Carpal tunnel syndrome

　　The carpal tunnel is a fibrous tunnel formed by the common encirclement of the transverse carpal ligament and the carpal bones, protecting the median nerve of the wrist. Generally, the wrist does not interfere with the median nerve during normal activities. However, when operating a computer, due to the certain height of the keyboard and mouse, the wrist must be extended at a certain angle, at this time, the wrist is in a forced posture, unable to stretch naturally. The wrist joint stays in a tense state for a long time, compressing the median nerve in the carpal tunnel, blocking the conduction of the nerve, causing sensory and motor disorders in the palm, leading to the symptoms mentioned above.

　　Any cause that compresses or reduces the carpal tunnel space can compress the median nerve and cause carpal tunnel syndrome. Malunion of Coles fracture, anterior dislocation of the lunate bone, edema of soft tissue 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 stages 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 sheaths. Finally, the nerve tissue turns into fibrous tissue, and the internal canal of the nerve disappears and is replaced by collagenous tissue, becoming an irreversible change.

　　1. The clinical manifestations of carpal tunnel syndrome mainly include numbness, tingling, or burning pain in the index, middle, and ring fingers due to compression of the median nerve, which may worsen at night after daytime work, and even cause awakening from sleep due to pain; local pain may radiate to the elbow and shoulder; there may be poor abductor strength of the thumb, and occasionally there may be a sudden drop when picking up objects. Examination: pain may increase when compressing or tapping the transverse carpal ligament, or when extending the wrist joint; in patients with a long course of the disease, there may be atrophy of the thenar muscle.

　　2. Symptoms may include numbness and pain in the wrist, palm, thumb, index finger, and middle finger, or accompanied by uncoordinated and weak hand movements; pain symptoms may worsen at night or in the morning, and may radiate to the elbow and shoulder, and may alleviate after daytime activities and hand waving; there may be decreased or absent sensation in the aforementioned areas; in some cases, muscle atrophy and paralysis of the hand may occur. If such a situation occurs and does not subside for several days, it is recommended by experts to see a doctor in a regular hospital as soon as possible for early diagnosis and treatment.

　　4. It is understood that carpal tunnel syndrome often occurs in people aged 30-50, with women being five times more likely than men. About 1/3 to 1/2 of patients have symptoms in both hands, and the ratio of women with bilateral symptoms to men increases to 9:1. As to why women have much higher incidence than men, one reason is that women tend to engage in繁琐, delicate, and frequent hand labor; another interesting reason is that

　　As the saying goes: prevention is better than cure. This saying is also very applicable to carpal tunnel syndrome. Since the ultimate cause is overexertion, that is, the unconscious long-term use of the wrist and fingers without rest, leading to overwork reactions. Understanding this, the way to prevent it is very clear, that is, to avoid long-term repetitive hand operations as much as possible. During this time, it is necessary to take a break for 15 to 30 minutes, change the movements. For example, if typing, take a break every 15 to 30 minutes, stretch the tendons of the fingers and wrists, and stretch in different directions. If possible, arrange different operations to alternate. For example, after 30 minutes of typing, switch to file processing. After a period of time, return to typing work. In this way, different muscle and tendon groups can work and rest in turn by using different operation content. Maintaining a good operating posture is the best way to avoid related injuries. The keyboard should be placed in the central position in front of the body at a level height to approach the keyboard or use the mouse, which can prevent the carpal tunnel from being injured; the wrist should be operated in a flat position, neither bent nor hanging down; the working angle of the elbow should be greater than 90 degrees to avoid compression of the median nerve in the elbow. The forearm and elbow should be as close to the body as possible, and try to relax, so as not to lean forward when using the mouse; ensure that the wrist is straight when using the mouse, sit up straight and use a good lumbar support, and the feet should be flat on the ground or footrest. The height of the display screen should be appropriate so that the head does not move up and down, and the eyes should be parallel to the screen after sitting up straight, ensuring that the brightness of the screen is moderate. Frequent stretching and relaxation of the operating hand during work can slowly bend the wrist, repeating 10 seconds every hour; you can also do a fist-clenching activity for 10 seconds every hour.

　　The arrangement of the work position is also an indispensable part, because the appropriate position should allow the wrist to be in the most relaxed and least stressed posture. Let's take typing as an example, the tilt of the keyboard should allow the wrist to work in an approximate 30-degree extension position. In this position, the pressure on the wrist is the least, and the nearby tendons will not be overly stretched or tightened, making the work more comfortable and relaxed.

　　White-collar workers who spend all day in front of computers and teenagers who frequently play video games may sometimes feel numbness in their palms or that their index fingers cramp easily when dragging the mouse. These symptoms are known as 'mouse hand'. It is caused by the compression of the wrist nerves due to long-term use of the mouse and keyboard, leading to muscle or joint numbness, swelling, pain, and cramps. These movements mainly train the wrist strength and finger flexibility to alleviate the persistent stiffness of the muscles. Of course, the shoulder on the side with 'mouse hand' may have symptoms such as wear and tear and pain compared to the other shoulder.

　　1. Shoulder training is also indispensable

　　1. Use a watch as an auxiliary tool, rotate the wrist 25 times in a clockwise and counterclockwise direction. Effect: Relieve wrist muscle soreness.

