Carpal Tunnel Syndrome

Although there are many disorders of the hand and wrist, one of the most common is carpal tunnel syndrome (CTS). It often affects workers who perform repetitive hand movements, such as typing or assembly tasks, and causes numbness, tingling and burning. Although CTS can be painful and debilitating, it is also highly treatable if diagnosed early.

Eventually, as the pain increases, your grip weakens and you may begin dropping things. Getting an early and accurate diagnosis is extremely important, both to relieve the pain and to help prevent permanent nerve damage.

Causes

The carpal tunnel is a tunnel in the center of the wrist containing tendons and a major nerve. CTS is caused when too much pressure is put on the median nerve which runs through the wrist. This can be due to swelling, thickening or irritation of the membranes that surround the tendons in the carpal tunnel. Common causes include:

• repetitive grasphing with the hands

• repetitive bending of the wrist

• bone disloaction and fractures

• fluid retention

• hypothyroidism

This compression causes pain, numbness, tingling and burning in the fingers. Eventually, as the pain increases, grip weakens and one may begin to drop things.

Diagnosis

Getting an early and accurate diagnosis is extremely important, both to relieve pain and to help prevent permanent nerve damage. During your evaluation, your doctor will take a medical history and will perform a physical exam. Other tests such as X-rays, a nerve conduction study or an electromyogram may be performed.

Treatment

Once CTS has been diagnosed, initial treatment may begin with a wrist splint to help reduce pressure on the nerve. Both night splints and occupational splints worn while working keep the wrist in a neutral position to help reduce swelling. Medications or injections are also used to reduce swelling and inflammation.

Surgery

If you have severe pain or if other symptoms persist despite non-surgical treatment, your physician may recommend carpal tunnel release surgery. As the word "release" implies, the ligament that forms the roof of the canal is cut to relieve the pressure on the median nerve. This procedure takes less than twenty minutes and can be performed on an outpatient basis, often under local anesthesia.

This procedure can be performed endoscopically using a smaller incision, or through a common "open" approach. In open carpal tunnel release, the physician makes a small incision, usually around two inches in length.

The transverse carpal ligament is cut, while the median nerve is protected. By cutting the ligament, pressure is relieved on the median nerve. This cut in the ligament will gradually fill with scar tissue. After the procedure, the skin is sutured, or sewn closed.

Before Surgery

Before your surgery, your doctor will explain the procedure, anesthesia options, risks and possible complications. You may need pre-operative lab tests. You may be instructed not to eat or drink anything after midnight the night before surgery.

After Surgery

You will be monitored in the recovery room after your procedure. Your hand will be bandaged and your arm will be elevated and will be in a well-padded dressing. You will be able to begin using the hand immediately.

A follow-up visit to your physician will be arranged and you will be given instructions about your home recovery and rehabilitation. You can expect tenderness at the incision site until complete healing occurs. Patients can usually return to normal activities in a few weeks.