Carpal Tunnel Syndrome
Encompassed by bones and ligaments:
Carpal tunnel is a narrow passage way located in the wrist which performs the function of protecting the main nerve i.e. the median nerve and tendons that enable bending of fingers. This tunnel is made of bones and strong connective tissue through which the median nerve travels from the forearm and passing through the wrist reaches the hand. The carpal tunnel does not enough space to stretch as its boundary is rigid.
Compression of the median nerve in the wrist:
causes carpal tunnel to shrink and become smaller resulting in various problems in the hand including numbness, pain, tingling, swelling and weakness The symptoms are first observed during the night which can be relieved by shaking the hand a little but eventually the thumb and first three fingers start to lose sensation and movement ability.
Having the potential to cause permanent damage:
to the nerve and muscles, it is essential that it is not left untreated. When symptoms become prevalent and start interfering with sleep and performance of daily activities the presence of carpal tunnel syndrome becomes important to be diagnosed. After physical examination and imaging tests such as X-ray, electromyogram and nerve conduction study, the hand specialist concludes the presence of carpal tunnel syndrome and takes up the treatment according to its severity.
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An insight into Dr. Gupta’s professional profile:
Having been in the field for more than 25 years and conducted more than 6000 successful Dr. Gupta is easily the best hand and shoulder specialist in India today. He has completed his graduation as an MBBS and MS in Orthopedics from All India Institute of Medical Sciences, New Delhi and fellowship from USA and Germany.
He joined AIIMS as associate professor and gradually went on to become Consultant Hand & Upper Extremity Surgery (orthopedics) At Fortis Hospitals. After having made a mark at Fortis, he joined as Director, Hand & Upper Extremity Surgery (orthopedics) At Medanta – The Medicity, Gurgaon and at present is the head of Hand and Shoulder division at Max Healthcare, the super specialty hospital in Delhi- NCR region.
Dr. Gupta has been honored with prestigious awards for his contribution in the field of upper extremity over the years. His popularity and respect is visible potent among peers and interns who hold his knowledge and experience in high esteem.
Hand2Shoulder Clinic on National Geographic
Case operated by Dr. Vikas Gupta covered by National Geographic Team for serial "Emergency Room". This video highlights careless attitude can lead to grievous injuries which can lead to permanent disability and these if treated properly on time can bring back person towards normal life.....
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Nonsurgical techniques:
when the symptoms are mild and have been present for less than 10 months, the patient is sought to be relieved by conservative techniques which comprise of-
Oral medications:
NSAIDs are prescribed to relieve the patient from the enervating pain but for a short period of time.
Corticosteroid Injections:
To release the pressure on Median Nerve and reduce pain and swelling, corticosteroid injections are inserted in the carpal tunnel. Not more than two injections can be given to the patient as steroids are harmful and may cause side effects.
Wrist Splinting:
To reduce the pressure on the median nerve and protect the wrist from being bent, it is placed in a brace or splint which helps the patient to perform daily activities without pinching the nerve.
Physical Therapy:
The patient is recommended some nerve gliding exercises under a therapist to relax the nerve and enable it to move freely in the tunnel. Some activity changes are also recommended to make workplace easier and reduce pressure on the nerve.
Surgical Techniques:
When nonsurgical techniques fail to provide relief to the carpal tunnel syndrome then the surgeon undertakes surgical techniques to provide relief. Surgical intervention for carpal tunnel is referred to as carpal tunnel release and is performed by cutting the ligament that is on the roof of the tunnel to relieve pressure on the nerve. It is performed in two ways-
Endoscopic Surgery:
The surgeon views the internal damage by a telescopic camera and cuts the ligament by making very small incisions. This surgery is considered to be minimally invasive and less painful than open surgery.
Open Surgery:
A large incision is made on the palm of the hand over the carpal tunnel and a cut is made on the ligament to free the nerve. It involves a lengthier procedure and is more painful than the endoscopic tunnel release.
