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Carpal Tunnel Syndrome
June 8, 2015
Many people who perform repetitive movements with their hands and wrists suffer from this problem. Most people have heard of it, and many have had the surgery to treat it. It is one of the more common things we see in an orthopedic clinic.
The carpal tunnel is found in the wrist, and is formed by the bones and a large thick ligament that spans the base of the hand. This ligament, called the transverse carpal ligament, is the cause and solution to carpal tunnel syndrome. It forms the "roof" of the tunnel. When inflammation forms in the tunnel, it can cause swelling in the soft tissues. Because the ligament is so thick, it does not expand with this pressure increase due to the inflammation. The pressure then increases on the major nerve within the tunnel that gives sensation to four of the digits in the hand. This nerve, the median nerve, primarily gives sensation to the thumb, index and middle finger.
Excessive pressure on the nerve causes pain and numbness to these digits. Many people have night pain because as they sleep, the unknowingly bend the wrist for extended periods of time. Bending the wrist puts increased pressures on the nerve as well, thus the symptoms can be worse at night. The pain and numbness can actually wake people up. Often times people find themselves shaking their hands trying to get the feeling back. Some complain of problems holding steering wheels, reading newspapers, and typing.
Treatment usually is conservative at first. We like to try night splints to prevent bending the wrists, non-steroidal anti-inflammatory medicines, and massage therapy under certain conditions. Corticosteroid injections done in the clinic can decrease the inflammation dramatically. Ice therapy is an option as well. We encourage modification of activity as well if possible. If an individual can avoid offending activity, this gives the nerve a chance to heal.
If months of conservative efforts fail, then surgery may be the last resort. Carpal tunnel release is a good option that often gives excellent immediate pain relief. Many types of surgery are performed. We prefer endoscopic carpal tunnel release, as the recovery time and pain from surgery is significantly reduced. Surgery time is less than 10 minutes usually, and complications are rare. We have had excellent results in this method, and continue to offer it to our patients.
The surgical procedure involves releasing the transverse carpal ligament with a small incision in the wrist. Recovery time takes 3-6 weeks depending on the individual, and many return back to work within 2 weeks. Most people return back to light activities within a day or two, and immediate change in the numbness and pain is often seen. Because of the advances in carpal tunnel treatment, many options are available for patients to try and cure this all too common problem.