Recently, Xie Xinxin, a rehabilitation physician at the Ruijin 2nd Road Community Health Service Center, often encounters some middle-aged and elderly patients with hand numbness as the main complaint in the outpatient clinic, thinking that it is cervical spondylosis, or adding cervical MRI examination showing the presence of cervical intervertebral disc bulge or herniation, he is more convinced that hand numbness is caused by cervical spine lesions, and has been treated according to cervical spondylosis.
If carpal tunnel syndrome is not taken seriously in the early stage, it can gradually progress from hand numbness to hand muscle atrophy and weakness, resulting in the inability to hold a comb, rotate the key and other basic daily activities, and even some patients find that their hand muscles are atrophied and weak, thinking that it is "ALS", causing panic. Therefore, it is especially important to understand carpal tunnel syndrome and distinguish it from other conditions.
What is carpal tunnel syndrome
Carpal tunnel syndrome is a set of signs and symptoms that manifest when the median nerve is pinched in the carpal tunnel. The carpal tunnel is a bone-fibrous tunnel in the wrist, through which the tendon and median nerve pass, and the median nerve is the most superficial, when the lumen becomes smaller or the contents of the lumen increase, it will lead to irritation or compression of the median nerve, which eventually leads to nerve degeneration, causing sensory impairment (numbness, pain, hypoesthesia) or motor symptoms (muscle atrophy, weakness).
What people are prone to carpal tunnel syndrome
Carpal tunnel syndrome is also a common and frequent disease in clinical practice, caused by the entrapment of the median nerve in the carpal tunnel, which is more common in people with repetitive excessive flexion and extension of the wrist, such as office computer operators or women with a lot of housework, in addition to wrist trauma, there is a mass in the carpal tunnel, and diabetic patients can also be associated with this disease.
How do you know you have carpal tunnel syndrome?
1. Symptoms: Patients generally first feel numbness or pain at the ends of the fingers of the radial side of the three and a half (thumb, index finger, middle finger, and ring finger on the radial side), especially the middle finger, which is caused by the involvement of median nerve sensory fibers. Some people feel that the symptoms are most severe at night or early in the morning, and they need to be relieved by "shaking their hands". Sometimes it can be accompanied by discomfort in the forearm. When median nerve motor fibers are involved, thenar muscle atrophy and poor thumb strength occur.
2. Signs: hyperesthesia or hypoesthesia in the three and a half fingers radial, atrophy of the thenar muscle, weakness of the thumb to palm, Tinel sign (+) and Phalen sign (+) of the median nerve of the wrist.
(Median nerve Tinel sign)
(Phalen征)
3.辅助检查:肌电图;肌骨超声。
and cervical radiculopathy
1. Radiculopathy is often confused with carpal tunnel syndrome because of hand numbness, but the former often has numbness and discomfort from the neck to the entire upper limbs, while the latter numbness is mostly from the wrist to the distal fingers, occasionally involving the forearm, but generally not more than the elbow.
2. Radiculopathy is related to the involvement of cervical spine segments, such as numbness of the little thumb and ring finger if the lower cervical segment is involved, and carpal tunnel syndrome is characterized by the characteristic numbness of the three and a half fingers on the radial side.
3. Patients with carpal tunnel syndrome combined with cervical spine lesions are not excluded in clinical practice, so it is necessary for specialists to conduct physical examination and combine auxiliary examinations to clarify the "monism" or "dualism" of disease diagnosis.
How to proceed with rehabilitation
1. Loosen the adhesions in the carpal tunnel, reduce the internal pressure of the carpal tunnel, reduce the stimulation of the median nerve, eliminate local inflammation and edema, and promote nerve repair through physiotherapy;
2. Improve the overall function of the wrist and upper limbs through rehabilitation exercises, including flexibility training of nerves and tendons in the carpal tunnel, stretching of forearm muscles, etc., which can prevent the recurrence or aggravation of symptoms.
Physiotherapy is commonly used
1. Ultrasound
2. Shock wave
3. Laser
Rehabilitation exercises
1. Tendon gliding training
2. Median nerve gliding training
3. Forearm muscle stretching
For the treatment of carpal tunnel syndrome, there are also drug nutrition nerves, wearing braces, local sealing, acupuncture, surgery and other programs, if you want to know the details of the diagnosis and treatment of carpal tunnel syndrome, you can go to the rehabilitation department of Ruijin 2nd Road Community Health Service Center for treatment.