Carpal Tunnel
What is carpal tunnel syndrome?
Carpal tunnel syndrome is compression or pressure on the median nerve at the wrist level.
Alignment at the wrist creates a tunnel through which the median nerve and nine tendons
course. The median nerve supplies sensation to the thumb, index, long finger, and half of
the ring finger, thus patients' complaints are altered sensation in these digits.
You can test yourself for carpal tunnel syndrome by simply maximally bending the wrist
down and waiting one minute. If you have increased symptoms of abnormal feeling in these
digits, then you may well have carpal tunnel syndrome.
What causes carpal tunnel syndrome?
There can be many causes of carpal tunnel syndrome. Jobs that require excessive bending of
the wrist tend to increase the pressure around the median nerve in the wrist. Similarly,
sleeping with your wrist in an acutely bent position will increase pressure on the median
nerve and cause carpal tunnel syndrome. Diabetes, alcoholism, hypothyroidism, and obesity
are also all factors towards developing carpal tunnel syndrome.
What is the best treatment for carpal tunnel syndrome?
Carpal tunnel syndrome can vary from just a small amount of pressure to extreme pressure,
and in the late stages of carpal tunnel syndrome, surgery may be necessary to release a short
ligament at the wrist level. Earlier on the best treatment will involve using a splint which
keeps your wrist completely flat and is worn at night. This will decrease the excessive
pressure that can develop at night when the wrist naturally goes into a bent position. Make
sure that the splint you wear at night keeps your wrist completely flat.
What about laser carpal tunnel surgery?
There have been no published reports to suggest that laser can improve or cure carpal tunnel
syndrome.
What about endoscopic carpal tunnel surgery?
The "classic" surgery for carpal tunnel syndrome involves an open technique where a small
incision is made over the region of the ligament which compresses the
median nerve. This ligament is released to decompress the median nerve. With the
introduction of endoscopic surgery in other locations in the body, some hand surgeons are
using a similar technique at the wrist. Usually two small incisions would be substituted
for one larger incision at the wrist level. The incidence of nerve injury is slightly higher
with the endoscopic surgery, but the return to work time may be slightly earlier. Because of
the slight increased risk to the median and ulnar nerves associated with endoscopic carpal
tunnel surgery, the majority of surgeons prefer an open technique. It is recommended that
you discuss in detail these two types of surgery with the particular surgeon you have chosen
to do your surgery.
I know several people who have had carpal tunnel surgery and it has not improved their
symptoms. Why would this be?
The likely answer is that these people have other things going on rather than just carpal
tunnel syndrome. remember that carpal tunnel syndrome will only produce altered sensation
in the thumb, index, long, and half of the ring finger. Any other symptoms that you have of
pain or numbness in the upper extremity is not due to carpal tunnel syndrome and should be
evaluated for other levels of nerve compression or muscle and tendon problems.
I know one person who following their carpal tunnel surgery had worse pain with a
burning sensation at the incision and numbness and pain in the ring and long fingers. What
should they do?
This may relate to a small nerve injury of the median nerve. If is does not resolve over a
few months, then they should seek a surgical consultation as this is not the "normal" course
following carpal tunnel surgery. |
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