Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

carpal tunnel anatomy
Reproduced and adapted from Rodner C, Raissis A, Akelman E: Carpal Tunnel Syndrome. Orthopaedic Knowledge Online. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2009.

Carpal tunnel syndrome is a condition caused by compression of the median nerve as it passes through the carpal tunnel. Inside this tunnel lies the tendons, which bend the fingers and thumb and median nerve that is responsible for the feeling in the thumb, index, middle and half of the ring finger. Carpal tunnel syndrome occurs when the ligament at the wrist thickens and compresses the nerve, thereby restricting blood flow to the median nerve.

What are the symptoms of carpal tunnel syndrome?

The loss of blood to the nerve will cause tingling or numbness in one or more fingers, except the small finger, and/or the thumb. Other symptoms can include burning pain or radiating pain up the arm.

Symptoms may occur or worsen during activities like driving, holding a book or phone, or even sleeping. At night, wrists are relaxed and therefore often flexed, increasing pressure on the median nerve and causing numbness. The numbness and overall decreased sensation in the fingers may result in clumsiness and weakness in the affected hand. Patients may find themselves dropping objects and less capable of performing tasks that require sustained gripping or pinching strength. In more advanced cases, numbness is constant, or the muscle at the base of the thumb may begin to waste away, giving a flattened appearance to the palm when compared to the other hand.

What causes carpal tunnel syndrome?

The underlying cause is unknown, but it is seen more in women, older patients and those with a family history of the condition. Contrary to popular belief, keyboarding does not appear to cause the development of carpal tunnel syndrome. Certain medical conditions can predispose a person to carpal tunnel syndrome, including:

  • Inflammation, swelling or thickening of the tendons that bend fingers (rheumatoid arthritis, hypothyroidism)
  • Trauma (fractures and dislocations around the wrist, or crushing injuries)
  • Pregnancy
  • Diabetes

What are the treatments for carpal tunnel syndrome?

Surgical and non-surgical options are available, depending on the severity of the condition.

Non-surgical treatment options:

  • Rest and Splint: These treatments are more helpful for patients with mild symptoms. Resting the hand and arm helps avoid activities that may provoke further symptoms, and the use of a splint may improve or relieve symptoms, especially at night.
  • Cortisone Injection: Reduces swelling and inflammation in the carpal tunnel, providing relief for the nerve. Cortisone injections are most helpful if given within 3-4 months of the onset of symptoms.

Surgical treatment option: Known as carpal tunnel release, this procedure involves cutting the transverse carpal ligament to remove pressure on the median nerve. Frequently asked questions and answers about this procedure include:

When is carpal tunnel release an appropriate treatment option?

  • When damage is present in the nerve, as determined by a nerve study
  • When numbness is constant or an abnormal feeling is present in one or more fingers at all times
  • When non-surgical treatment options do not relieve symptoms

How is it done?

  • The technique is called “mini-open,” and the incision is typically less than one inch long.
  • The ligament is carefully cut and the incision is closed with nylon sutures.
  • The post-op dressing is similar to a large bandage with adhesive on all sides.

How long will it take to recover from surgery?

Recovery time varies based on the individual. Activity can resume immediately after the surgery as pain allows. The rule is simple: if an activity hurts, stop doing it; if it doesn’t hurt, it is okay to continue the activity.

Will surgery relieve my symptoms?

The answer depends on the severity of the damage done to the median nerve:

  • For patients who only experience episodes of numbness, damage to the nerve is not likely and the numbness episodes will usually resolve.
  • For patients with constant numbness, the relief of symptoms will depend on the patient. Most will notice improvement, and for some it will resolve completely. Other patients will not recover normal sensation due to nerve damage. Improvements may occur for up to one year after surgery. And, while full sensation may not return, the surgery will prevent symptoms from getting worse.
  • The rate of recurrence of carpal tunnel syndrome is less than five percent (5%). Younger patients have a greater risk of recurrence, simply because they have longer to live.

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