　　2. Hold a water bottle with weight in your hand, first hold the bottle with the palm facing up, do the movement from natural下垂 to upward lifting, then hold the bottle with the palm facing down, do the movement from down to up, 25 times each, to exercise the flexor muscles of the wrist. Effect: Prevent and treat osteophyte hyperplasia of the wrist joint and enhance wrist strength.

　　3. When stretching all parts of the body, also stretch the five fingers of both hands with force, for 20 to 30 seconds each time, and do 2 to 3 times. Effect: Enhance joint resistance and promote blood circulation.

　　4. Inhale deeply and clench your fists with force, exhale forcefully, and then extend the little finger, ring finger, middle finger, and index finger rapidly in order. Do 10 times with each hand. Effect: Exercise the joints of the hands and relieve stiffness.

　　5. Rub the fingers of one hand with the thumb and forefinger of the other hand, starting with the thumb, for 10 seconds each, and breathe smoothly. Effect: Promote blood circulation and relax the body and mind.

　　6. Hold a ball (such as a tennis ball) or an object that can be held in the palm (such as fruit, etc.), flip the wrist up and down 20 times. The weight of the ball can be determined according to your own strength. Effect: Strengthen wrist strength and exercise coordination ability.

　　7. Clasp both hands together, move them forward and backward to generate a slight warmth. Effect: Promote blood circulation in the hands. Shoulder: When the left arm stretches to the right, the neck stretches to the left. Pay attention not to raise the arm too high, keep a certain distance from the chest, and do not feel any pressure. Hold for 30 to 45 seconds, then switch to the right arm.

　　2. Maintaining a good operating posture is the best way to avoid related injuries

　　1. Place the keyboard in the central position in front of the body, so that it is at the same height as the keyboard or mouse, which can prevent wrist injury;

　　2. Keep the wrist as flat as possible when operating the keyboard, neither bending nor hanging down;

　　3. The elbow working angle 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 lumbar support. Both feet should be flat on the ground or on a footrest.

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

　　7. During work, frequently stretch and relax the operating hand, slowly bend the wrist every hour, repeating for 10 seconds; or continuously clench your fist for 10 seconds every hour.

　　1. Electrophysiological Examination

　　Electrophysiological examination suggests that electromyography of the thenar muscle and the median nerve conduction velocity of the wrist and fingers have signs of nerve damage, which are significant for diagnosis.

　　1. Nerve Conduction Velocity Measurement:

　　The normal time interval from the proximal wrist crease to the abductor pollicis brevis is less than 5ms, while in carpal tunnel syndrome, the nerve conduction time is prolonged.

　　2. Muscle Potential Measurement:

　　The muscles controlled by the median nerve in the center of the thenar eminence show denervation changes.

　　Two, X-ray Examination

　　X-ray films can understand whether there are pathological changes in the bones and joints of the wrist.

　　Three, Arthroscopy

　　Arthroscopy is a new examination method that has been developed in recent years. Under arthroscopy, it is possible to understand the pathological changes inside the carpal tunnel, which can further clarify the diagnosis and can also perform carpal tunnel release surgery under the microscope.

　　Four, CT and MRI Examinations

　　Wrist MRI and CT scans can provide useful clinical information that can be used to understand the condition inside the carpal tunnel, but they are not routine examinations.

　　1. Eat less milk, sheep's milk, and other dairy products and peanuts, chocolate, millet, cheese, sugar, and other foods containing tyrosine, phenylalanine, and tryptophan, as they can produce prostaglandins, leukotrienes, tyrosine kinase autoantibodies, and anti-milk IgE antibodies that cause arthritis, which are easy to cause allergies and worsen arthritis, recurrence, or deterioration.

　　2. Eat less fatty meat, high animal fat, and high cholesterol foods, as the ketone bodies, acids, arachidonic acid metabolites, and inflammatory mediators produced can inhibit the function of T lymphocytes, easily cause and worsen joint pain, swelling, bone decalcification, and joint destruction.

　　3. Eat less sugar, as the sugars are easy to cause allergies, which can worsen the development of synovitis and increase joint swelling and pain.

　　4. Drink less alcohol and coffee, tea, and other beverages, and avoid passive smoking as much as possible, as they can all exacerbate the progression of arthritis.

　　5. You can eat more animal blood, eggs, fish, shrimp, bean products, potatoes, beef, chicken, and beef shank meat, which are rich in histidine, arginine, nucleic acids, and collagen, and other foods.

　　1. External fixation, for patients with obvious symptoms, use a plaster splint or brace to fix the wrist in a slight extension position for 1-2 weeks.

　　2. Carpal Tunnel Closure: Inject procaine and prednisolone (hormone) into the carpal tunnel, once a week, for a total of 3-4 times.

　　3. Take anti-inflammatory and analgesic drugs.

　　4. Surgical Treatment: If non-surgical treatment is ineffective or symptoms worsen or there is atrophy of the thenar muscle, early surgical treatment should be performed, such as transection of the transverse carpal ligament to relieve the pressure on the median nerve. However, most patients mainly use carpal tunnel closure, which can be supplemented with anti-inflammatory and analgesic drugs.