Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) is a condition caused by compression of the median nerve, a major nerve that passes through the wrist. Carpal actually means wrist. The carpal tunnel is a narrow passageway comprised of bones and a thick band called the transverse carpal ligament. In addition to the median nerve, multiple tendons pass through the carpal tunnel. For various reasons the space in the carpal tunnel can get smaller or the contents can enlarge causing a “pinched nerve”. CTS impacts an estimated three to six percent of the population.
In most cases CTS is just part of the normal aging process. As we age, the canal tunnel can get smaller and/or its contents can enlarge. In addition, autoimmune disorders (e.g., rheumatoid arthritis, lupus, gout), diabetes, fluid retention due to pregnancy or menopause, fractures or trauma to the wrist, or bone spurs in the wrist and thyroid disorders may contribute to CTS.
Another cause or contributing factor may be repetitive motions of the hand and wrist. Although there is no proof, many people believe that repetitive movement can cause swelling of the membranes around the tendons (called tenosynovitis).
The median nerve is responsible for feeling in the thumb, index, middle and one half of the ring finger. It also provides innervation to the muscle at the base of the thumb. Symptoms of CTS are variable, but classic symptoms include pain and tingling of the fingers and hand. These symptoms can be constant or intermittent but are often worse at night. CTS pain can radiate to the forearm and even sometimes up to the shoulder. In more advanced cases, true numbness (loss of feeling) of the fingers and/or weakness can occur. In severe cases, the muscle at the base of the thumb can atrophy (shrink) causing loss of ability to oppose the thumb (pinch the thumb against other fingers). Unfortunately, CTS is often progressive over time, and as the condition gets worse it can become irreversible. If treated early CTS is often completely correctable.
There are no definitive steps to prevent CTS.
Since CTS is more easily treated in its early stages, it is important to see a physician experienced in the diagnosis and treatment of CTS as soon as symptoms appear. Unfortunately, most physicians have received little training in CTS. Hand surgeons and orthopedic surgeons usually have the most experience with CTS. Often, an experienced physician can make the diagnosis based on medical history and physical examination. Electrodiagnostic testing and ultrasound can assist in confirming the diagnosis or differentiating it from other conditions (i.e., pinched nerve in the neck, diabetic neuropathy).
- Corticosteroid injections (can reduce swelling in the carpal tunnel and make space for the median nerve)
- Wearing a wrist brace to possibly help night symptoms
- Medications such as anti inflammatories to possibly help some of the symptoms
- Treating the underlying condition, such as rheumatoid arthritis or diabetes
Surgical Treatment Options
If conservative measures are exhausted, surgery is a consideration. CTS surgery is common, with approximately 500,000 procedures per year. It is an accepted and highly-effective procedure. One comprehensive article states that various trials show that 70 to 90 percent of those who underwent CTS surgery were subsequently free of nighttime pain.
There are two basic types of carpal tunnel release (CTR) surgeries, both of which are designed to relieve pressure on the medial nerve. At NEOSM, we specialize in both. These surgeries are performed on an outpatient basis and have proven successful with similar satisfaction rates, safety and effectiveness between the two procedures. In both procedures, the transverse carpal ligament is divided. This takes pressure off of the nerve thereby “unpinching” the nerve.
Endoscopic Carpal Tunnel Release
This minimally invasive technique includes the use of an endoscope, a thin tube with a camera attached. After making one or two small incisions in the wrist and/or palm, the endoscope is used to visualize the transverse carpal ligament and then a specialized tool is used to divide the ligament.
For open surgery, the surgeon makes a small incision at the base of the palm on the hand. This provides a direct view of the transverse carpal ligament which is then divided.
Recovery from either surgery is relatively short. A bandage is usually worn for about one to two weeks. Initially, there is some mild to moderate soreness which will affect the ability to do heavy or repetitive activity with the hand. Most people can use the hand for light activity within a few days. Although mild soreness can persist for one to three months, most patients get back to their normal life activity fairly quickly.
To receive a diagnosis and explore treatment for carpal tunnel syndrome schedule an appointment with one of our specialists today.