What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is a progressively painful hand and arm condition caused by a pinched nerve in your wrist. The median nerve and nine tendons that move your fingers pass through a narrow passageway in the palm side of your wrist. Compression of the nerve produces the symptoms of numbness, pain and, eventually, hand weakness that characterize carpal tunnel syndrome. Fortunately, for most people who develop carpal tunnel syndrome, proper treatment usually can relieve the pain and numbness and restore normal use of their wrists and hands.
What are the symptoms of Carpal Tunnel Syndrome?
Vague aching in the palm and wrist is the hallmark beginning of carpal tunnel syndrome. This progresses to tingling or numbness in your fingers or hand, especially your thumb and index, middle or ring fingers, but not your little finger. This often occurs at night, while holding a steering wheel, phone or newspaper or upon awakening. Many people “shake out” their hands to try to relieve their symptoms. As the disorder progresses, the numb feeling may become constant. Another symptom can be pain radiating from your wrist up your arm to your shoulder or down into your palm or fingers, especially after forceful or repetitive use. This usually occurs on the palm side of your forearm. Lastly, weakness may develop in the hands and gripping objects may be difficult.
What causes Carpal Tunnel Syndrome?
No one cause has been identified, however, anything that crowds, irritates or compresses the median nerve in the carpal tunnel space can lead to carpal tunnel syndrome. For example, a cyst could take up space in the tunnel and compress the nerve, a wrist fracture can narrow the carpal tunnel and crowd the nerve, and the inflammation caused by rheumatoid arthritis can cause nerve irritation. Some chronic illnesses, such as diabetes and alcoholism, increase your general risk of nerve damage, including your median nerve. Repetitive motion may exacerbate existing symptoms. Also, carpal tunnel syndrome is generally more common in women. This may be because the carpal tunnel area is relatively smaller than it is in men. Women who have carpal tunnel syndrome may also have smaller carpal tunnels than women who don’t have the condition.
What tests can be done to see if I have Carpal Tunnel Syndrome?
In addition to a thorough history and physical examination, an X-ray of the affected wrist may be recommended to exclude other causes of wrist pain, such as arthritis or a fracture. Other tests include an electromyogram and a nerve conduction study. Electromyography measures the tiny electrical discharges produced in muscles. A thin-needle electrode is inserted into the muscles to be studied. An instrument records the electrical activity in the muscle at rest and as it is contracted. This test can help determine if muscle damage has occurred. In a nerve conduction study, two electrodes are taped to the skin. A small shock is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel. The electromyogram and nerve conduction study tests are also useful in checking for other conditions that might mimic carpal tunnel syndrome, such as a pinched nerve
What are the treatment options for Carpal Tunnel Syndrome?
The treatment options can be separated into two categories: non-surgical and surgical. Non-surgical options include taking frequent breaks to ice the wrists, anti-inflammatory medications (such as Ibuprofen, Advil, or Aleve), wrist splinting particularly at night, and a corticosteroid injection into the carpal tunnel. Corticosteroids decrease inflammation and swelling which can relieve pressure on the median nerve. If several months of non-surgical treatment fails to provide adequate relief then surgery may be indicated. Surgical options include open or percutaneous carpal tunnel release. During carpal tunnel release surgery, the transverse carpal ligament is cut relieving pressure on the median nerve. Open surgery is accomplished with an incision on the palm of the hand cutting the ligament to free the nerve. Percutaneous carpal tunnel release is a minimally invasive technique performed under local anesthesia with two tiny poke hole incisions. Percutaneous surgery allows for a more rapid recovery and less time off from work and other activities. Dr. Snow performs carpal tunnel release using the Manostm carpal tunnel release system.
Incision for traditional open carpal tunnel release Percutaneous incisions for minimally invasive carpal tunnel release
In general, you are encouraged to use your hand after surgery, gradually working back to normal use of your hand while avoiding forceful hand motions or extreme positions of your wrist. This recovery can be accelerated if the percutaneous minimally invasive technique is able to be used. Soreness or weakness may take from a few days to as long as a few months to resolve after surgery. If your symptoms were very severe before surgery, symptoms may not go away completely after surgery.