pathology: carpal tunnel syndrome

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carpal tunnel syndrome (median nerve compression syndrome, genuine atrophy of the ball of the thumb)

Definition

The tendons of the profound finger flexors and the superficial finger flexors and the long thumb flexor as well as the median nerve run through the carpal tunnel in the carpal region on the palmar side of the hand. Women are more frequently affected, peak age 40-50 years, right more frequently than left, in 50% on both sides. Carpal tunnel syndrome is a common overuse syndrome. Cubital tunnel syndrome (sulcus ulnaris syndrome), which is located more proximally, is similar, but is located in the forearm, near the elbow.

ICD G56

Cause

  1. idiopathic (most common), often due to recurring similar movements
  2. Ganglion(ganglion)
  3. Injuries
  4. Tendonitis

Predisposing

– Musculoskeletal system

  1. Gout
  2. Rheumatoid arthritis (RA) / Chronic polyarthritis (CP)
  3. Tendovaginitis
  4. near fractures

– Dispositional diseases

  1. Diabetes mellitus
  2. Hyperthyroidism
  3. Myxedema (in hypothyroidism)
  4. Acromegaly
  5. Dysproteinemias

– Other factors

  1. Gravidity
  2. Alcohol abuse
  3. Obesity

Diagnosis

  1. Nerve conduction velocity
  2. Tests and signs: Phalen test, reverse Phalen test, Tinel sign, Flick test

Symptoms

  1. Atrophy of the ball of the thumb muscles
  2. Paresthesias in the supply area of the median nerve: the area of the thumb, index finger, middle finger (swearing hand)
  3. Night pain attacks(brachialgia nocturna), feeling of fingers falling asleep, first pain on exertion, later also pain during the day and at rest, radiating into the arm; first morning weakness of grip, later persistent
  4. Test: Tinel’s sign: Knocking pain over the carpal tunnel when the wrist is hyperextended (strongly dorsiflexed), is present anyway, as even hyperextension is painful

Complications

  1. Muscular dystrophy in the ball of the thumb
  2. Grip weakness

Therapy

  1. Nocturnal orthosis against plantar buckling of the wrist
  2. Initial immobilization
  3. local anaesthetics
  4. non-steroidal anti-inflammatory drugs
  5. Cryotherapy
  6. Heat therapy
  7. if none of the above improves: surgery: cut the annular ligament (open or endoscopic), then rest from weight-bearing but not from movement