Carpal Tunnel

Introduction

Carpal Tunnel Syndrome is a common condition affecting the hand and wrist. It occurs when the Median Nerve in the wrist is compressed. The Median Nerve is responsible for carrying signals for sensation and muscle movement, and when it is compressed or entrapped, it cannot function properly.

Carpal Tunnel Syndrome has received a lot of attention in the last few years because of suggestions that it may be linked with jobs that require repeated use of the hands. However, little proof of this actually exists.

Carpal Tunnel Syndrome is more common in women and those between the ages of 30 and 60 years old. It is one of the most common nerve entrapment syndromes, affecting up to 10% of the population. Those with Carpal Tunnel Syndrome may feel numbness, pain, and a “tingly” sensation in their fingers, wrists,arms, and may have difficulty performing grasping and gripping activities.

Anatomy

The Median Nerve passes from the arm, through the wrist, and into the fingers. In the center of the wrist joint, the Median nerve passes through the Carpal Tunnel. The wrist bones form the bottom of the Carpal Tunnel. The Transverse Carpal Ligament covers the top. In addition to the Median Nerve, the Carpal Tunnel also is made up of many tendons. These tendons attach to the muscles, allowing our fingers to bend or flex.

The Median Nerve supplies the sense of feeling to our thumb, index finger, middle finger, and about half of the ring finger. The Median Nerve also sends messages to the Thenar Muscles that move the thumb.When compressed inside the Carpal Tunnel, the Median Nerve sends faulty messages as it travels into the hand and fingers.

Carpal Tunnel Syndrome Causes

Carpal Tunnel Syndrome develops when the tissues and tendons in the Carpal Tunnel swell, thus making the area within the tunnel smaller. The increased pressure within the tunnel causes the Median Nerve to become compressed and disrupts the way the nerve works and causes the symptoms of Carpal Tunnel Syndrome.

Rheumatoid arthritis, joint dislocation, and fractures can cause the space in the tunnel to narrow, thus causing the Carpal Tunnel Syndrome symptoms to begin. Some women develop Carpal Tunnel Syndrome because of swelling from fluid retention caused by hormonal changes such as during pregnancy, premenstrual syndrome, or menopause.

Carpal Tunnel Syndrome Symptoms

The typical symptoms of Carpal Tunnel Syndrome are pain, numbness, and tingling. The numbness and tingling is typically present in the thumb, index, middle, and half of the ring finger. The paid has been described as a deep ache or burning. The pain may actually radiate into your arms. The thumb may feel weak and clumsy, making it difficult to  grasp items, and you may start to drop things. The symptoms may be more pronounced at night, when you perform certain activities, or in colder temperatures.

Carpal Tunnel Syndrome Diagnosis

The doctor can diagnose Carpal Tunnel Syndrome by conducting a medical examination, reviewing your medical history, and asking about your activities and symptoms. During the physical exam, the doctor will check your wrist and hand for sensation and perform a thorough hand examination.

The doctor may ask you to perform a couple of simple tests to determine if there is pressure on the Median Nerve:

  • Phalen’s Test- you will firmly flex your wrist for 60 seconds. The test is considered positive if you feel numbness, tingling, or weakness.
  • Tinel’s Sign- the doctor will tap on the Median Nerve at the wrist. The test is considered positive if you feel tingling or numbness in the distribution of the median nerve.
  • Lab tests may be ordered if the doctor suspects a medical condition that is associated with Carpal Tunnel Syndrome. The doctor may take an X-ray to identify arthritis or fractures.
  • Nerve Conduction Velocity (NCV) test- during this study, a nerve is stimulated in one place and the amount of time it takes for the message or impulse to travel to a second place is measured. The NCV may feel uncomfortable, but only during the time that the test is conducted.
  • Electromyography (EMG) test- often conducted at the same time as the NCV test. An EMG measures the impulses in the muscles to identify poor nerve input. Healthy muscles need impulses to perform movements. The doctor will place needles through your skin, into the muscles that the Median Nerve controls. The doctor will be able to determine the amount of impulses conducted when you contract your muscles. Your muscles may be sore following the test.

Carpal Tunnel Syndrome Treatment

The symptoms associated with Carpal Tunnel Syndrome can often be relieved without surgery. Some individuals respond to treatments that relieve pain and provide rest. The doctor may recommend that you wear a splint nightly to hold your wrist in a neutral position or during activities that aggravate your symptoms. The doctor may prescribe an anti-inflammatory medication to help reduce your pain and swelling. Sometimes a corticosteroid injection is offered to provide symptom relief.

Carpal Tunnel Syndrome Surgery

Surgery is only recommended when non-surgical options fail. There are a few types of outpatient surgery to remove pressure on the Median Nerve:

  • Open Release- The surgeon uses a local or regional anesthetic to numb the hand. For this procedure, the surgeon makes a 2-3” opening along the palm. This allows the surgeon access to the Transverse Carpal Ligament, or the roof of the Carpal Tunnel. The surgeon then makes an incision in the Transverse Carpal Ligament to open the tunnel,making it larger. By doing this, pressure is taken off of the median nerve. The surgery time for an Open Release is about fifteen minutes.
  • Endoscopic Carpal Tunnel Release- This type of surgery is done using an endoscope placed in a small incision and may be used in conjunction with a camera or video system. Endoscopic Carpal Tunnel Release most often uses a local or regional anesthetic to numb the wrist and hand area. In some cases, individuals are sedated for the surgery. The surgeon makes a small opening below the crease of the wrist and inserts the endoscope to view the Carpal Tunnel. Sometimes, the surgeon will make a second incision in the palm of the hand. The surgeon then places a tube called a cannula along the side of the Median Nerve. A special surgical instrument is inserted through the cannula that makes an incision in the Transverse Carpal Ligament. Endoscopic Carpal Tunnel Release avoids some of the tissue in the palm, individuals may heal faster and experience less discomfort.

Carpal Tunnel Syndrome Recovery

Following Carpal Tunnel Syndrome surgery, the incision will be wrapped in a soft dressing. It may be recommended that you wear a splint to provide support and promote healing. You should be able to move your fingers immediately after surgery. However, you will need to avoid heavy grasping or pinching motions for about six weeks. The doctor may recommend that you undergo some physical therapy to gain strength, joint stability, and coordination. It may take several months for strength in the wrist and hand to return to its normal condition.

 

At SPORT, our orthopedic providers can help relieve the pain of a hand or wrist injury and restore your flexibility and range of motion. For an appointment at our Dallas or Frisco office, call (469) 200-2832 today or use our convenient online appointment request form.

Sports Physicians Orthopedics and Rehabilitation of Texas