EN 
ES Dr. Sheila Espinal, Coordinator of Physical Medicine and Rehabilitation of the General Hospital of the Plaza de la Salud.
The tingling sensation and pain in the hands corresponds to frequent symptoms in the consultation of physical medicine and rehabilitation. These manifestations are usually associated with carpal tunnel syndrome.
By definition, this disease corresponds to a chronic entrapment of the median nerve at the wrist level, in a virtual space known as carpal tunnel. This virtual tunnel is crossed by tendon structures that are directed to the fingers to allow them to flex and the median nerve, making the latter susceptible to compression during the journey through the wrist.
Carpal tunnel syndrome (STC) is the most frequent compressive neuropathy of the upper limb, with an annual incidence of 99 out of every 100,000 patients per year.
This condition is more common in middle-aged women, with a bilateral presentation in up to 50% of cases.
Causes of carpal tunnel syndrome. Carpal tunnel syndrome may be secondary to compression of the median nerve due to cysts, tumors, inflammation of the tendons of the deep and superficial flexor muscles of the fingers.
The presence of this pathology is usually associated with conditions such as:
. Pregnancy
. Mellitus diabetes
. Thyroid disorders
. Autoimmune diseases such as rheumatoid arthritis
. Alcoholism
. Vitamin B12 deficit
Symptom. This understanding of the nerve can produce symptoms such as itching, heat, tingling, pain, numbness and diminution of sensitivity in the palm's territory, especially in the first three fingers of the hand, commonly known as thumb, index and major.
These symptoms may occur during the night, causing the patient to wake up and shake hands vigorously to relieve discomfort (Flick's sign).
As the pathology progresses, the symptoms can evolve and translate weakness to hold objects, atrophy of the hand muscles and worsening of pain.
Diagnosis. The diagnosis of carpal tunnel syndrome is in clinical principle, due to pain and paresthesia data and their irradiation.
The physical exam assesses sensitivity, trophism and muscle strength looking for motor compromise data that suggest severity of the condition.
The diagnosis can be supported in the performance of imaging studies such as musculoskeletal ultrasonography and magnetic resonance imaging, especially in nerve conduction studies, in order to have prognostic support.
Treatment. In principle the treatment of carpal tunnel syndrome is conservative. This includes some of the following alternatives:
. Modification of physical activity involving flexo extension of the wrists
. Physical therapy
. Wrist immobilization
. Anti-inflammatory drugs
. Corticosteroid injection.
Surgical treatment is an option in cases refractory to conservative management, and in those patients with severe signs and symptoms with data on axonal damage in nerve conduction studies.
In these patients, surgical decompression of the carpal tunnel is necessary to achieve symptomatic control.
What is the carpal tunnel?
The carpal tunnel corresponds to a virtual space or passageway that contains tendons, ligaments, carpal bones and the median nerve. It is located at the wrist level.
The base of this tunnel is formed by some of the carpal ossicles (these are: pisiform, semilunar, pyramidal, trapezius, trapezoid and large bone scaphoid) and it is delimited at the top by a connective tissue band known as a reticulum flexor.
Ten structures run through this tunnel: the four tendons that belong to the superficial common flexor muscle of the fingers, four tendons corresponding to the deep common flexor muscle; the tendon of the flexor long muscle of the thumb and the median nerve.
There is the possibility that the flexor tendons that cross the carpal canal in conjunction with the median nerve, present edema secondary to tenosynovitis due to overuse, and may cause understanding of the nerve at the wrist level; starting the symptoms of cramping and tingling in the first fingers of the hand.
Posted in: the Today Digital Newspaper.
