Carpal Tunnel Syndrome Case Study Paper Example

Condition description and anatomical structures

Carpal tunnel syndrome occurs when the hand and the arms experience pain; there are various symptoms such as tingling and numbness on the hand mostly around the thumb. The whole condition is due to the compression of the meridian nerve. The pain in the median nerve is squeezed throughout the wrist. The condition needs immediate treatment since carpal tunnel syndrome can end up becoming so serious over a period. Carpal tunnel syndrome is a chronic condition since it keeps on recurring over time; the condition is seen to last for even months if it is not treated.

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In addition, this syndrome is a condition that is as a result of tightening of the median nerves in the wrist (George, 1966). The syndrome is often experienced at night after a vigorous activity that was carried out during the day. This condition is among the neuropathy which is seen in the sports, whereby the athletes have numbness that occurs as a result of median nerve tightening of the arm (Rettig, 2004). The injuries are seen to be traumatic, and the joints such as the interphalangeal joints have the major impacts especially to the athletes' competitions, such as the bicyclists, who from time to time experience the numbness on the joints that are on the arms. Women are seen to be on higher incidences to develop the carpal tunnel syndrome as compared to the men.

Anatomical structure

The carpal tunnel is found at the wrist and comprises of nine tendons. On this context will focus on the structures located in the carpal tunnel, and they include the four ligaments of flexor digitorum profundus, four ligaments of flexor digitorum superficial muscles and one tendon of flexor pollicis longus. The nine tendons help in the communication of various nerves that are present in the palm and the fingers.

Tendon flexor digitorum profundus

These are muscles that are found in the forearm; additionally, it acts as a flexor of the wrist and also on the specific joints that are located on the wrist. These flexor muscles acts as the extensors on the interphalangeal joints (Zhao, Amadio, Zobitz & Kai-Nan, 2006) Therefore the tendon flexor digitorum profundus are essential in the reduction of tension that is found on the joints of the fore ear.

Tendon flexor digitorum superficilias muscles

These are the muscles that are responsible for the movement of the four medial fingers. These medial fingers have three bones which facilitate the whole process; the bones include the middle phalanges, distal phalanges and the proximal phalanges (Schnabel, Mohammed, Miller, McDermott, Jacobson, Santangelo & Fortier, 2006). Various aspects are seen to come into place; there is the tissue regeneration which is through the platelet-rich plasma. Tissue regeneration is vital in the contractions of the medial fingers.

Tendon flexor pollicus longus

Flexor pollicus longus is located at the lower side of the hand, and almost on the same side as the flexor digitorum profundus. Tendon flexor is demonstrated to be a special flexor, and in case of any injury on this part, then the whole process might take quite some time before healing, and this is because the no flow of blood is taking place to the tendons (Casaletto, Machin, Leung & Brown, 2009).

Causes of the condition

Excess pressure in the arm damages the wrist due to severe straining of the median nerves. The athletes who are involved in activities such as cycling tends to experience so much pressure on their arms. (Bagatur & Yalcinkaya, 2009). The exerted pressure from the inside of the carpal tunnel can be described as the intrinsic factor, while the pressure exercised from the outside is defined as extrinsic. These two types of pressure are both causes of the condition. On some other factors, the condition may occur due to stress where an athlete is in so much stress on how he or she should be able to win the competition. Stress is not only harmful to human beings, but it can result in developing certain conditions, which might take longer to treat. Therefore, it advised that athletes should not be stressed. Another cause can be through a medical condition of someone; some athletes tend to have medical conditions.

Signs and symptoms of CTS

Tingling and numbness are the most common types of carpal syndrome that is being experienced by the hands. The hands become extremely weak and the athlete might end up dropping whatever she or he was handling (Jackson, Hynninen, Caborn & McLean, 1996). In sports, the athlete might drop the ball if there was a football activity that was taking place, the bicycle if there was a cycling activity or even the racket if the sport involved having the racket. The cause numbness is the effect of median nerves being compressed and lacking the sensitivity that it has. Thus the joint become unable to keep up with the impact resulting to the numbness. The possible test that is conducted on this condition is known as the Phalen's test or the tinel's test. These tests are quite useful as they provide a clear insight on whether the condition is on the athlete or not. The orthopedic experiment is used to diagnose Phalen's test. The whole process is conducted at the wrist as this is where the median nerve is located in the human body. A clinical neurophysiologist may decide on the kind of nerve conduction studies that is best suitable for the athlete (McKeon & Yancosek, 2008). On the other hand, Tinel's test traces the irritating nerves which can be done by anyone with the basic understanding on medicine. The patients are advised to undergo the magnetic resonance imaging (MRI) to establish seriousness of the condition.

