CARPAL TUNNEL SYNDROME

• Carpal tunnel syndrome(CTS) is a peripheral neuropathy caused by compression of the median nerve by the transverse carpal ligament
• Most common compressive neuropathy Characterised by both sensory disturbances ( pain, tingling and numbness) and motor symptoms ( weakness and clumsiness of the thumb) in the area innervated by the median nerve distal to the carpal tunnel
• More common in middle aged woman

• Repetitive motions like typing or any wrist movement
• Certain athletic activities like cycling, tennis, throwing etc.
• Mal united colle’s fracture 

Associated conditions

• Diabetes mellitus
• Hypothyroidism
• Rheumatoid arthritis
• Pregnancy
• Amyloidosis

Risk factors

• Female sex
• Obesity
• Previous fracture of distal radius
• Advanced age
• Chronic renal failure – dialysis associated
• Smoking and alcohol

Compression can be caused by skeletal abnormalities, swelling of the tissues within the tunnel or thickness of retinaculum

• Pins and needles in the fingers-particularly index, middle fingers and sometimes thumb
• Pain and paraesthesia occur in the distribution of the median nerve
• Symptoms typically worsen at night
• Loss of function- As the compression increases, neurological symptoms appear
• There may be incoordination of fingers
• Weakened Pinch and grip – patients complain of dropping objects

Signs

• Slight tenderness over the carpal tunnel
• Fingers and wrists fully flexed for few moments
• Light touch sensitivity and tow point discrimination may be reduced in the skin innervated by median nerve
• Later stages - wasting of thenar muscles

• Clinical diagnosis
• Nerve conduction velocity test
• Electromyography
• Hand elevation test – The hand is held above the head of patient for approximately 2 minutes. The test is considered positive if the symptoms of CTS are reproduced
• Tinels sign- Provocative tests performed by tapping the median nerve over the volar carpal tunnel
• Carpal tunnel compression test(Durkan's test)- performed by pressing thumbs over the carpal tunnel and holding pressure for 30 seconds. Onset of pain or paresthesia in the median nerve distribution within 30 seconds is a positive result
• Phalens sign - wrist volar flexion against gravity for about 60 sec produces symptoms

• Wrist splint
• Activity modification
• Corticosteroid injection
• NSAIDs
• Surgery - in failure of conservative management (carpal tunnel release surgery)

Auyrvedic Treatment

Internal medication

• Amrutothara Kashaya
• Guggulu tikthaka Kashaya
• Prasaranyadi Kashaya
• Dhanwantara Kashaya
• Shaddharanam gutika
• Abha guggulu
• Kaisohra guggulu
• Dashamoolarishta
• Bala Thaila internally 

Procedure

• Lepana – Karuthavattu, Nagaradi choorna
• Upanaha - kolakulathadi
• Agni karma - Salaka/ Madhu/ Taila
• Jambeera Pinda Sweda – Locally
• Patra Potala Sweda - Locally