Symptoms in hands, fingers, and wrist are reasons for frequent consultation. The causes vary from nerve compression (such as carpal tunnel syndrome and cervical radiculopathy), to tendonitis, and muscular contractions.

The carpal tunnel is a channel formed by the wrist bones and the transverse carpal ligament, located in the palm side to of the wrist, right in the skin folds. There come together the median nerve that provides sensitivity in the thumb, index, and half of the annular fingers; the muscles that mobilize the base of the thumb and wrist and fingers' flexor tendons.

The Carpal Tunnel Syndrome is often seen as a cumulative trauma to the wrist and is caused by high pressure -compression- in the carpal tunnel, producing ischemia in the median nerve, disorders in nerve function, pain, and tingling. In the beginning, the symptoms are intermittent, the neurological findings are reversible, and there are no changes in the structure of the median nerve. Frequent or prolonged episodes of high compression can cause demyelinisation and weakness. When ischemia is prolonged, the nerve's dysfunction is irreversible.

A variety of conditions is associated with the syndrome, between which are included: pregnancy, arthritis, hypothyroidism and diabetes, use of steroids or estrogens; and amyloidosis. There are jobs whose repetitive actions -by hands and wrists- predispose the appearance of the syndrome, they are: construction workers, tree cutters, and food processors.

The clinical history of the carpal tunnel syndrome is variable. Abnormalities in nerve conduction tend to get worse with time, and the prevalence of symptoms increase. The syndrome produces pain, tingling, ardor, and burning sensations in the palm side of the wrist, forefinger, index, and annular fingers with greater intensity during the night.

Diagnosis

Patients with symptoms, in hands and wrist, must be evaluated with a detailed medical history and physical examination that includes sensory and motor function tests, such as: electromyography, as well as provocation maneuvers, to confirm the diagnosis and allow discarding other neuropathies.

Treatment

Treatment of associated conditions, such as diabetes or hypothyroidism, aids to improve the symptoms. Immobilization and neutral wrist positioning also alleviate the inconvenience. The use of non-steroids anti-inflammatory, diuretics, and vitamin B6 (pyridoxine) has not demonstrated effectiveness and can produce secondary effects. Surgery is reserved for patients with suggestive axonal loss symptoms, like weakness or loss of sensitivity during at least a year. The systemic treatment of this affection has managed to improve the symptoms, nerve sensitivity, preserve the integrity of the median nerve and avoid surgery, diminishing the pressure on the tunnel by means of the use of superior plants such as Panax Quinquefolius , Harpagophytum procumbens and Rhodiola Rosea ; which do not produce secondary effects.