Immediate treatment for the CTS

The immediate and most common treatment for the CTS is placing of ice cubes on the wrist for some minutes which should be done twice. The purpose of this treatment is to ease the pain. After placing the ice cubes twice, the next step is relaxing the hand for some minutes, this involves not engaging in any activity and if the pain is still there, then it is recommended to take some pills, a non- steroidal anti-inflammatory drug and this is to relieve the pain. The last treatment can be done by flexing the wrist on warm water and this helps in soothing the pain. The soothing makes one forget about the pain since the hand is trying to relax. These techniques are home remedies carried out with a lot of care not to cause no more damage to the wrist. After doing all this, it is proper to consult the doctor for a further check-up to avoid any complication in the future.

Extended treatment

There are two different ways of treating the CTS, the surgical treatment and non-surgical treatment. Surgical treatment is done through anesthesia and the main objective of this surgery is to eliminate the accumulated pressure that is on the nerves, and so are the tendons passed on the carpal tunnel (Shi & MacDermid, 2011). After the surgical treatment, it is very rare to have the condition recurring since the ligaments that caused the pressure on the hand are eliminated and very few cases report the recurring.

Non-surgical treatment starts by having the wrist splint during the night and taking pills to ease the pain, and at some point, there can be injection that is introduced, but not recommended unless the pain is too much (Shi & MacDermid, 2011). Non-surgical treatment can only be for temporal treatments, and when it does not help that much one should opt to have the surgical treatment.

Rehabilitation

As stated earlier very few cases report the recurrence of the CTS, the reconstruction for this is developing a special technique to prevent the repetition of the same condition on the wrist. Rehabilitation following the surgery is seen to be good as there is a therapy given to ensure the patient recovers fast and after some few weeks can be able to go back to the sports (Nathan, Meadows & Keniston, 1993). During this rehabilitation, the wrist has to rise, but slowly and gently, the fingers have to move as it acts as good therapy for the wrist.

Prevention

Prevention is an important aspect in any department, a couple of methods can be put in place to avoid unnecessary damage on the wrist that might take place in the future. One should use a padded wrist; the padded wrist is being worn on the hands to prevent the pressure from accumulating. Creating awareness on the risk t involved during the sports (Verhagen & Kay, 2010). Prevention is ensuring that there is no straining while having the sports, straining might make one develop stress and this might not be for one's health.

References

Bagatur, E, A, & Yalcinkaya, M, (2009), Unilateral Carpal Tunnel Syndrome caused by an occur Palmar Lipoma, Journal of Orthopedics. 32,(10). Retrieved from, https://doi.org/10.3928/01477447-20090818-20

Casaletto, A, J, Machin, D, Leung, R & Brown, J, D, (2009). Flexor Pollicus Longus Tendon Ruptures after Palmar Plate Fixation of Fractures of the Distal Radius. Journal of Hand Surgery (European Volume), Retrieved from, https://doi.org/10.1177/1753193408100964

George, P, (1966). The Carpal Tunnel Syndrome: SEVENTEEN YEARS' EXPERIENCE IN DIAGNOSIS AND TREATMENT OF SIX HUNDRED FIFTY-FOUR HANDS. The Journal of Bone and Joint Surgery, Vol.48, Issue.2

Jackson, D, Hynninen, B, Caborn, D & McLean, (1996), Electrodiagnostic study of carpal tunnel syndrome in wheelchair basketball players. Clinical Journal of Sport Medicine

McKeon, J & Yancosek, E (2008), Neural Gliding Techniques for the Treatment of Carpal Tunnel Syndrome: A Systematic Review. Journal of Sports Rehabilitation, Vol.17

Nathan, P, Meadows, K & Keniston, R (1993), Rehabilitation of carpal tunnel surgery patients using a short surgical incision and an early program of physical therapy, Journal of Hand Surgery, Vol.18, Issue.6, Retrieved from https://doi.org/10.1016/0363-5023(93)90401-N

Rettig, C, A (2004). Athletic injuries of the wrist and hand, part 11: Overuse injuries of the wrist and traumatic injuries to the hand. The American Journal of Sports Medicine, Retrieved from, https://doi.org/10.1177/0363546503261422

Schnabel, L, Mohammed, O, Miller, B, McDermott, G, Jacobson, M, Santangelo, K & Fortier (2006). Platelet rich plasma (PRP) enhances anabolic gene expression patterns in flexor digitorum superficialis tendons. Journal of Orthopedic Research, Retrieved from https://doi.org/10.1002/jor.20278

Shi, Q & MacDermid, J (2011), Is surgical intervention more effective than non-surgical treatment for carpal tunnel syndrome? A systematic review, Journal of Orthopaedic Surgery and Research, Retrieved from, https://doi.org/10.1186/1749-799x-6-17

Verhagen, E & Bay, K (2010), Optimizing ankle sprain prevention: a critical review and practical appraisal of the literature, British Journal of Sports Medicine

Zhao, C, Amadio, P, Zobitz, M & Kai-Nan, (2006), Gliding characteristics of tendon repair in canine flexor digitorum profundus tendons. Journal of Orthopaedic Research, Retrieved from https://doi.org/10.1016/S0736-0266(00)00055-3