Carpal Tunnel

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Carpal tunnel syndrome is just a median nerve compression neuropathy as it passes through the carpal tunnel of the wrist. It is one of the most recurrent pathologies treated in Nervenia Clinics with deep nerve stimulation (DNS).

Symptoms

Carpal tunnel syndrome generally begins with the sensation of tingling in the first three fingers of the hand, on one side or on both sides. Frequently it occurs in people where manual activity is made up of fixed positions or repetitive movements, so it is often considered an occupational disease. If it is not treated in time or adequately, it can gradually worsen, bringing constant tingling, weakness and paralysis of the first three fingers of the hand. Carpal tunnel syndrome can also occur during pregnancy, in people with rheumatic diseases, it is common in people who use their hands for precision and repetitive work, in patients with fibromyalgia and in women from forty years onwards.

Generally the disturbances appear at night.

Carpal tunnel syndrome originates when the median nerve is compressed or irritated in the carpal tunnel which leads it to enter the hand. However, it happen frequently that there can be disorders similar to those described previously even when the median nerve is irritated in its pathway along the arm, starting from the cervical spine, and not only in the carpal tunnel. In these cases, surgery or classic local physiotherapy treatments are not very helpful, because they focus only on the symptoms and not on the cause.

This is why it is important to contact Nervenia professionals who are specialized in identifying and treating any nerve related problems.

Diagnosis

The diagnosis of carpal tunnel syndrome occurs through the history of the symptoms accused by the patient and through the tests of Tinel and Phalen. The Tinel test is performed by striking the carpal tunnel and the Phalen test keeping the wrist in forced flexion from 30″ to one minute. In both cases, if the above symptoms are evoked, the tests are to be considered positive. The actual diagnosis is certified with the electromyography of the wrist tract.

Treatment

In general, the treatment is physiotherapy through the local provision of analgesic therapy with ultrasound, tens, laser, or medical treatment through cortisone infiltration. When carpal tunnel syndrome is advanced, surgical treatment under local anesthesia is recommended, which consists in releasing the median nerve. Surgery can be performed with two different procedures, one defined as having a large incision which has the consequence of a recovery period of about 90 days except for complications created by the large scar or through a minimal surgical technique which creates a small incision (0.2 – 0.5 cm) in the carpal area and which allows an almost immediate recovery.

Once the operation has been performed, the pain resolves quickly, while the paresthesias can last even for a few weeks as the nerve, when compressed for a long time, slowly recovers. If the compression has lasted too long it is possible that the nerve does not recover anymore despite the intervention.

For us at Nervenia it is essential to examine and test the entire nerve pathway both clinically and instrumentally to carry out the most targeted and effective treatment possible.

The particular evaluation of Nervenia serves to define how much the symptoms are really due to the passage of the nerve in the tunnel or to irritations in its pathway at the cervical level or along the arm. The tests allow us to intervene in two ways:

on nerve compression: entrapment is fixed through manual therapy and neurodynamics in any part of the nerve course,
on its ability to correctly transmit impulses with Deep Nerve Stimulation (DNS), a particular type of current that acts specifically on nerve tissue.

The treatment of Nervenia finds an important application also in the post-surgical phase for two reasons: