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An in-depth analysis of carpal tunnel syndrome (cts), including its anatomy, nerve supply, pathogenesis, symptoms, diagnosis, and treatment. It covers topics such as the anatomy of the hand and nerve supply, the anatomy and pathogenesis of cts, signs and symptoms, tests and investigations, causes, and principles of treatment. It also discusses risk factors and complications.
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Median nerve microcirculation injury
Ischemic vascular injury and the breakdown in the blood-nerve barrier have also been identified as an essential component in CTS. The blood-nerve-barrier is formed by the inner cells of the perineurium and the endothelial cells of endoneurial capillaries that accompany the median nerve through the carpal tunnel. These endoneurial microvessels are formed from nutrient branches that arise from the radial and ulnar arteries, proximal to the flexor retinaculum. An increase in pressure within the tunnel can cause a breakdown of vasculature within this barrier, causing an accumulation of proteins and inflammatory cells. This may induce a miniature closed compartment syndrome by increasing the permeability, contributing to increased endoneurial fluid pressure and development of an intra-fascicular edema. Patients with vascular problems or prolonged exposure to static loading are particularly prone to a breakdown in the blood-nerve- barrier.
Pain- irritation of nerve
Tingling and numbness – CTS pt affect medial nerve sensory innervation
Vasodilation and stasis of movement during sleep so it shows symptoms during morning and sleep.
NSAIDs work on a chemical level. They block the effects of special enzymes -- specifically Cox-1 and Cox-2 enzymes. These enzymes play a key role in making prostaglandins. Contributor to inflammatory process. By blocking the Cox enzymes, NSAIDs stop your body from making as many prostaglandins. This means less swelling and less pain.
Nonsteroidal anti-inflammatory drugs (NSAIDs) may relieve pain and inflammation and are available with or without a prescription. They work best if your tendon is inflamed. NSAIDS don't relieve pressure on the median nerve, but they may make you feel better.
Corticosteroids may be a treatment option when NSAIDs don't effectively relieve pain and inflammation. But these are powerful anti-inflammatory medicines. They have side effects that should be considered. Corticosteroids can be taken in pill form or injected into the wrist by a doctor.
What to think about
Medicine should be used with other measures (such as ice, rest, and splints) to reduce pain and inflammation.
Corticosteroids:
Usually aren't used until nonsurgical treatments (such as rest, ice, splints, or anti-inflammatory medicines) have been tried for several weeks with no improvement.
Often provide temporary relief (for several weeks or more). Injected corticosteroids usually provide longer-lasting results than those taken by mouth (oral). But oral or injected medicines rarely provide permanent relief from carpal tunnel symptoms.
Carpal tunnel syndrome can cause tingling, numbness, weakness, or pain in the fingers or hand. Some people may have pain in their arm between their hand and their elbow.
Symptoms most often occur in the thumb, index finger, middle finger, and half of the ring finger. If you have problems with your other fingers but your little finger is fine, this may be a sign that you have carpal tunnel syndrome. A different nerve gives feeling to the little finger. You may first notice symptoms at night. You may be able to get relief by shaking your hand.
(i) Exam Overview : Physical exam for carpal tunnel symptoms, your doctor will:
(ii) Tinel's sign test
iii. Phalen's sign test
BEHAVIORAL
Things that put you at risk for carpal tunnel syndrome include:
A number of factors have been associated with carpal tunnel syndrome. Although they may not directly cause carpal tunnel syndrome, they may increase your chances of developing or aggravating median nerve damage. These include:
However, the scientific evidence is conflicting and these factors haven't been established as direct causes of carpal tunnel syndrome.
Several studies have evaluated whether there is an association between computer use and carpal tunnel syndrome. However, there has not been enough quality and consistent evidence to support extensive computer use as a risk factor for carpal tunnel syndrome, although it may cause a different form of hand pain.