digits.
  • Patient complains of being woken at night by pain and tingling.The pain is relieved by hanging their hand out of the bed.
  • There is complain of clumsiness while picking of objects or carrying heavy weights.
  • It is usually bilateral(occurs in both hands).

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Investigations:

  • Electrophysiologic studies,including electromyography (EMG) and nerve conduction studies(NCS),are the first line of investigations suggested.
  • MRI of carpal tunnel is useful pre-operatively if the space –occupying lesionin the carpal tunnel is suggested.
  • USG can be diagonostic of CTS and help- to guide steroid injections into the carpal tunnel.
  • No blood work is indicated.however,blood work for any associated conditions can be done if indicated clinically.

Treatment:

  • Non operative treatment includes night splintage of the wrist in extension and steroid injections.
  • If surgery is required the median nerve is surgically decompressed by incising the roof of the tunnel(flexor retinaculum),as either an open or endoscopic percutaneous procedure.

 

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By,

Gourav Talukdar

3rd Year MBBS

Murshidabad Medical College and Hospital

 

 

 

GT

About the author: Hi, I am Gourav Talukdar. I am pursuing MBBS from Murshidabad medical college and hospital. I am currently a student of 3rd proff part 1. My hobby is writing microtales and musings.

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