Carpal Tunnel Syndrome

DIAGNOSIS, THERAPY AND PREVENTION

INTERVIEW WITH
DR Giuseppe ANDREOLETTI
HEAD OF ORTHOPEDIC UNIT
POLICLINICO SAN MARCO (BERGAMO)
DR Davide MOLISANI
ORTHOPEDIST
POLICLINICO SAN MARCO (BERGAMO)
 

A syndrome affecting both workers doing heavy manual labour and sedentary workers who are often using their mouse incorrectly

Tingling in the fingers, especially the thumb, middle and index finger. Pain and soreness often occurring during the night, tending to recur and intensify, and that can eventually lead to difficulties in holding objects in the hand. These are the symptoms of carpal tunnel syndrome, an extremely common condition, particularly among women and those who work in a profession that requires muscular effort and repetitive hand movements. But how does it present itself? Why does it mainly affect women? What therapy is needed to alleviate discomfort and prevent it returning? We asked Doctor Giuseppe Andreolotti, head of the Orthopedic and Traumatology Unit at the Policlinico San Marco, and Doctor Davide Molisano, orthopedist with the same unit and with Smart Clinic, the Gruppo San Donato healthcare facilities inside the "Le Due Torri" (Stezzano) and Oriocenter shopping centres.
 

Doctor Andreolotti, what is carpal tunnel syndrome exactly?

"Carpal tunnel syndrome is one of the most common and most debilitating conditions affecting the hand. In the most serious cases, it can even interfere with the carrying out of the normal activities of everyday life. This syndrome comes under the umbrella of those conditions described as "canalicular syndromes of the upper extremity", well known to the orthopedic specialist and hand surgeon. Specifically, they concern conditions of the elbow, wrist, and other nerves of the upper limb; that is to say, they affect the complex relationship of spaces between the extremely delicate nerve structures that cross the muscular and skeletal spaces, and the channels that contain them. The onset of tingling and pain results from the fact that the nerves are extremely sensitive structures and are immediately affected by compression from any other anatomic part. To be precise, symptoms occur when, in the passageway of the narrow carpal tunnel (a part-bone and part-fibrous anatomical structure in the wrist), there is the slightest expansion or swelling of the transverse ligament and of the sheaths surrounding the flexor tendons of the finger, and the median nerve is compressed against the tunnel wall. In almost all canalicular syndromes, the condition is not of the nerve itself but depends on a change in that which surrounds it: a demonstration of this is the onset of carpal tunnel syndrome after a wrist fracture, when the bone walls of the carpal tunnel have undergone a change in structure. Most cases, therefore, concern an increase in volume of the tendon structures, due to various types of inflammation or conditions which bring fluid to the carpal tunnel region".
 

What are the symptoms?

513"It initially presents with the onset of occasional intermittent tingling in the thumb, and sometimes of the index and middle fingers, a symptom which tends to recur with increasing frequency. This disorder sometimes reaches such levels that it is accompanied by pain or functional impairment, that is, difficulty in using the hand, with loss of grip and of the usual abilities of this much-used part of the body. Those suffering from carpal tunnel syndrome often tend to drop objects and to sleep badly, as the tingling becomes increasingly frequent and occurs mainly during the night. The pain associated with this condition can also occur during the day, at rest, or at work. This syndrome affects both workers carrying out heavy manual labour and sedentary workers who frequently use a mouse and keyboard".
 

Is it true that women are most affected by the problem? If so, why?

"Yes. There is a prevalence among females. It is possible that the condition is linked to a circadian adjustment (the circadian rhythm regulates our body clock and generally coincides with the sleeping and waking cycles) of the hormonal balance, which is more variable in women than in men. Indeed, the condition tends to occur more frequently in adult or elderly women, as a result of hormonal changes due to pregnancy or menopause, and is much less common at a younger age".
 

Doctor Molisano, how is the condition diagnosed?

"The diagnosis of carpal tunnel syndrome is carried out through a careful clinical examination by a specialist using an electromyography study (a test that measures the health of the nerves) to confirm the extent and site of the problem with the median nerve".
 

What kind of therapy do you recommend? And can it be prevented?

"Treating it with rest, local anti-inflammatories, neurotrophics (drugs that act on the health of the nerve) and ice can sometimes be enough. In some circumstances a local injection of cortisone (anti-inflammatory of choice) and targeted physiotherapy can be of benefit, although this is often only temporary. The prevention of this problem lies in eliminating the conditions of conflict between what is within the tunnel (flexor tendons and median nerve) and the structure of the tunnel itself".
 

When is surgery needed?

"If conservative treatment does not give satisfactory results, it will be necessary to resort to a surgical solution that consists in opening up the carpal tunnel's fibrous element, in order to literally give the structures more space. The choice of treatment must always be balanced, appropriate to the symptoms, the patient, and their functional needs: the surgeon's experience provides further assurance of the successful treatment of the condition. The operation, which can be carried out in the traditional way or with mini-incision techniques, involves the longitudinal incision (cut) of the carpal ligament. Often the compression is long-standing, and the nerve damage is difficult to recover. In this case functional recovery may be slower and some of the symptoms may never be entirely eliminated, especially if the necessary measures to prevent a recurrence of the compression (suitable anti-inflammatory therapy, a monitored diet, post-operative physiotherapy) are not undertaken. It is often an out-patient surgery, with minimal impact on the patient: not minor surgery but small-scale surgery, which in itself has many variables and must be handled with precision and experience".
 
Date: 19/07/2019
By: Elena Bounanno and Valentina De Vittorio
Translation: TDR Translation Company
Editing: Victor Cojocaru