Carpal Tunnel Syndrome
What Is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is a common problem that affects the use of your hand. It occurs when the median nerve passing through your wrist, becomes inflamed after being aggravated by repetitive movements such as typing on the computer keyboard, playing the piano, or using your hands to operate vibrating machinery, or wearing tight gloves. The condition may cause progressive narrowing and/or compression of the median nerve as it passes through the tight carpal tunnel region. The carpal tunnel is formed by the bones behind it, tendons and ligaments around the median nerve within the confines of the carpal tunnel, and is covered by the carpal ligament which runs across the whole wrist.
Since the median nerve supplies sensations to the thumb, index and middle fingers and part of the ring finger, and provides motion of the muscles of the thumb and hand, patient's will also notice numbness and weakness in these areas. Finger numbness or wrist pain may be the most significant symptoms during the night. This may in fact wake the patient up several times during the night. During the day, it may occur in doing any activity that the importance bending the wrist, or putting pressure on this area.
Symptoms can include hand and wrist pain, a burning sensation in the middle and index fingers, thumb and finger numbness, or an electric-like shock through the wrist and hand. These symptoms are often exaggerated when the wrist is bent forward, and felt mostly during the night.
Common Causes of Carpal Tunnel Syndrome:
Diseases or conditions that may predispose the development of carpal tunnel syndrome include pregnancy, diabetes mellitus, hypothyroidism, menopause, broken or dislocated bones of the wrist, and obesity. Additional causes include repetitive and forceful grasping with the hands, bending of the wrist, and arthritis.
Any repetitive motions that may cause significant swelling, thickening or irritation of membranes around the tendons in the carpal tunnel, result in pressure on the median nerve, disrupting transmission of sensations from the hand up to the arm and central nervous system.
Diagnosing Carpal Tunnel Syndrome:
It is important to seek medical assistance when he first noticed persistent symptoms. Do not wait for the pain to become intolerable.
Before your doctor can recommend a course of treatment, he has to perform in the evaluation of your condition, including and medical history, physical examination, and diagnostic tests. Your doctor would have to document the symptoms and find out from you to what extent the symptoms are affecting your daily living. The physical examination will include an assessment of sensations, strength, and reflexes in your hands.
If conservative treatments such as oral medications, physical therapy, doing not provide sufficient relief, the doctor may perform diagnostic studies to determine if surgery is an effective option. These diagnostic options, into but not limited to the following: Electromyography with nerve conduction studies is usually the most important test that will confirm the diagnosis. Rarely, MRI scan of the wrists detect the earliest changes of carpal tunnel pathology.
Conservative (Non-Surgical) Treatment Options:
The main objective of conservative treatment is to reduce or eliminate repetitive injury to the median nerve. In some cases, carpal tunnel syndrome can be treated by immobilizing the wrist in a splint to minimize postop pressure on the nerves, particularly at night. If that does not work, patient says sometimes prescribed an anti-inflammatory medication or cortisone injections in the wrist to reduce swelling around the nerve. Also, hand and wrist exercises may be recommended both during and after work hours. Treatment for carpal tunnel syndrome I include rest, the use of wrist splint during sleep, or physical therapy. Alternative treatment methods may continue for up to 6 or 8 weeks. If the cause of the carpal tunnel syndrome is medical, medical treatment of the underlying cause, should naturally be the primary modality of treatment.
Surgical Treatment Options:
The patient was experiences severe pain that cannot be relieved by conservative treatment options, then surgery becomes the second line of treatment. These options are geared towards relieving the pressure on the median nerve as it courses within the carpal tunnel. Neurosurgeons are uniquely qualified to perform these operations, as they are trained to treat disorders affecting the entire nervous system. The most common procedure is called carpal tunnel release, which can be performed using a small open incision, to incise the carpal ligament and open up the tight tunnel, and release any scar tissue or adhesions around the nerve. The procedure may be performed under a regional block or local anesthetic, with monitored anesthesia care. It is usually performed in same day surgery, in outpatient hospital facilities, or ambulatory surgery centers.
Only a small percentage of patients require surgery. Factors leading to surgery are the presence of persistent neurological symptoms and lack of response to conservative management. Recurrence of symptoms after surgery for carpal tunnel syndrome is rare, occurring in less than 5% of patients. If the symptoms recur then a redo procedure may be indicated.
Recovery After Surgery:
Approximately 1% of individuals with carpal tunnel syndrome can develop permanent injury. The majority recover completely. They avoid reinjury by changing the way they perform repetitive movements, the frequency with which they perform these movements, and the amount of time they rest between periods when they must perform the movements.
After surgery, a dressing will be applied to the hand. You should leave this dressing clean and dry until the sutures come out. If the dressing becomes wet or dirty it may introduce infection into the wound area. If that happens, the dressing is to be changed either in your family doctor's office, or the surgeon's office, or the nearest emergency room to your residence. In the meantime, you may require extra assistance at home completing everyday activities. The sutures may be removed approximately 10-14 days after surgery. You would have to keep your hand elevated above the level of your heart for the first 72 hours after surgery. You should use two pillows to elevate your hand while laying down, or a sling while ambulatory.
You will notice that the pain and numbness begin to improve shortly after surgery, but you may have tenderness, or hypersensitivity, in the area of the incision for several months. If this becomes troublesome, we may have to send you to a physical therapist to desensitize the scar tissue area.
