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Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

Carpal tunnel is an extremely common condition where one of the major nerves of the hand becomes compressed in a small tunnel at the wrist. Essentially, it is a pinched nerve at the wrist level. The carpal tunnel is an enclosed space within the wrist where 9 tendons run adjacent to the median nerve. With limited space for all of these different residents of the tunnel, the nerve can easily become compressed.

What causes carpal tunnel syndrome?

Although there have been many theories for why carpal tunnel syndrome occurs (related to work, repetitive activities, specific motions, etc), the reality is that the true cause is usually unknown. Generally speaking, it is an issue of space – when the nerve does not have enough space, it can become compressed, and this can in turn cause symptoms. Other ways that the nerve can become compressed include: swelling of the lining of the flexor tendons, called tenosynovitis; joint dislocations; fractures; arthritis; fluid build-up during pregnancy.

What are the symptoms of carpal tunnel syndrome?

The main symptom that indicates carpal tunnel syndrome is numbness or tingling of the first three and a half fingers of the hand (thumb, index, middle, and half of the ring). Tingling is often worse at night or first thing in the morning. It may be provoked by activities that involve gripping an object, for example a cell phone or newspaper. Patients may be awoken in the middle of the night by “night pain”, and may feel the need to “shake out their hand” to improve symptoms. In early carpal tunnel syndrome, the symptoms of tingling will be temporary and eventually return to normal. If the condition gets worse, the feeling may become continuous. Patients often described a feeling of clumsiness and drop objects easily. In severe cases, the muscles at the base of the thumb may irreversibly waste away.

How is carpal tunnel syndrome diagnosed?

The diagnosis of carpal tunnel syndrome is generally made on physical examination. Your doctor will perform numerous physical exam maneuvers, and combined with the story of your injury, will determine if carpal tunnel syndrome is suspected. Testing will be requested to help confirm the diagnosis – a nerve conduction study and electromyography. Additional testing such as an ultrasound or x-ray may also be required to help diagnose the injury.

What treatments are available for carpal tunnel syndrome?

The goal in treating carpal tunnel syndrome is to improve the feelings of numbness, tingling, and pain while also ensuring the disease process does not progress to cause irreversible damage to the median nerve. At The Center for Hand & Upper Extremity Surgery, we use an algorithmic approach to treating this very common problem.

Depending on how severe your case is, your doctor may start with non-operative measures to improve your symptoms. This will include changing the patterns of how you use and position your hand as well as splinting to reduce pressure on the nerve. Next, a steroid injection may be performed in an attempt to help reduce swelling and inflammation around the nerve.

If your symptoms continue, or if you have a severe case, we may pursue surgical treatment to decompress the nerve. We use either a minimally invasive technique called “endoscopic carpal tunnel release” or a more traditional open carpal tunnel release. The endoscopic procedure is used to prevent a large scar on your palm, and to improve your recovery. Our belief, as supported by literature, is that the early recovery is much more comfortable for the patient and the scar burden is much less using the endoscopic approach. The procedure involves a very small transverse incision on your wrist, and the introduction of cameras to see on the inside of your hand. Your surgeon will then use a specialized internal blade to cut the “transverse carpal ligament” to release the pressure on the median nerve. There are situations where the more traditional open carpal tunnel release is indicated – your surgeon will help you determine which surgery is more appropriate for you.

Will I need therapy after carpal tunnel syndrome surgery?

Most patients do not require formal hand therapy after carpal tunnel release. Motion is started immediately after surgery, and stiffness is uncommon.