WHAT YOU SHOULD KNOW
 The carpal tunnel is a space near the wrist and palm where 9 tendons and the median nerve make a narrow passage under a tight band of tissue, the transverse carpal ligament. Carpal tunnel syndrome is when the tendons swell so much in the tight space that they put pressure on the nerve. Everyday use of the hands and certain positions of the wrist during daytime and nighttime, in certain instances, may be the only cause.
MEDICAL HISTORY: Patients usually complain of pain, numbness, and tingling that begins in the wrist region and travels out to the fingertips of the thumb, index, long, and ring fingers. The symptoms are often worse in the middle of the night causing waking or in the morning. Driving, fixing one's hair and time at the computer are other problem activities. When severe patients may even lose coordination and drop things.
 EXAMINATION: Pressure applied over the nerve at the wrist will recreate the pain, numbness, and tingling. The doctor will measure strength in the muscles (motor) and feeling ability (sensory) in the skin for specific areas serviced by the median nerve. In more advanced conditions, patients will demonstrate loss of motor and sensory functions.
ADDITIONAL TESTS: Electrical nerve tests provide actual numbers that tell the story of how well or poorly the nerve is conducting signals in the area of the carpal tunnel and if the muscles have sustained any damage as a result of prolonged nerve pressure.
TREATMENT OPTIONS
| |
NON-OPERATIVE |
SURGICAL RELEASE |
| CONSISTS OF |
Night splints, ergonomic training, and cortisone shots into the carpal tunnel |
Release of the tight band, taking pressure off the nerve |
| FEATURES |
Limit of 2 cortisone shots designed to shrink tendon swelling |
Brief outpatient surgery using a fiber optic camera via a single 1cm incision at the wrist.* |
| ADVANTAGES |
Avoids surgery |
Definitive solution to problem |
| DISADVANTAGES |
Only effective in mild cases |
Always the risk of scar tissue forming near nerve |
*Be aware that there are other surgical techniques for carpal tunnel release that require either a much larger incision without using a camera, or two incisions–one at the wrist and a second separate incision in the palm of the hand.
RECOVERY
After the surgery no splints are used and there are no sutures that will need to be removed. Immediate use of the hand is encouraged for all light activities of daily living. Even forceful or heavy use of the hand is possible immediately, but such early over activity will be painful and is not encouraged. Specific therapy exercises should be done to limit scarring around the nerve. Return to a normal lifestyle is quite rapid.
Back to Medical Conditions
|
)
)
){kind=link}