Carpal Tunnel

Carpal Tunnel Syndrome (CTS) is a progressive and painful condition caused by increased pressure on the median nerve, which runs from the forearm into the palm of the hand. The carpal tunnel, which is at the base of the hand, is defined as a passageway of ligaments and bones that house the median nerve and tendons. When the tendons thicken and become irritated, swelling causes the median nerve to become compressed, resulting in pain and discomfort.

SYMPTOMS OF CARPAL TUNNEL

• Burning, tingling, weakness, swelling or numbness in the palm of the hand and in the fingers (particularly the thumb, index and middle fingers)
• Difficulty forming a fist and weakness while attempting to hold onto various objects
• A feeling of stiffness in the wrists upon waking up
• Progressive weakness in the thumb that may result in an inability to discern the difference between hot and cold

CAUSES

• The carpal tunnel is smaller in some people, which creates a congenital predisposition
• Injury to the wrist that results in swelling, sprain or fracture
• Hypothyroidism
• Rheumatoid arthritis
• Long-term use of vibrating hand tools, for example, construction equipment
• Growth of a tumor or cyst
• At times, no cause can be determined
• Although repetitive or stressful movements, such as long hours at a computer keyboard are often associated with Carpal Tunnel Syndrome, there is no accepted clinical data that definitively proves a diagnosis

TREATMENT

The first step should always be to consult with and orthopedic hand doctor so he or she can perform tests and evaluate the severity of the condition. After testing, doctors usually prescribe at least two weeks of rest for the affected wrist and hand.

• Initial conservative treatments include a wrist splint and the application of icepacks to the swollen area.
• Other nonsurgical treatments include: Medication, including aspirin, ibuprofen and other over-the-counter pain relievers, all of which are non-steroidal anti-inflammatories. Other options are using diuretics to decrease swelling; prednisone, which can relieve pressure on the median nerve and Vitamin B6, which some studies have shown can ease symptoms.
• Exercise supervised by a physical therapist to stretch and strengthen the affected areas.
• Other treatments, often called alternative therapies, are an option. They include acupuncture and chiropractic treatments, both of which have been a benefit to some patients. Others have found relief using yoga to increase overall flexibility.

If nonsurgical treatments fail to alleviate pain over a period of six months or more, patients should consider surgery.

In a procedure called Carpal Tunnel Release, the doctor makes a small incision (about 1 inch in length) in the wrist and releases the transverse carpal ligament, which in turn makes the carpal tunnel larger and takes the pressure off of the median nerve. Another option is Endoscopic Carpal Tunnel Surgery, during which the surgeon makes a smaller incision in the wrist and then inserts a camera for a close inspection of the tissue. The transverse carpal ligament is cut and the operation, performed under local anesthesia, tends to limit scarring and scar tissue.

RECOVERY

Surgery has the potential to alleviate symptoms and pain, but a patient should not expect full recovery until several months have passed. Possible side effects include: Infection, nerve damage, stiffness and pain at the incision site.

Most patients require physical therapy after surgical procedures to restore strength in the wrist. Those with occupational issues might find it necessary to alter what they do at work, or even change jobs completely.