Peripheral nerves are structures that send messages from the brain and spinal cord to the rest of the body. These structures can be easily damaged due to excessive pressure, stretching or rupture.
It’s important to get medical attention to avoid complications and permanent damage. The injury to these nerves is called peripheral neuropathy and shows symptoms such as pain, numbness, weakness, and tingling.
The first three syndromes result from the compression of a nerve passing through the carpal tunnel (wrist), ulnar tunnel (elbow), or radial tunnel (forearm and/or elbow), respectively. A neuroma, on the other hand, is the result of thickening of nerve tissue.
Depending on the severity of the injury, recovery may happen within a few weeks with the use of pain relievers, anti-inflammatories, and, in some cases, immobilization of the affected area. However, some injuries can only be treated with surgery.
Neuroma
A neuroma is the result of compression and irritation of a nerve, causing its dilation or thickening. If left untreated, it can lead to permanent nerve damage.
Although they can develop anywhere in the body, one of the most common is digital palmar neuroma, which appears on the palm of the hand, especially the fingers, and is often associated with compression of the nerve in that area.
Symptoms
Common symptoms in the area of the damaged nerve include:
- Pain
- Burning
- Tingling
- Numbness
The symptoms worsen when receiving a blow or applying pressure to the damaged nerve.
Diagnosis and Treatment
The diagnosis of a neuroma is made through the medical history of the patient’s symptoms and a physical examination, where the specialist may percuss or apply pressure to try to reproduce the symptoms. Additionally, they may request imaging diagnostic tests such as X-rays.
Non-surgical treatment of a neuroma involves the use of splints and pads, especially for neuromas secondary to repetitive movements. Medications such as pain relievers, anti-inflammatories, and corticosteroid injections may be part of the treatment.
In severe nerve injuries or if it’s secondary to the formation of bone or scar tissue, surgical repair or resection of the affected nerve may be necessary.
Carpal Tunnel Syndrome
Carpal tunnel syndrome results from painful compression of the median nerve as it passes through the wrist in the carpal tunnel. This syndrome is one of the most common nerve injuries and occurs mainly in women aged 30 to 50, pregnant women, people with diabetes, hypothyroidism, rheumatoid arthritis, and conditions where fluid retention happens.
Furthermore, individuals with jobs or activities that require repetitive flexion and extension of the wrist are at higher risk of developing carpal tunnel syndrome. If not treated properly, it can lead to complications such as weakness and atrophy of the muscles in the thumb area.
Diagnosis and Treatment
Diagnosis requires a physical examination of the hand and wrist where symptoms are present, and sometimes nerve conduction studies and imaging diagnostic tests such as magnetic resonance may be necessary.
Treatment for this syndrome will depend on its severity and the existence of other underlying conditions, as described above. To relieve symptoms, it’s necessary to place the affected hand in a neutral position, often accomplished with the help of a wrist splint, especially at night. Other measures include:
- Ergonomic improvements, such as adjusting the angle of the computer keyboard.
- Management and control of comorbidities, if applicable.
- Mild pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs.
- Corticosteroid injections into the carpal tunnel.
- Surgery, especially when the muscle has atrophied or weakened, and pain or numbness is intense.
What is carpal tunnel surgery like?
During carpal tunnel surgery, the orthopedic surgeon performs surgical decompression of the tunnel, either through an open or endoscopic technique. The carpal tunnel is narrow, and its upper part is a thick ligament called the carpal ligament. Any inflammation in this area can compress the nerve and cause pain.
In a carpal tunnel operation, the person will be under anesthesia to avoid experiencing pain. The specialist makes a small incision in the palm of the hand near the wrist and cuts the bands of fibrous tissue that exert pressure on the median nerve. Finally, they close the tissue and skin.
Have you ever experienced numbness, pain or burning sensation in your fingers? Set an appointment with me. I am Dr. Emmanuel Ruiz, a carpal tunnel surgeon, and I can help you with this problem.
