What is it?
The median nerve that passes between the wrist bones and a strong ligament at the end of it can be compressed. This nerve provides sensation of touch to the first three fingers and part of the ring finger. This nerve also provides strength to the muscles of the thumb. Among the causes of carpal tunnel syndrome are injury from repetitive or excessive use, thyroid disease, diabetes , pregnancy, infection, rheumatoid arthritis and other types of inflammatory arthritis.
A similar disorder called tarsal tunnel syndrome can affect the nerve located on the inside of the ankles that provides sensation of touch to the toes and sole of the foot. Ankle nerve compression can occur when the ankle fractures, due to rheumatoid arthritis or foot deformities.
What is the cause?
Generally, bursitis, tendinitis and other soft tissue syndromes such as carpal tunnel syndrome are the result of one or several factors. They include:
What are the symptoms?
Symptoms of the carpal tunnel are numbness or tingling in the hand, initially only at night or when the wrist is flexed for long periods of time, feeling of swelling of the hand, weakness of the thumb when pinching and unexplained pain in the hand.
Symptoms of tarsal tunnel syndrome include painful burning in the foot, usually at night or after standing, pain or burning in the sole of the foot or fingers and pain that is partially relieved by moving the foot, ankle or leg.
How is it diagnosed?
Treatment of rheumatic soft tissue syndromes
(bursitis, tendonitis, myofascial pain, carpal tunnel tennis elbow, golfer's elbow, tenosynovitis and plantar fasciitis)
Soft-tissue syndromes such as bursitis and tendonitis are very common in people They are rather healthy. Many of the syndromes disappear by themselves over time. In most cases, the general practitioner can treat these types of disorders. Some people should be seen by a rheumatologist (a specialist in arthritis, rheumatic diseases and related musculoskeletal conditions) for treatment.
The treatment is based on the reduction of pain and inflammation and on the preservation of mobility and prevention of disability and recurrence. The treatment of many soft tissue diseases is similar. Your doctor's recommendations may include the combination of rest, orthotics , application of heat and cold , medications, physical or occupational therapy . You can try different treatments before finding the one that feels best to you. The following sections describe various treatments that your doctor may prescribe for you.
Rest and orthopedic devices
Many soft tissue diseases are due to excessive use, so the first treatment may include rest of the affected area or avoid a particular activity for a certain time. Rest allows the injured or inflamed area to heal.
The braces allow the particular area rest until the pain subsides. The splints are used to help tennis elbow, DeQuervain tendinitis, Achilian tendinitis and carpal tunnel syndrome . These devices should not be used indefinitely because they may result in limited movement and force. Ask your doctor how long and how often you should bring these devices.
Cold compresses can help reduce initial inflammation and pain in acute conditions (severe but short-lived). Cold therapy is usually most effective during the first 48 hours after the onset of inflammation. The guidelines for cold therapy are as follows:
After 48 hours of chronic (long-term) pain, heat, dry or wet, may be more beneficial than cold compresses. Follow these tips:
Your doctor can prescribe medicines or suggest that you try various over-the-counter (OTC) medicines to help relieve pain and / or inflammation. The following medications are commonly used to treat soft tissue diseases.
Nonsteroidal anti-inflammatory drugs ( NSAIDs ) reduce inflammation and pain. There are different kinds of NSAIDs, such as aspirin, ibuprofen, naproxen and ketoprofen. These drugs can be obtained with or without a prescription. Your doctor will determine which medication is appropriate for your condition based on factors such as your age, other medical problems, habits, other medications you are consuming, side effects, and the cost of the drug.
The effects of NSAIDs include heartburn, nausea, diarrhea, ease of bleeding or presence of bruising and dizziness. More severe effects are ulcers, kidney problems and inflammation of the liver. Talk to your doctor if you notice any of the following signs while you are being treated with NSAIDs: stomach pains or cramps, pain that goes down after eating or taking antacids, bloody or black stools, vomiting with blood. Most people with soft tissue syndromes do not need long treatment with NSAIDs because the treated condition usually lasts a few weeks.
Corticosteroids are synthetic forms of cortisol, which is a natural hormone of the body. The corticosteroids reduce inflammation. Most rheumatic soft tissue syndromes can be treated with corticosteroids injected into the pouch, joint, or tendon to reduce inflammation and pain. These injections are typically used if NSAIDs or other therapies do not provide relief after three to four weeks of treatment. (Corticosteroids in pill form are not used for this type of disorder). Symptoms may diminish or disappear several days after the injection. The risks of these injections can be bleeding, infection, rupture of the tendon or atrophy of the skin. Frequent injections in the same area are not recommended.
Your doctor can refer you to a physical therapist, who can provide the following therapies:
Occupational therapy Occupational
therapists can identify modifications in daily activities and work habits to prevent repeat injuries. These therapists can also create splints for their hands and wrists and suggest devices to help make their daily activities easier. The Occupational therapists can recommend exercises for fingers, wrists and elbows.
Surgery is rarely needed to treat most of these conditions. However, you may need surgery if the problems persist and other treatments do not improve the symptoms.
Prevention of rheumatic soft tissue syndromes
(Bursitis, tendinitis, myofascial pain, carpal tunnel, tennis elbow, golfer's elbow, tenosynovitis and plantar fasciitis)
Since many soft tissue conditions are due to excessive use, the best treatment is prevention. It is important to avoid or modify the activities that cause the problem. They must correct triggering conditions such as differences in leg length, position or incorrect technique in the execution of sports or work.
Be aware of excessive use or damage during your daily activities and change your habits to prevent problems. Otherwise, problems may persist or occur repeatedly. Here are some ideas on how to avoid future problems:
Protection of the elbows
Protecting the wrists and hands
Knee protection Use knee pads when gardening or kneeling on the ground.
Perform daily strengthening exercises (extended leg lift). Strong muscles in the thighs (quadriceps) provide additional support to your knees.
Protecting the hips
Wear walking or jogging shoes that provide good support. High instep shoes are suitable for people with ankle problems.
Wear comfortable shoes that fit well.
Carry templates for heels as recommended by your doctor.
Exercise on flat or level surfaces.