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Carpal tunnel syndrome

This syndrome is produced by a mechanical conflict between container and content inside the carpal channel. More precisely, the median nerve is compressed against the traverse carpal ligament, generating sensory and motor deficits of variable entity. 

It exists a primitive type of this pathology (the most common) that is due to a hypertrophic synovitis of the flexor tendons and a secondary type due to systemic diseases (amyloidosis, rheumatoid arthritis, diabetes mellitus) or outcomes of wrist fractures that produced a narrowing of the carpal tunnel.

The syndrome is definitely more common in women in fertile age and it is usually bilateral.

The hormonal factor plays a crucial role in the appearance of the pathology, even if it has not been totally clarified. This explains the major recurrence of symptoms during pregnancy and menopause.

In its primitive forms, symptoms are characterised by night tingling joined by a sensation of numbness involving the first four fingers. In the secondary, pain is usually present and it tends to worsen with movement, becoming a generally diurnal problem.
Diagnosis of this disorder is based on specific clinical tests backed up by an electromyography (EMG) test to confirm the extent of the nerve degeneration. Other tests, such as blood tests, X-rays and CT scans may be useful in cases of secondary forms of the pathology.
Prognosis are generally positive and lead to the total absence of sensory disturbances in its primary forms.  The treatment of the primary forms is initially conservative and based on the application of physical therapies (ultrasounds and laser therapy), on the reinforcement of muscular groups  with deficits and on exercises leading to the recovery of fine co-ordination. In its more resistant forms, it is necessary to recur to the surgical solution.

Carpal tunnel syndrome - Rehabilitation

It is a canalicular syndrome caused by compression of the median nerve at the wrist. The patient, depending on the degree of compression, presents different symptoms (irritation, compression, deficits, paresis or paralysis) that tend to vary by changing the position of the arm. Depending on the cause of the compression, the indicated solution can be surgical or conservative; in both cases, the rehabilitation treatment has common characteristics, obviously the recovery time varies.

The first phase of the rehabilitation protocol is aimed at reducing inflammation, through the use of physical therapies (laser, tens, ice) and draining massage therapy of forearm and hand and recovery of the joint function, especially the thumb through tensile physiotherapy of the wrist, stretching of the capsular structures and active and passive mobilization of the wrist and hand.

After reaching the full range of motion and movement without pain/paresthesia you can start the second phase of rehabilitation, the recovery of the strength and fine coordination with strengthening exercises for the muscles of the thenar eminence, the lumbrical and flexed/extensor carpi (especially in eccentric, even manual) with rubber bands, balls, nets. The goal is to improve the neuromotor control by recovering and training the opposition movements of the thumb and the gripping mechanism.

The rehabilitation program ends with the last phase, the recovery of technical movements in the field with growing difficulty exercises to safely recover the gestures and the complex movements of the hand, arm, forearm in dynamic situations.
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