Carpal tunnel syndrome

　　Carpal tunnel syndrome refers to hand diseases caused by repeated mechanical movement of one or two fingers while using a mouse for a long time, which leads to wrist movement. There are many causes of carpal tunnel syndrome, which can be roughly divided into three categories:

　　1. Local factors

　　(1) Factors causing a decrease in the volume of the carpal tunnel: such as Colles fracture, Smith fracture, scaphoid fracture, and malunion after lunate dislocation, as well as acromegaly, etc.

　　(2) Factors causing an increase in the contents of the carpal tunnel: such as lipoma, fibroma, ganglion cyst, abnormal position of muscles within the carpal tunnel (such as a low belly of the flexor digitorum profundus, a high belly of the lumbricals), nonspecific synovitis, hematoma.

　　2. Systemic factors

　　(1) Factors that cause neurodegeneration: such as diabetes, alcoholism, infection, gout, etc.

　　(2) Factors that change fluid balance: such as pregnancy, oral contraceptives, long-term hemodialysis, hypothyroidism.

　　3. Posture factors

　　Overuse of the wrist, such as computer operators and disabled people walking with crutches, repetitive flexion and extension of the fingers and wrist joints. Gellman and others investigated 77 paraplegic patients and found that 38 of them (49%) had carpal tunnel syndrome.

　　Carpal tunnel syndrome is not only prone to computer users but also to other workers who frequently use both hands, such as musicians, teachers, editors, journalists, architectural designers, miners, etc. Data show that women are the biggest victims of carpal tunnel syndrome. This is because the carpal tunnel in women's wrists is usually smaller than that in men, and the median nerve is prone to compression. In addition, some pregnant women, patients with rheumatoid arthritis, diabetes, hypertension, and thyroid dysfunction may also suffer from carpal tunnel syndrome.

　　Carpal tunnel syndrome, in a popular and narrow sense, is also known as 'mouse hand'. Its common complications include: Coles fracture malunion, scaphoid anterior dislocation, soft tissue edema due to infection or trauma, thickening of the transverse carpal ligament, ganglion cysts, lipomas, xanthomas, and some systemic diseases such as obesity, diabetes, thyroid dysfunction, amyloidosis, or Raynaud's disease may sometimes be associated with carpal tunnel syndrome. In the early stage of the disease, there is edema and congestion of the median nerve, which gradually leads to fibrosis within the nerve due to compressive ischemia, compression of nerve axons, and disappearance of myelin sheath. Finally, the nerve tissue turns into fibrous tissue, and the nerve lumen disappears and is replaced by collagen tissue, becoming an irreversible change.

　　The reason why this disease has quickly become a rapidly spreading modern civilization disease is mainly due to the drastic change in the lifestyle of modern people, with an increasing number of people exposed to and using computers for a long time every day. Carpal tunnel syndrome is more common in people aged 30-50, with women being five times more likely than men. About 1/3 to 1/2 of patients have bilateral onset, with a male-to-female ratio of 1:9.

　　Carpal tunnel syndrome (Carpal Tunnel Syndrome) is the most common peripheral nerve compression disease and is the most common disease treated by hand surgeons. What symptoms does carpal tunnel syndrome have? Let's take a look together.

　　1. There is numbness and pain in the wrist, palm side of the radius, and the radial sides of the thumb, index finger, middle finger, and ring finger. The pain can radiate to the elbow and shoulder. Symptoms worsen at night or in the morning and improve after activity and swinging the hand.

　　2. There is a decrease or disappearance of sensation in the aforementioned area. The strength of abduction, flexion, and opposition of the thumb is weakened. Compression of the palmar side of the wrist can worsen the symptoms.

　　3. In patients with a long course of disease, atrophy and paralysis of the thenar muscles may be seen.

　　4. Both the wrist flexion test and the nerve root tapping test (Tinel sign) are positive.

　　Carpal tunnel syndrome, also known as 'mouse hand', is common in middle-aged women and pregnant women, with more cases on the right side than on the left. The prevention of carpal tunnel syndrome includes the following points:

　　1, The keyboard should be placed in the central position in front of the body, close to the keyboard or use the mouse at a level height, which can prevent the carpal tunnel from being injured.

　　2, The wrist should be kept as flat as possible when operating the keyboard, neither bending nor hanging down.

　　3, The working angle of the elbow should be greater than 90 degrees to avoid compression of the median nerve inside the elbow.

　　4, The forearm and elbow should be as close to the body as possible, and as relaxed as possible, to avoid leaning forward when using the mouse.

　　5, Ensure that the wrist is straight when using the mouse, sit up straight and preferably use a good backrest, the feet should be flat on the ground or on a footrest.

　　6, Place the screen at a height in front of the body so that the head does not move up and down, when sitting up straight, the eyes should be in a parallel straight line with the screen, ensure that the brightness of the screen is moderate.

　　7, During work, frequently stretch and relax the operating hand, slowly bend the wrist, repeat 10 seconds every hour; or hold a fist for 10 seconds every hour.

