Carpal tunnel syndrome of the hand carpal tunnel operation by median nerve endoscopy decompression surgery or corticosteroid infiltration EMG exploration, rehabilitation post-operative physical exercises, when to treat carpal tunnel syndrome medication without operation, relieve pain by wearing ‘Hand wrist splint, Night carpal tunnel orthosis. clinical examination by a Phalen and Tinel test. Anatomical reminder of the carpal tunnel. carpal tunnel Physiopathology Carpal tunnel: – osteofibrous tunnel, located in the proximal part of the palm; – limited behind and laterally by the carpal bones and in front by the flexor retinaculum; – contains the median nerve and the tendons of the superficial and deep flexors of the long fingers and the flexor digitorum longus. Symptoms: – reflect the compression of the median nerve in this inextensible tunnel; – increased during flexion or extension movements; – nocturnal recrudescence linked to uncontrolled flexion of the wrist and to the nycthemeral cortisol cycle. Then, daytime paresthesias at rest or during prolonged hand positions (driving, telephone conversation, reading the newspaper, knitting). With development, permanent disorders: – difficulty in performing fine gestures (buttoning your jacket, for example); – headaches radiating to the elbow and shoulder. Examination of the hand Look for sensory and motor deficits: – test the opponent and the abductor pollicis brevis (lateral thenar amyotrophy); – measure the force of the grip and that of the thumb-index pliers on a dynamometer. Syndrome provocation tests (at the end of the examination): – Tinel pseudo-sign: reproduction of electrical type paresthesias on percussion of the median nerve opposite the flexion fold of the wrist; – Phalen’s sign: flexed wrists, elbows on the table positive if the paresthesias appear in less than 1 minute. Assessment: Electromyogram (EMG): – additional reference examination, not compulsory (box); – recommended by HAS before any surgical treatment (less than 3-6 months before the act); – not systematic before an infiltration of corticosteroids. Ultrasound: sometimes useful; very suggestive sign: sectional surface of the nerve just upstream of the proximal opening of the inferior canal at 9 mm; – allows a dynamic study of the median nerve and identifies a local cause (tumor, synovitis). X-rays of the wrist: to rule out degenerative, traumatic or congenital bone damage. MRI: looks for a tumor lesion or an intracanal supernumerary muscle. Surgical treatment: how to relieve pain In the event of failure of conservative treatment or in the first intention in severe forms. Section of the flexor retinaculum to decompress the contents of the carpal tunnel open or under endoscopy (local or locoregional anesthesia) and, unless there is a specific contraindication, in outpatient surgery. Anticoagulants, even antivitamin-K: stop not necessary if local anesthesia. In the event of complete hospitalization, prior agreement from the Health Insurance medical service is required. Minimally invasive techniques, endoscopic or not: beyond 6 months, same safety and effectiveness as conventional surgery on: disappearance of paresthesias, palm pain (due to the section of the ligament), recovery of grip strength; faster return to work according to some studies. Percutaneous techniques under ultrasound: in development. Recommended stop (HAS): 7 to 56 days depending on the patient’s physical activities. Rare recurrence (to be distinguished from incomplete section of the retinaculum or sequelae in a severe form). Secondary forms 1) Endocrine causes: hypothyroidism, diabetes, acromegaly, pregnancy, menopause. 2) Microtraumatic: prolonged or repeated pressure on the heel of the hand, repetitive or prolonged movements of extension of the wrist or gripping of the hand, which may be of occupational origin (table 57c of occupational diseases). 3) Overload diseases, sarcoidosis, scleroderma, systemic lupus, type I mucopolysaccharidosis. 4) Tumors: lipoma, synovial cyst. 5) Infections. 6) Supernumerary muscles. 7) Rheumatoid arthritis, gout. 8) Intracanal hemorrhages. 9) Pregnancy: Can trigger or worsen the syndrome NSAIDs contraindicated mostly in the 1st trimester and formally in the 3rd trimester, and throughout pregnancy for indomethacin. Please leave your testimonials in the comments. .
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