Lesions due to repetitive movements related to the work have raised in the last decades. This type of lesions includes the so-called cumulative trauma injuries which represents the 60% of the occupational diseases. Among these the CTS is the more frequent.
The name comes after the 8 wrist bones, the carpal bones, which form a tunnel-like structure. Through this tunnel pass the flexor tendons that control the hand movement. Moreover provides a space for the median nerve to reach, after his ramification, the hand sensory receptors. Repetitive flexioning and extending of the wrist may cause the swelling of the tendon coverings of protection. These inflammate coverings, or tenosynovitis, made pressure on the median nerve and produces the CTS.
Symptoms usually start gradually, with frequent burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers. Some carpal tunnel sufferers say their fingers feel useless and swollen, even though little or no swelling is apparent. The symptoms often first appear in one or both hands during the night, since many people sleep with flexed wrists. A person with carpal tunnel syndrome may wake up feeling the need to “shake out” the hand or wrist. As symptoms worsen, people might feel tingling during the day. Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In chronic and/or untreated cases, the muscles at the base of the thumb may waste away. Some people are unable to tell between hot and cold by touch and even unable to accomplish minor works like tie the shoes or pick up small objects.
Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. Most likely the disorder is due to a congenital predisposition – the carpal tunnel is simply smaller in some people than in others. Other contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture; overactivity of the pituitary gland; hypothyroidism; rheumatoid arthritis; mechanical problems in the wrist joint; work stress; repeated use of vibrating hand tools; fluid retention during pregnancy or menopause; or the development of a cyst or tumor in the canal. In some cases no cause can be identified.
There is little clinical data to prove whether repetitive and forceful movements of the hand and wrist during work or leisure activities can cause carpal tunnel syndrome. Repeated motions performed in the course of normal work or other daily activities can result in repetitive motion disorders such as bursitis and tendonitis. Writer’s cramp – a condition in which a lack of fine motor skill coordination and ache and pressure in the fingers, wrist, or forearm is brought on by repetitive activity – is not a symptom of carpal tunnel syndrome.
In the last decade a raising number of cases of carpal tunnel syndrome have been reported in the medical literature. A reason for this may be the automatizacion and specialization of the work which have reduced the tasks of the worker even until to a series of movements replied several times per day.
At the workplace, workers can do on-the-job conditioning, perform stretching exercises, take frequent rest breaks, wear splints to keep wrists straight, and use correct posture and wrist position. Wearing fingerless gloves can help keep hands warm and flexible. Workstations, tools and tool handles, and tasks can be redesigned to enable the worker’s wrist to maintain a natural position during work.
Jobs can be rotated among workers. Employers can develop programs in ergonomics, the process of adapting workplace conditions and job demands to the capabilities of workers. However, research has not conclusively shown that these workplace changes prevent the occurrence of carpal tunnel syndrome.
Treatment for the CTS may include surgery to reduce the pressure on the median nerve and/or anti-inflammatories and the splint of the hand in order to reduce the inflammation of the carpal tunnel.
We perform the surgical release for carpal tunnel syndrome usually with local anaesthesia as a day case in the Associated Hospitals. In La Coruña and Madrid.