Carpal Tunnel Syndrome
Carpal tunnel syndrome is due to compression of the median nerve at the level of the wrist. It’s the most common site of compression for any nerve in the upper extremity.
When I see patients with carpal tunnel syndrome, they will typically describe numbness in the hand. Typically, the numbness involves the median nerve distribution, which is the thumb, the index, the long and part of the ring finger. This numbness may be worse with certain activities, such as driving a car, and may wake the patient up at night, causing nighttime symptoms. Often, patients will complain that they have to shake out the hand to relieve their symptoms.
Carpal tunnel syndrome affects approximately five percent of the population. If left untreated, the occasional numbness can become permanent and the patient might suffer muscle loss in the hand, which can lead to loss of strength and loss of dexterity.
There are many different treatment options for carpal tunnel syndrome. Typically we’ll begin with conservative measures first. That includes bracing, particularly at nighttime. We might also consider a steroid injection. The steroid is used to decrease the inflammation surrounding the medial nerve in the carpal tunnel. This can be used as a diagnostic tool as well as a therapeutic tool. If a patient tries conservative measures, such as braces or injections, and still has symptoms consistent with carpal tunnel syndrome, it’s at that time that I would recommend a carpal tunnel release.
For this procedure, we make approximately a one-inch incision centered over the palm of the hand and identify the transverse carpal ligament, which is the roof of the carpal tunnel. We release this ligament to take the pressure off the median nerve, which is beneath [the ligament] in the carpal tunnel. This is performed as an outpatient procedure, so the patient will come and go the same day. The surgery can be performed under local anesthetic alone, or we can do it under local anesthesia with sedation. This is entirely up to the patient and his or her preferences.