1 .- Concept. INTRODUCTION
Repetitive addition, other conditions can lead to compression of the median nerve, arthritis, diabetes, fluid retention, gout and misaligned fractures, chemical imbalances, emotional stress and, sometimes, hormonal changes in women.
The Carpal tunnel syndrome is a condition that can be caused by repeatedly carrying out stressful movements by hand or by having a hand in the same position for long periods. It is considered as a cumulative trauma disorder, a disease that attacks the body’s musculoskeletal system and specifically affects the nerves and blood flow of the hands and wrists.
This syndrome is already known for a long time. The meat packers began to complain of pain and loss of hand function by the year 1860. At that time, these complaints were largely attributed to poor circulation. But the nature of work has changed over years, today, many jobs are highly specialized and require the repetitive use of only a small number of muscles. With the increase in the number of people using computers and keyboards, and a greater interest in improving the health of workers, carpal tunnel syndrome is a real concern for employers and health professionals. Recent studies have shown that carpal tunnel syndrome, as well as other cumulative trauma disorders, is increasing while other occupational injuries have stabilized. Many companies are seeking the support of physiotherapists to aid in the design and implementation of programs of health promotion and injury prevention to protect their employees from CTS.
The carpal tunnel is located at the base of the palm. It is formed by bones in the wrist and the transverse carpal ligament. An increase in pressure in the tunnel affects the function of nerve.
2 .- MORBIDITY
The Carpal tunnel syndrome affects men and women of all ages, and is commonly seen among workers performing tasks that require repetition of the same movement of the hands or fingers for long periods. The US Department of Labor recognizes the carpal tunnel syndrome and other cumulative trauma disorders as the cause of 48% of all industrial illnesses. The disease affects more than five million Americans.
The CTS has appeared among meatpackers, clutch on assembly lines, jackhammer operators and employees who spend time working on computers or typewriters. The Carpal tunnel syndrome is also found in athletes and housewives.
3 .- SYMPTOMS
The symptoms of the carpal tunnel syndrome usually include pain, numbness, current, or a combination of all three. The numbness most often occurs in the thumb, index, middle and ring fingers. Symptoms often occur during the night but also during the day activities like driving or reading the newspaper. Sometimes patients notice a decrease in grip strength, clumsiness, or may find that they drop things. In severe cases, there may be a permanent loss of sensation and thenar muscles.
People with the CTS experience numbness, weakness, tingling and burning in hands and fingers. If left untreated, these symptoms may progress to acute and persistent pain. The CTS can become so disabling that the person may have to stop working and can not do simple tasks around the house. In extreme cases, the carpal tunnel syndrome requires people to have surgery and miss many days of work or prevents them from working at all because the operation of their hands completely deteriorates them.
In summary, we could cite as common symptoms of the CTS the following:
1 .- Tingling in the fingers.
2 .- Numbness of the fingers.
3 .- Pain in the thumb, perhaps extending to the neck.
4 .- Burning from the wrist to the fingers.
5 .- Changes in sensitivity to touch or temperature.
6 .- Numbness of the hands.
7 .- weakness of grip, ability to click and other actions with the fingers.
8 .- Swelling of hand and forearm.
9 .- Changes in the pattern of sweaty hands. Vegetative alterations.
4 .- DIAGNOSTIC CRITERIA
When evaluating a patient with suspected CTS, we must evaluate a number of criteria that will guide us to detect whether or not we have this pathology:
Colles fracture, rheumatoid arthritis, diabetes, gout, hypothyroidism, pregnancy, tendonitis, kidney failure, and so on.
b) Clinical Summary.
– Pain.Location, irradiation, related to manual labor, hours of submission, dominant hand, time of evolution.
– Paresthesias. Location, continuous or intermittent, time of presentation.
– Paresis. Specify muscles.
c) Physical examination.
– Thenar atrophy.
– Phalen test positive (forced flexion of the wrist more than 60 seconds).
– Test of nerve compression (medium compression on the north for a few
30 seconds, causes numbness and pain in the territory of the medium).
– Tinel sign.
(These tests are not conclusive, but their presence strongly suggests a CARPAL TUNNEL SYNDROME).
Cervical disc herniation, thoracic outlet syndrome gorge, compression of N. medium to another level.
e) Diagnostic studies.
1. Radiography of the wrist.
2. Electromyogram and nerve conduction studies.
3. Hematological, serological and endocrinological if systemic disease.
4. Radiography of the cervical region if cervical origin suggested.
5. Chest radiograph, the suggestion of thoracic outlet syndrome.
Electromyographic studies are useful when positive, but may be negative in some patients. The most difficult differential diagnosis is given in cases with diabetes mellitus and probable carpal tunnel syndrome.
5 .- TREATMENT
Symptoms can often be relieved without surgery. Identifying and treating associated diseases, changing the habits of using the hand, keeping the wrist straight with a splint can help reduce pressure on the nerve. Wearing a splint at night may relieve the symptoms that interfere with sleep. Anti-inflammatory medication taken by mouth or injected into the carpal tunnel may relieve symptoms.
When symptoms are severe or do not improve, you may need a surgery to create more space for the nerve. The pressure on the nerve is decreased by cutting the ligament that forms the roof (top) of the tunnel on the palm side of the hand.
The incision for this surgery may vary, but the goal is the same: to enlarge the tunnel and decrease pressure on the nerve. After surgery, discomfort around the wound may take several weeks or months. The numbness and the feeling of power can disappear quickly or slowly. The strength in the hand and wrist may take several months to return to normal. Carpal tunnel symptoms may not disappear completely after surgery, especially in severe cases.
In cases with moderate symptoms, no thenar atrophy, it is advisable:
– Splint in neutral position.
– Infiltration of corticosteroids.
– Treat underlying disease if one exists.
As for the recommendations for patients with CTS, as well as physical therapy sessions, it must address the following points:
1 .- Keep at rest the affected area. Later, as the pain subsides Drills for strengthening all the muscles of the arm.
2 .- Make contrast baths at home at least twice a day.
3 .- Apply ice several times a day for ten minutes, with breaks of five minutes.
6 .- Physiotherapeutic ACTION PROTOCOLS. ERGONOMIC INTERVENTIONS IN THE WORKPLACE PREVENTION MEASURES TO CTS
Physical therapists with specialized training in treating cumulative trauma disorders have worked in industry and business for many years, in order to meet the needs of occupational health care in the United States. They work closely with employers to educate workers about the CTS, especially its causes and its prevention through proper use of the musculoskeletal system. Physical therapists can correct bad habits and work environments such as furniture, equipment and inadequate working space. They can also assess the potential risk of a person and determine if it is unable to perform a particular job.
Among its many responsibilities, physical therapists, health awareness teach work safety measures. A typical program includes exercises that education employees can perform at home, as well as early warning signs to avoid expensive and painful surgery.
Among the exercises that the physiotherapist can recommend, we have a large battery of protocols and actions that aim at providing more ergonomic the frequent and repetitive movements that a person does in their workplace, in order to prevent those diseases can develop as Carpal Tunnel Syndrome.