Carpal Tunnel Syndrome

Carpal tunnel syndrome is the most frequent cause of nerve compression in the human body. It is caused by compression of the median nerve at the level of the wrist. The median nerve and 9 tendons occupy a tight space called the carpal tunnel. When the tendons swell, pressure is placed on the nerve and the fingers start to tingle and go numb. The hand becomes weak, cramps, and some patients begin to drop items they are using from either poor sensation and control of the grasp mechanism, or from weakness. Pain may radiate from the fingers across the wrist and up the forearm or even more proximal to the shoulder. These symptoms are often worse at night and can cause nighttime awakening. The condition is made worse by leaving the wrist in a poor positions (excessive flexion or extension) for a prolonged time, or from repetitive activities that also places the wrist in a poor functional position. The most common mistake is to assume that all patients who have these symptoms suffer from carpal tunnel syndrome. There are many other conditions that can cause similar symptoms. Sorting this out is done by a hand specialist trained in nerve compression surgery. It is common to obtain an electrical nerve test before surgery for treatment decisions, prognosis and for a baseline study for future comparison.

Three non-surgical steps are taken to relieve symptoms. A splint is used to keep the wrist straight instead of bent at night or during work or leisure activities.Therapists can teach the patient to use the hands in a safe ergonomic way. Finally, cortisone is injected into the carpal canal to help shrink the swollen tendon synovial lining which indirectly takes pressure off the median nerve. This works for most patients. If symptoms persist, the patient may need a relatively simple outpatient surgery to release the tight space around the nerve. This is called a carpal tunnel release. The procedure takes less than 10 minutes to perform and can be done by putting just the affected arm to sleep or the entire body depending on the patients preference. Below is the recommended ergonomic position that should be used when sitting in front of a computer and takes into consideration the neck, shoulders, arms and legs.

In selecting the correct treatment, non-operative vs operative treatment will depend on the severity, chronicity or time that the condition has been present, response to prior nonoperative treatment and other patient factors affecting the final outcome. At the ROC, your surgeon will explain the rationale behind the proposed treatment during your visit. Previously, carpal tunnel surgery required a large incision that extended from the hand and traveled across the wrist and into the forearm. That caused more pain and scarring and takes longer to recover. Many surgeons still use this technique successfully. Currently, a much less invasive method is done through a one-centimeter incision at the level of the wrist or a two incision procedure where one incision is on the wrist and the other in the mid-palm. The second technique is the older of the two and was invented by Jimmy Chow in St Louis. The later is the preferred technique at ROC. Both techniques have been around since for over 20 years. During the endoscopic technique, A fiber optic camera is used to cut the tight carpal ligament, expanding the space around the nerve. The ligament then heals in a expanded position which allows more room for the nerve.After surgery, a light dressing is applied to the wrist. Patients are encouraged to use the hand right away with minimal restrictions. Hand therapy may be necessary in some cases. Therapy consists in of exercises that improve recovery, by performing nerve and tendon gliding to minimize scar adhesion’s. Patients are back to most activities within a month.