Carpal Tunnel Syndrome
Carpal tunnel occurs when the median nerve, which runs from the forearm in to the palm of the hand, becomes pressed or pinched at the wrist. The median nerve controls the sensation to the palm side of the thumb and fingers. If the tendons become irritated it may cause thickening of the carpal tunnel which is a narrow rigid passageway of ligament and bones. This may cause pressure against the nerve and result in pain, weakness or numbness.
There are various factors that can cause carpal tunnel syndrome including congenital reasons where the carpal tunnel is simply small. Other contributing factors can combine to cause the resultant carpal tunnel syndrome including trauma or injury to the wrist, mechanical problems in the wrist joint, work stress, repeated use of certain tools, etc. In some cases, carpal tunnel syndrome has been linked to diabetes, thyroid disease, rheumatoid arthritis and even due to fluid retention during pregnancy.
Symptoms usually take place gradually and include burning, tingling or numbness in the palm of the hand or in the fingers, especially in the thumb, index and middle or ring fingers but not in the little finger. Many people wake with these sensations and feel the need to shake out their hands.
Early diagnosis and treatment to prevent damage to the median nerve. A thorough physical examination of the wrists, hands, arms, shoulders and neck may be done to determine if the pain may be due to an underlying cause. Lab tests and x-rays may also be ordered to rule out other conditions such as diabetes, arthritis and fractures. Often a Nerve Conduction Study will be requested in order to determine the severity of damage to the nerve.
Conservative treatment is usually the first option when treating carpal tunnel syndrome. Nonsteroidal drugs such as ibuprofen may ease the symptoms which were caused due to repetitive or strenuous activity. Injections can also be given to relieve symptoms or provide immediate relief. Physical therapy and various exercise can also help with symptoms in some cases.
When conservative methods fail, carpal tunnel release surgery is a great option and is one of the most common surgical procedures in the United States. This type of involves the severing of the band of tissue around the wrist to decrease pressure on the median nerve. Surgery may be performed in a couple of ways:
- Open release surgery: this is the traditional surgery to correct carpal tunnel syndrome and requires an incision up to two inches in the wrist in order to cut the carpal ligament and enlarge the carpal tunnel.
- Endoscopic surgery: this type of surgery is done through an incision in the wrist and in the palm, then the surgeon inserts a camera attached to a tube in order to view the tissue and ligaments on a screen and then cuts the carpal ligament. Single opening endoscopic surgery is also available and can result in less post operative pain in scarring.