Carpal tunnel syndrome is a common condition caused by pressure or entrapment of the median nerve in the carpal tunnel (tunnel). The median nerve is one of the three major nerves in the hand. Its course starts from the cervical part of the spine, with a direction along the arm and forearm, where it ends in the palm, passing through the carpal tunnel. When the capacity of the carpal tunnel is limited, the median nerve becomes entrapped and compressed. Pressure on the median nerve within the canal can cause severe symptoms and compromise the nerve.
The cause of the syndrome is the relative narrowing of the carpal tunnel space, which results in impaired conduction and therefore functional damage to the sensitive median nerve, due to the increased compressive forces exerted on it.
The narrowing of the space in the carpal tunnel can be due to structural or congenital abnormalities, but usually the main cause is thickening – hypertrophy and chronic irritation of the transverse ligament and the sheaths of the flexor tendons that pass through the carpal tunnel. This can be attributed to overexertion due to work, to hormonal disorders such as diabetes mellitus, thyroid and ovarian diseases, rheumatic diseases, but also less often to taking certain medications, or previous injuries. Its appearance is more common in women than in men.
Numbness can be very annoying and can be combined with severe pain and weakness in the fingers, palm and wrist area. Also, it can often appear during the night hours, interrupting the patient’s sleep, but also after using the hand during the day.
In an advanced stage, loss of sensation, even weakness of the muscles of the fingers and the limb can be observed.
To diagnose the syndrome, in addition to taking a good history and a good evaluation of the clinical findings, a nerve conduction test may be needed, that is, an electromyogram, which is a special test that records the functionality of the nerves of the hand.
In mild conditions, physical therapy is very effective, since with methods such as manual therapy and nerve tissue mobilizations, the release of the nerve can be achieved.
But if conservative treatments fail and symptoms persist (such as thumb muscle weakness or numbness), then the nerve can be released by surgically cutting the transverse ligament to give the nerve tissue the space it needs. It is a surgical procedure that is performed with great reliability and brings immediate results to the patient.