　　The median nerve is compressed within the carpal tunnel, causing numbness, pain, and (or) atrophy of the thenar muscle, known as Carpal Tunnel Syndrome (carpal tunnel syndrome), common in middle-aged women and pregnant women, more on the right side than the left. What kind of examinations should be done for Carpal Tunnel Syndrome?

　　The main examination methods for this disease are as follows:

　　1, Electrophysiological examination

　　Electrophysiological examination suggests that the electromyogram of the thenar muscle and the median nerve conduction velocity of the wrist fingers have signs of nerve damage, which is of certain significance for diagnosis.

　　2, X-ray examination

　　X-ray flat film can understand whether there are bone and joint pathological changes in the wrist bone area.

　　3, Arthroscopy

　　Arthroscopy is a new examination method developed in recent years, under arthroscopy, it is possible to understand the pathological changes within the carpal tunnel, it can further clarify the diagnosis, and wrist tunnel release surgery can also be performed under the microscope.

　　Carpal Tunnel Syndrome (CTS) is the most common peripheral nerve compression disease, the pathological basis of Carpal Tunnel Syndrome is the median nerve being compressed in the carpal tunnel at the wrist. Below, the editor introduces eight food therapy methods for the treatment of Carpal Tunnel Syndrome.

　　1, Appropriate amount of red bean, decoct and take with a little brown sugar, warm, this formula is suitable for the stage of activating blood and removing blood stasis.

　　2, 1000 grams of pork bones, 250 grams of soybeans, add water and simmer over low heat until soft, season with salt and ginger, divide and eat.

　　3, One set of pork backbone, wash clean, 120 grams of red dates, 90 grams of lotus seeds, 9 grams of Dingxiang, 9 grams of raw licorice root, add water and simmer over low heat until soft, season with ginger and salt, drink in several doses.

　　4, Two fresh Hu crab, take the meat (with the yolk), when the sticky rice porridge is cooked, add the crab meat, and then add appropriate amounts of ginger, vinegar, and soy sauce for consumption, take regularly.

　　5, A male chicken weighing about 500 grams, remove the skin, feathers, and internal organs, wash clean, cut 5 grams of 'Sanqi' into slices, put it into the chicken's belly, add a small amount of yellow wine, steam over water, serve with soy sauce after it is cooked, take regularly.

　　6, Raw Astragalus 30-60 grams, decoct to extract the juice, add 100 grams of sticky rice, cook to make porridge, take in the morning and evening.

　　7, Astragalus 20 grams, Astragalus membranaceus 100 grams, a young hen, boil with water to make a soup for consumption.

　　8, Zidan Shen 50 grams, wash clean, boil with water, take the juice, mix the juice with 1000 grams of pork long bone, 250 grams of soybeans, and boil until soft. Add a small amount of cinnamon and salt, and it is ready.

　　The Western medical treatment of carpal tunnel syndrome is divided into conservative treatment and surgical treatment. Today, we will mainly talk about the methods of surgical treatment:

　　For patients who have been treated conservatively for 2 months without effect and have severe symptoms, early surgical treatment should be performed. The usual procedure is to perform carpal ligament release and carpal tunnel decompression. The surgical incision is usually an arc-shaped incision convex towards the ulna along the radial border of the hypothenar muscle, and extended towards the wrist, which can avoid injury to the median nerve palmar branch. After separating the palmaris longus tendon and the radial flexor carpi ulnaris tendon to the sides, the median nerve and the carpal ligament can be exposed. The carpal ligament is incised from near to far along the ulnar side of the median nerve to avoid injury to the median nerve return branch, as about 23% of people have the median nerve return branch passing through the carpal ligament to the thenar muscle. After incising the carpal ligament, explore the condition inside the carpal tunnel. If the median nerve is adherent to the surrounding tendons and bursae, it should be carefully released. If there is a new growth in the carpal tunnel, it should be surgically removed. The carpal ligament does not need to be reconstructed, and the wound is sutured after thorough hemostasis. The short arm cast is fixed to the wrist in extension for 7 to 9 days after surgery to prevent the flexor tendon from herniating, and then the cast is removed to start active activity.

　　Some people suggest performing interbundle decompression of the median nerve bundle under a microscope after carpal tunnel release. However, interbundle separation can cause nerve fiber tearing, resulting in a large amount of scar formation inside or around the nerve after surgery, and can cause reflex sympathetic dystrophy. Some studies have also found that there is no significant difference in efficacy between simple carpal tunnel release and carpal tunnel release with intraneural decompression, so intraneural decompression is of little significance and is rarely used now.

　　Carpal Tunnel Release with Arthroscopy, the application of arthroscopy for carpal tunnel release has the advantages of less surgical trauma, faster recovery of daily life and work for patients, and shorter hospitalization time, which is welcomed by patients. Some surveys have shown that there is no significant difference in efficacy between arthroscopy and open carpal tunnel release, but arthroscopy carpal tunnel release may have complications such as median nerve or superficial palmar arch section, hematoma, and ulnar nerve stimulation at the wrist, which should be avoided.