Carpal tunnel syndrome

　　Currently, it is believed that the onset of carpal tunnel syndrome is mainly related to the following factors:

　　1. Long-term repetitive extension and ulnar deviation of the wrist joint, with the hamate bone as the fulcrum, forming a tensile posture, causing the ligament and synovium to develop aseptic inflammation, edema, and proliferation. Since the extensibility of the carpal tunnel is poor, the pressure within the tunnel increases, compressing the ulnar nerve and causing local degeneration and thickening of the perineurium.

　　2. Long-term heavy use of the right hand can cause thickening and abnormal positioning of the right hand vessels, leading to compression of the ulnar nerve by the hypothenar muscle tendinous arch. Since the width of the space under the hypothenar muscle tendinous arch is greater than the transverse diameter of the vascular nerve bundle, and the longitudinal height is almost equal to the longitudinal diameter of the vascular nerve bundle, at the same time, the abnormal vascular pulsation stimulates the compressed nerve, producing abnormal bioelectric impulses, causing the sympathetic nerve that支配血管to lose the control of vasoconstriction and vasodilation, resulting in increased pressure within the carpal tunnel and further compression of the ulnar nerve.

　　3. Local occupancy lesions such as ganglion cysts can increase the contents of the carpal tunnel, and their proximity to the proximal end of the carpal tunnel where the ulnar nerve has not yet divided into deep and superficial branches, so the resulting lesions are of sensory-motor dysfunction type.

　　4. Compression injury causing wrist joint lesions can lead to hemorrhage and edema within the carpal tunnel or changes in the internal structure, causing local fibrous tissue proliferation, scar adhesion, and leading to compression of the ulnar nerve.

　　Any cause that compresses or reduces the capacity of the carpal tunnel can compress the median nerve, leading to carpal tunnel syndrome, malunion of Coles fracture, anterior dislocation of the lunate bone, soft tissue edema due to infection or trauma, thickening of the transverse carpal ligament, ganglion cysts, lipomas, xanthomas. Systemic diseases such as obesity, diabetes, thyroid dysfunction, amyloidosis, or Raynaud's disease may sometimes be associated with carpal tunnel syndrome, which initially manifests as edema and congestion of the median nerve, gradually leading to fibrosis within the nerve due to compressive ischemia, compression of nerve axons, and disappearance of myelin sheaths. Finally, the nerve tissue becomes fibrous tissue, the internal canal of the nerve disappears, and is replaced by collagen tissue, becoming irreversible changes.

　　Carpal tunnel syndrome is more common in middle-aged males, laborers, or those with a history of hand and wrist trauma, fractures. Depending on the type of carpal tunnel syndrome, the clinical manifestations may vary.

　　1. If the superficial branch of the ulnar nerve is involved, the clinical manifestations include sensory disturbances in the skin of the ulnar side of the palm, the ulnar side of the small finger, and the ulnar side of the ring finger. Sensation above the wrist joint is normal. The symptoms are mild and localized, without motor dysfunction.

　　2. If the deep branch of the ulnar nerve is involved, the clinical manifestations include motor impairment of the intrinsic muscles of the hand, atrophy, weakness, or paralysis of the interosseous muscles. In patients with a long course of disease, claw-like deformity may appear without sensory disturbances.

　　3. If there is tenderness and a mass palpable on the ulnar side of the wrist flexor muscles, it suggests the presence of a ganglion or tumor compressing the tendons.

　　4. The wrist flexion test can worsen numbness, tingling, and burning sensation in the ring and small fingers.

　　Carpal tunnel syndrome can be caused by various etiologies, with most patients suffering from excessive hand and wrist activity. Preventive measures for such patients are meaningful, not only before the onset of symptoms but also after symptoms have been relieved to prevent recurrence.

　　1. When the work of the hand and wrist is intense, attention should be paid to rest during the work period to prevent the median nerve at the wrist from being compressed continuously. Middle-aged women should pay more attention to this during work. In addition, relaxing the wrist before and after work and fully exercising the wrist joint can help prevent the occurrence of carpal tunnel syndrome.

　　2. Pay attention to avoiding cold water washing during work, avoiding cold stimulation and excessive extension and flexion, and paying attention to local warmth.

　　3. For patients who have been treated for the disease and whose symptoms have been relieved, attention should be paid to prevent recurrence, and it is necessary to avoid long-term hand and wrist activities with high intensity.

　　4. For patients with fractures and dislocations caused by trauma, if there is numbness and pain in the fingers, it is necessary to go to the hospital for examination and treatment in time to obtain good curative effect.

　　Since the site of onset of carpal tunnel syndrome is at the wrist, the clinical examination of carpal tunnel syndrome mainly adopts local examination, and the main examination methods are as follows: 3 kinds:

　　1. The hypothenar and interosseous muscles have varying degrees of atrophy, and the ulnar side of the thenar muscle is atrophied. Muscle strength is weakened or lost, and the adduction and abduction of the 2-5 fingers are restricted.

　　2. Ring and little finger claw hand deformity.

　　3. Positive paperclip test, positive Froment sign.

　　The diet of carpal tunnel syndrome patients should be light and easy to digest, with more fruits and vegetables, a reasonable diet, and attention to adequate nutrition. In addition, patients should also pay attention to avoiding spicy, greasy, and cold foods.

　　According to the degree of illness, different treatment methods are formulated for patients with carpal tunnel syndrome.

　　1. For patients with mild sensory impairment, conservative treatment can be temporarily adopted, with local blockage and oral nerve nutrition drugs.

　　2. Once the carpal tunnel syndrome is diagnosed, it should be treated surgically as soon as possible.

　　The shorter the course of the disease, the faster the recovery of nerve function. The reason is that surgery relieves the fibrous scar and mechanical compression around the nerve, improves local blood flow disorder, reduces intraneural hydrostatic pressure, benefits the maintenance of the stability of the internal environment of the nerve, promotes the regeneration of nerve fibers, and restores its normal conduction function.