Carpal Tunnel Syndrome is a common condition that occurs when the median nerve is compressed at the wrist, resulting in pain, numbness, and tingling of the hand and fingers. The carpal tunnel is a tight area of the wrist that many important tendons and nerves pass through. It has a floor, walls, a ceiling, an entrance, and an exit. The floor and walls of the tunnel are made up of the bones.
The ceiling is the transverse carpal ligament. The median nerve runs from the forearm to the hand and directly through the carpal tunnel. This nerve controls some of your hand muscles and also allows sensation of your thumb, index, middle, and half of your ring finger. When this nerve is pressed and squeezed, carpal tunnel syndrome develops.
What are the symptoms of Carpal Tunnel Syndrome?
There are nine tendons that pass through the carpal tunnel and these attach muscles of this area to bones to allow your your thumb and fingers to flex. Each of these tendons has a slippery covering called the synovium. This covering allows the tendons to slide easily as the fingers are moved.
When the synovium becomes inflamed or thickened, pressure develops on the median nerve, adversely affecting its function. With a compromised median nerve, there is less blood and nutrients available, leading to numbness, weakness, and pain of the fingers and thumb. These symptoms are considerably worse at night or while driving.
The space allowed for the median nerve and the tendons cannot expand because ligaments and bone do not stretch. This mechanism results in the pressure that develops on the median nerve and the symptoms associated with Carpal Tunnel Syndrome. The longer the nerve is compressed, the more the nerve becomes damaged and after prolonged compression, the damage can become permanent
How is Carpal Tunnel Syndrome prevented?
Often repetitive exercises such as typing, driving or manual labor cause carpal tunnel symptoms. Though the symptoms worsen with these activities, these are often not the cause of carpal tunnel syndrome, as the cause is likely genetic as often the symptoms occur in both hands and are familial. There are ways you can reduce your symptoms.
Ergonomic changes: Arrange your work space and activities using ergonomic guidelines to help prevent the symptoms of Carpal Tunnel Syndrome. Office ergonomics focuses on workstation set up, which includes the placement of your desk, computer monitor, paperwork, chair, and associated tools like a computer keyboard and mouse. The same set up can help you arrange your position for other daily activities, as well.
Proper body mechanics are essential to the prevention of Carpal Tunnel Syndrome.
Evaluate your daily routine for activities that increase your risk of syndrome development. Take frequent breaks from activities to allow for stretching, rest, change in positions, or alternation with another activity.
What treatments are available for Carpal Tunnel Syndrome?
There are several treatments for Carpal Tunnel Syndrome. You should discuss these with our hand surgeons and find out what is best for your particular case. Some people respond to non-surgical options, including wrist bracing, activity modification, or temporary steroid injections. When the conservative options do not relieve your symptoms, surgery is generally recommended as the nerve is clearly at risk. Conservative treatment measures are typically tried for a period of 8 to 12 weeks. However, when there is significant loss of muscle to the thumb or significant median nerve damage, carpal tunnel surgery might be necessary.
These alternative treatments include:
- Anti-inflammatory medication
- Activity/ergonomic changes
- Wrist splint
- Steroid injections given directly to the area surrounding the nerve – often providing good temporary relief
What surgical measures are available for Carpal Tunnel Syndrome?
Surgery is generally considered when the symptoms do not improve or even worsen. Please note that nerve damage makes surgery more urgent and this can often be detected by nerve conduction studies. Surgery is usually required when the symptoms are either persistent or progressive, restricting your normal activities of daily living. Again these symptoms involve numbness in your thumb, index and middle finger, loss of coordination loss of strength in the thumb, and inability to sleep due to severe pain. Also, our surgeons will consider surgery when you are at risk for median nerve damage due to a severe case of Carpal Tunnel Syndrome.
Carpal Tunnel Release Surgery
This type of surgery is done to reduce the pressure on the median nerve in the wrist region. It involves cutting the ligament that is in the top of the carpal tunnel. When this ligament is cut, it relieves the pressure on the median nerve. Our surgeons also remove any other inflammatory tissue that might put pressure on the nerve as well.
Mini -Open Carpal Tunnel Release Surgery
This is the most common type of surgery done in the United States. It involves cutting the transverse carpal ligament so the pressure is lessened on the median nerve of the wrist. The open procedure is done through a one-centimeter incision, which allows our surgeons release the carpal tunnel by releasing the transverse carpal ligament. The success rate is quite high with properly chosen patients and the recovery generally includes a soft dressing for 3 days and return to work by one week. The stitches are removed at 10-14 days.
Endoscopic Carpal Tunnel Release Surgery
This procedure is gaining in popularity in the United States. It requires a very small incision, disturbing less tissue allowing for a potentially quicker recovery period than the open release procedure. With Endoscopic Carpal Tunnel Release Surgery, scars tend to heal quicker, incisions are smaller, and the recovery is less painful for you.
What are the risks associated with Carpal Tunnel Surgery?
Carpal tunnel surgery is quite safe. Infection occurs in less than 1 out of 250 cases. Anesthetic risks are generally extremely low as the anesthetic can generally be localized to the hand and wrist.
Questions?
Do not hesitate to call our office at 206-633-8100 for a timely consultation. Our hand surgeons Dr. Scott Ruhlman, MD or Dr. Wayne Weil, MD make their schedules readily available for consultation.
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