Carpal tunnel syndrome Discussion

Carpal tunnel syndrome is the effect of abnormal pressure on the median nerve. It can result in a variety of problems, including pain, tingling, numbness, swelling, weakness or clumsiness of the fingers and thumb. Tendon swelling and tendinitis results from a person's own tendency to collect fluid around their tendons and joints. This may be aggravated by repetitive or strenuous activities, but there is no scientific evidence that such activities cause the problem. When the lining around the tendons swells, the pressure cuts off the blood supply to the nerve. Scar tissue may form around the nerve from repeated episodes of pressure. Nerve damage is suspected when any symptoms occur regularly during the day. Electrical nerve study evaluation is indicated in selected cases if there is a question of other nerve compression syndromes, metabolic neuropathy, or nerve damage. Otherwise, management options are based on history and physical examination. In mild cases with tolerable symptoms and no evidence of nerve damage, conservative management is indicated. Nonoperative options include antiinflammatory medication, vitamin B6, wrist splints while sleeping, and cortisone injection into the carpal tunnel. Risk Factors for failure of conservative management include age greater than 50, constant paresthesias, symptoms greater than 10 months, trigger digits, Phalen's test positive in less than 30 seconds, or any sign of nerve damage. Surgery is indicated for patients who have failed conservative management or have evidence of nerve damage. Additionally, patients with mild current symptoms who are having other surgery on the same hand should be strongly considered for carpal tunnel release to avoid the difficult problem of acute carpal tunnel syndrome in the postoperative period. The longer the nerve is irritated, the less likely it is to have a full recovery. Conservative treatment has the risk of progressive nerve damage from prolonged compression, as well as increasing the chance of developing reflex sympathetic dystrophy. The main surgical risks are persistence of numbness due to damage that has already occurred to the nerve or from a secondary site of compression, soreness of the palm (pillar pain), as well as the risks of surgery.

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