What is carpal tunnel syndrome?
carpal tunnel syndrome
Carpal tunnel syndrome is the most common nerve disorder in the human body.Carpal tunnel syndrome occurs when the median nerve, one of the major nerves to the hand, is compressed or pinched within the carpal tunnel.
The carpal tunnel is a tight passage that the median nerve runs through at the level of the wrist, on its way to the hand.Modern studies are determining that the most common cause of carpal tunnel syndrome is probably genetics.However, health issues such as diabetes, thyroid disorders, rheumatoid arthritis, gout and obesity can increase the chance of carpal tunnel syndrome occurring.
Carpal tunnel syndrome leads to tingling and numbness of the fingers of the hand.The most common fingers involved are the middle and ring fingers, but all fingers may be involved.The numbness of carpal tunnel syndrome is often worse at night, when it often wakes people up, and in the morning upon awakening.
The numbness also commonly occurs during activities involving grip, such as driving or holding a book.It is very common for people with carpal tunnel syndrome to try to shake the hand out, or move the wrist and fingers to try to decrease this numbness.Carpal tunnel syndrome tends to worsen over time, and can eventually lead to nerve damage with decreased sensation, weakness and clumsiness of the hand.
Carpal tunnel syndrome is best diagnosed on a history and physical examination by a hand specialist.A nerve study is frequently obtained. While a nerve study can be helpful, it misses the diagnosis of carpal tunnel syndrome 20-33 percent of the time. In cases where carpal tunnel syndrome is strongly suspected but is not detected by a nerve study, a diagnostic steroid injection into the carpal tunnel can be performed.If a carpal tunnel injection temporarily improves or relieves the numbness, then the diagnosis of carpal tunnel syndrome is confirmed.A carpal tunnel injection is actually more accurate than a nerve study.
For early carpal tunnel syndrome, wearing a wrist splint at night may decrease symptoms.Most people sleep in the fetal position with the wrist flexed.Wrist flexion decreases the space in the carpal tunnel, leading to increased pressure on the median nerve and increased symptoms.A wrist splint keeps the wrist straight when asleep.The splint does not need to be worn while awake.
If a month or so of splinting fails, a carpal tunnel release is extremely effective treatment.If the carpal tunnel syndrome has progressed to the point where the numbness is constant, atrophy (loss of size) of the thumb muscles has occurred, or the nerve conduction study detects irreversible changes, a carpal tunnel release should be performed.A carpal tunnel release may also be performed for people who prefer more definitive treatment instead of the night splints.
The least invasive technique that returns most people back to their activities the quickest is the single-incision endoscopic carpal tunnel release.The single-incision endoscopic carpal tunnel release is a quick outpatient surgery that is extremely effective.Typing and computer use may be resumed the next day.The wound needs to be kept clean and dry for 48 hours, and then showering is allowed.The wound should not be submerged under water for 10 days.The stitches are absorbable and there are no stitches to remove.While there are no formal activity restrictions, it is best to avoid heavy gripping and lifting for 6 weeks in order to minimize pain, inflammation and swelling.
Dr. Jeffrey E. Budoff is a board certified orthopedic surgeon specializing in the hand, wrist, elbow and shoulder. He has completed fellowships in both hand surgery and sports medicine. He practices orthopedics in Houston and is an expert in arthroscopic and open surgery. Follow this #ALExpert on Twitter @DrBudoff. Angie's List. Ratings are subject to change based on consumer feedback, so check Angie's List for the most up-to-date reviews. The views expressed by this author do not necessarily reflect those of Angie's List.