Carpal tunnel syndrome is a common condition that causes pain, numbness, and tingling in the fingers, hand and/or arm. This occurs when the median nerve, a major nerve of the hand is squeezed on as it makes it ways from the forearm into wrist.
The median nerve is made up of branches of smaller nerves, that like most nerves in the body originate in the neck. These branches come together to form a single nerve in the arm. The median nerve goes down the arm and forearm, passes through the carpal tunnel at the wrist, and goes into the hand. The median nerve will then branch out, similar to the branches of a tree, to provide sensation to the thumb, index, middle and part of the ring fingers; it will also control the small muscles in the hand that control the thumb.
The carpal tunnel is a narrow space in the wrist. Within that tunnel there are nine tendons, and the median nerve. The floor, side walls and roof are made of bones and ligament that do not stretch, thus minimal pressure caused by various things may cause symptoms in affected patients.
Early on, symptoms can often be treated with simple noninvasive measures: wearing a wrist splint or avoiding certain activities. To prevent permanent damage to the nerve, early diagnosis and treatment are critical.
If pressure on the median nerve continues, however, it can lead to worsening symptoms and permanent nerve damage. To prevent this, surgery to relieve pressure on the median nerve may be recommended.
Symptoms may occur when the tunnel becomes narrowed secondary to arthritis of the bones, or swelling of the tendons or the nerve within the tunnel occur. This abnormal pressure on the nerve can result in pain, numbness, tingling, and weakness in the hand. Most cases of carpal tunnel syndrome are caused by a combination of factors.
Risk factors include:
- Repetitive hand or wrist positions over a prolonged period may aggravate the tendons in the wrist, causing swelling that puts pressure on the nerve.
- Wrist position: activities that involve extreme flexion or extension of the wrist for a prolonged period can increase pressure on the nerve.
- Total body swelling: pregnancy, kidney failure, fluid retention
- Conditions that cause swelling of tissues: Diabetes, and autoimmune conditions.
Symptoms of carpal tunnel syndrome may include:
- Numbness, tingling, pain and clumsiness—in the thumb and index, middle, and ring fingers
In most cases, the symptoms of carpal tunnel syndrome begin gradually—without a specific injury. Many patients find that their symptoms at first are intermittent. But, as the condition worsens, symptoms may occur more frequently, may persist for longer periods of time or become more intense.
Patients may report that symptoms occur when holding something for a prolonged period with the wrist bent. As the condition worsens and because many people sleep with their wrists bent, patients may wake up from sleep. Some patients find that moving or shaking their hands helps relieve their symptoms.
If you are concerned that you may have carpal tunnel, make an appointment with Dr. Chattar-Cora.
During your evaluation, Dr. Dee will obtain a detailed history about your symptoms, get a thorough medical history and examine you and do some noninvasive tests to determine if you have findings that suggest the diagnosis of carpal tunnel syndrome. Depending on your situation, Dr. Dee may suggest some treatments or recommend further testing to help with the diagnosis.
If during your clinic visit, Dr. Dee has some doubts about your diagnosis he may order special x-rays or nerve studies that are done by another doctor.
If Dr. Dee thinks that you have carpal tunnel syndrome he may recommend that you wear splints when you sleep or a have a steroid injection into the carpal tunnel. The splint will help keep your wrist straight at night time when you sleep, while a steroid injection will help with swelling in the carpal tunnel. On occasion Dr. Dee will suggest a steroid injection as a diagnostic test. If the steroid injection helps, it maybe all you need for treatment. On occasion a repeat injection may be required to treat your carpal tunnel syndrome. If possible, he may recommend that you avoid certain activities that aggravate your symptoms.
If nonsurgical treatment does not relieve your symptoms or if there is evidence of nerve damage (to prevent further damage) Dr. Chattar-Cora will recommend surgery.
Surgical Procedure and Recuperation
Carpal tunnel release will make an incision in the ligament of the carpal tunnel, essentially opening up the roof of the carpal tunnel. This will relieve the pressure on the median nerve.
In most cases, carpal tunnel surgery is done on an outpatient basis. After surgery you will wake up with a splint that will be used for one week, however to regain full use of your hand you will be expected to use your hand for normal activities of daily living. Elevation, and movement of the hand will help alleviate swelling and pain which in turn improve motion of the hand. The recuperation will be different for each patient, but the scar will usually be tender from six to twelve weeks, during that period you can use your hand as much as tolerable; once that tenderness has resolved most patients will be able to do the activities they were able to do before surgery.
There is no such thing as risk free surgery and Dr. Chattar-Cora will take all precautions to avoid them when he performs any operation. The most common complications of carpal tunnel release surgery include:
- Nerve irritation