Carpal Tunnel Syndrome (Carpal Tunnel Syndrome)

Article written by BSCK II Khuc Thi Nhen, Department of Medical Examination - Vinmec Times City International General Hospital

Carpal tunnel syndrome is a common neurological disease, more common in women than in men. The disease is not fatal but affects daily work and quality of life. The disease can be completely cured if diagnosed, treated properly and timely.

The carpal tunnel is a small tunnel extending from the crease of the wrist to the crease of the hand (about 2.5 cm wide) created by the two sides of the carpal bone, the roof of which is a band of connective tissue called the transverse ligament. Within the tunnel are the median nerve and the flexor tendons of the finger. The inherently narrow tunnel, combined with unfavorable factors, will cause the internal organizations to press on each other, especially the median nerve is the softest and located in a shallow position, so it is very vulnerable.

The median nerve is one of the main nerves in the hand that controls sensation of the thumb, index finger, half of the middle finger and ring finger, and also controls muscle movement of the thumb tissue.

Carpal tunnel syndrome has many causes:
Congenital: because at birth, the carpal tunnel is narrow, making the median nerve easily compressed, often in both hands. Gender: Women have a smaller carpal tunnel structure than men, moreover, women do a lot of manual work such as washing clothes, cleaning the house, etc., so they have a higher incidence of the disease. Occupational nature: jobs that require repetitive hand movements for a long time will also damage the tendons and make the tendons swollen and inflamed, increasing the volume of internal organs, creating pressure. nerve compression (worker, painter, guitar player, computer user....) Pregnancy: Hormonal changes during pregnancy can cause inflammation of the carpal tunnel components. affect nerves. Medical history: synovial hernia, chronic arthritis, rheumatoid arthritis, kidney failure, thyroid dysfunction, ... Trauma: trauma to the wrist or dislocation causing the bones to move puts pressure on the median nerve.

Sensory disturbances: numbness, paresthesia, stinging or burning pain in the skin from the carpal tunnel to the thumb, index finger, middle finger and half of the ring finger, mainly at night. Sometimes the pain radiates to the forearm, arm, and shoulder. Movement disorders: appear when the disease is severe. Expression of loss of flexion of the index and middle fingers of the thumb, the patient cannot perform the movement of comparing the thumb with other fingers, later may see muscle atrophy of the thumb tissue.

4.1 Based on clinical symptoms and some tests Tinel's test: Using a reflex hammer to knock on the carpal tunnel at maximum extension, causing pain or numbness to the thumb, index finger, middle finger and half of the ring finger => positive test (+). Phanel test: flex the wrist fully (90 degrees) and hold for 60 seconds. The test is positive if the patient experiences numbness or pain in the median nerve innervation. Durkan test: The physician presses with the thumb of the patient's wrist. The test is positive when the patient feels numbness, pain increases with the distribution of the median nerve. 4.2 Based on laboratory tests Electromyography: decrease in sensory conduction velocity and increase in motor potential. In the advanced stage, there is no longer a response to muscle movement in the female tissue. Wrist ultrasound: Can detect the cause of carpal tunnel syndrome such as bursitis of the superficial and deep flexor tendons of the fingers, tumors, pseudotumors of the carpal tunnel... or The median nerve can be seen edematous due to compression.

5.1. Medical treatment Surgery to treat carpal tunnel syndrome is considered a "golden" treatment with long-term effectiveness. During surgery, your doctor will cut the transverse carpal tunnel to relieve pressure on the median nerve. There are two surgical methods that are laparoscopic and open surgery.
In addition to the two methods above, it is recommended to have combined rehabilitation treatment, including:
When signs of the disease appear, you should go to a reputable medical facility for early examination and treatment to avoid many complications. serious symptoms. Vinmec International General Hospital is a high-quality medical facility in Vietnam with a team of highly qualified medical professionals, well-trained, domestic and foreign, and experienced.
A system of modern and advanced medical equipment, possessing many of the best machines in the world, helping to detect many difficult and dangerous diseases in a short time, supporting the diagnosis and treatment of doctors the most effective. The hospital space is designed according to 5-star hotel standards, giving patients comfort, friendliness and peace of mind.

References:
Vinmec Hospital. EL MRINI A. Le syndrome du canal carpien. Les cahiers du Médecin, 2007; T IX-N° 110 : 54-5. BLANCHER A, KUBIS N. Physio pathogénie des syndromes canalaires. Revue du Rhumatisme, 2007; 74: 319–26.