Compression of median nerve at the wrist is named as carpal tunnel syndrome (CTS).
Compression of median nerve at the wrist is named as carpal tunnel syndrome (CTS). CTS causes numbness, tingling and weakness in fingers of the hand. It happens when there is increased pressure within the wrist on a nerve called the median nerve. This nerve provides sensation to the thumb, index, and middle fingers, and to half of the ring finger. The small finger (the "pinky") is typically not affected.
Median nerve is one of the major nerves of forearm and hand. It originates from brachial plexus in the arm pit. Median nerve compression is a mononeuropathy that causes motor and sensory loss majorly in hand. Median nerve can also be compressed near the elbow or in the forearm apart from at the wrist.
The carpal tunnel is a narrow canal or tube in the wrist. Similarly, to a tunnel you could travel through by car, this tunnel allows the median nerve and tendons to connect the hand and forearm.
Carpal tunnel syndrome is also more common in women than in men in their middle age.
Carpal tunnel syndrome is caused when the space (the carpal tunnel) in the wrist narrows. This presses down on the median nerve and tendons (located inside the carpal tunnel), which cuts off sensation in the fingers and hand.
Symptoms usually begin slowly and can occur at any time. Early symptoms include:
In fact, because some people sleep with their wrists curled, night time symptoms are common and can wake people from sleep. Shaking the hands helps relieve symptoms in the early stage of the condition.
Common daytime symptoms can include:
As carpal tunnel syndrome worsens, symptoms become more constant. These symptoms of progression include:
In the most severe condition, the muscles at the base of the thumb visibly shrink in size (atrophy) or the patient develops tiny ulcers due to burns on the finger tips
Diagnosis of carpal tunnel syndrome is mostly clinical where a proper history, clinical examination and detail of pre-existing diseases help in arriving at proper diagnosis. Two clinical tests commonly done are-
Few investigations are done to confirm the diagnosis-
Carpal tunnel syndrome can be treated non-surgically or with surgery. Non-surgical treatments are used for less severe cases and allow you to continue with daily activities without interruption. Surgical treatments can help in more severe cases and have very positive outcomes.
Non-surgical treatments
Non-surgical treatments are usually tried first. Treatment begins by:
Other treatments focus on ways to change your lifestyle to decrease symptoms. This is often seen in the workplace, where you can make modifications to help with carpal tunnel. These changes might include:
Surgical treatments
Surgery is recommended when carpal tunnel syndrome does not respond to non-surgical treatments or has already become severe. The goal of surgery is to increase the size of the tunnel in order to decrease the pressure on the nerves and tendons that pass through the space. This is done by cutting (releasing) the ligament that covers the carpal tunnel at the base of the palm. This ligament is called the transverse carpal ligament.
Recovery times can vary depending on your age, general health, severity of carpal tunnel syndrome and how long you had symptoms. You will continue to gain strength and sensation in the following year after surgery.
If the patient has presented very late and muscles of hand (base of thumb) have atrophied, then he or she would not be able to bring out thumb in perpendicular direction to the palm when hand is placed flat on the table. There would be loss of coarse movements of the hand with complete loss of sensation over the thumb, index, middle and half of ring finger.
Such condition is usually seen in long standing compression of the median nerve or injuries of the median nerve or in patients with leprosy.
During tendon transfers for median nerve palsy, one tendon from the front of the hand is taken, re-routed and sutured to the tendon of the outer aspect of the thumb so that the patient can abduct (bring out thumb) and also make a meaningful pinch with the other fingers so as to hold objects with the thumb and fingers (OPPONENSPLASTY)
The surgery is usually done under brachial block or general anaesthesia and a splint or slab is given for immobilization in the post operative period. The patient is usually discharged second day after the surgery. Sutures are removed 14 days after surgery.
Splint is removed 3 to 4 weeks after the surgery and gradual training of the transferred tendon is started so that it may regain its newly assigned function.
If the patient has presented very late and muscles of hand (base of thumb) have atrophied, then he or she would not be able to bring out thumb in perpendicular direction to the palm when hand is placed flat on the table. There would be loss of coarse movements of the hand with complete loss of sensation over the thumb, index, middle and half of ring finger.
Such condition is usually seen in long standing compression of the median nerve or injuries of the median nerve or in patients with leprosy.
During tendon transfers for median nerve palsy, one tendon from the front of the hand is taken, re-routed and sutured to the tendon of the outer aspect of the thumb so that the patient can abduct (bring out thumb) and also make a meaningful pinch with the other fingers so as to hold objects with the thumb and fingers (OPPONENSPLASTY)
The surgery is usually done under brachial block or general anaesthesia and a splint or slab is given for immobilization in the post operative period. The patient is usually discharged second day after the surgery. Sutures are removed 14 days after surgery.
Splint is removed 3 to 4 weeks after the surgery and gradual training of the transferred tendon is started so that it may regain its newly assigned function.
Indivisual results may vary from person to person.
These pictures are shown for the purpose of education only.
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If you have flat or small breast and you want to improve your breast and hip contour ratio then you are a good candidate for it. The answer will be best provided after the first consultation with Dr Amit Agarwal.
Acute pain will be there for almost a week which gradually reduces and there will be soreness and swelling which may take up to 3 weeks to subside.
You can join your work and daily routines after a week of the procedure and can start exercising after 3 weeks of it.
Yes, you have to wear it round the clock unless we suggest you to remove it.
This surgery does not affect the ducts or the areas of the breast involved in milk production. Thus, it does not affect the breast feeding.
This surgery does not affect the ducts or the areas of the breast involved in milk production. Thus, it does not affect the breast feeding.
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