CARPAL TUNNEL SYNDROME

CLICK HERE TO SEE IF YOU SUFFER FROM CARPAL TUNNEL SYNDROME BY TAKING THE CARPAL TUNNEL QUIZ

WHAT IS CARPAL TUNNEL SYNDROME?

Physicians define carpal tunnel syndrome as a compression neuropathy of the median nerve. Additionally, compression neuropathy means that compression has made the nerve (‘neuro’) sick (‘pathy’). Inside the carpal (wrist) tunnel lies a tight space bordered by bones on three sides and the tight carpal tunnel ligament holding everything down like a tight belt on top. Moreover, the contents of the carpal tunnel include the flexor tendons to the fingers and the median nerve.

Furthermore, the median nerve provides sensation to the thumb, index and middle finger and motor function to the thumb. Additionally, compression of this nerve will cause numbness, tingling and pain in the thumb, and index and middle fingers. Eventually, leading to weakness of the thumb muscles. This condition exists as the most common peripheral compression neuropathy, accounting for 90% of peripheral cases. Additionally, experts estimate that 5% of the US population suffers from this syndrome.¹

WHAT CAUSES CARPAL TUNNEL SYNDROME?

The most common cause of carpal tunnel syndrome is ‘idiopathic’- meaning that we do not know what exactly causes it. This condition likely occurs from a combination of events. Some risk factors include:

Demographics: female sex, older age
Health conditions: pregnancy, diabetes, thyroid disease, rheumatoid arthritis
Hand and wrist position: activities that hold the hand in the extremes of flexion or extension can increase pressure on the median nerve
Repetitive hand use: overuse of the flexor tendons running through the carpal tunnel can lead to inflammation and swelling of the tendons, leaving less space for the median nerve and contributing to its compression
Heredity: inherited anatomic differences likely play a role in the development of this condition

WHAT ARE SYMPTOMS OF CARPAL TUNNEL?

Moreover, people experience symptoms of this condition differently. However, the most common symptoms include numbness/tingling, electric shocks, burning, or pain of the thumb, index and middle fingers. Often people with carpal tunnel will complain of dropping objects and waking up in the middle of the night and can lose 2.5 hours of sleep per night.² Severe carpal tunnel will present with weakness of the thumb and difficulty getting the thumb out of the palm of the hand.

DIAGNOSIS AND TREATMENT

Physicians can often diagnose this syndrome by confirming the symptoms and by performing a clinical examination including provocative physical examination tests to reproduce the symptoms. Moreover, patients may undergo US (ultrasound) studies in our office to examine the median nerve as it enters the carpal tunnel as well. At times Doctors require EMG and NCS (nerve conduction studies) to measure nerve conduction velocities to determine where and how the compression lies. Besides compressing the carpal tunnel, in rare cases it may compress the neck and the forearm as well. Moreover, PM&R or neurology doctors can perform EMG/NCS. This is an invasive study that involves placing small needles the size of acupuncture needles in the forearm and hand. Moreover, it gives small electric shocks to determine nerve function and speed.

TREATMENT OF CARPAL TUNNEL SYNDROME

Treatment of this condition includes conservative non-operative treatment options and surgical options. Non-operative treatment may benefit mild carpal tunnel syndrome. However, it usually offers only temporary relief in moderate and severe carpal tunnel syndrome for which doctors recommend surgical release as definitive treatment.

To address this syndrome, various treatment options are available. Firstly, lifestyle modifications involve reducing repetitive hand and wrist movements and modifying activities to minimize prolonged extremes of wrist flexion and extension. Additionally, wearing a wrist cock-up brace is recommended to maintain the wrist in 20 degrees extension, which maximizes the space within the carpal tunnel. While NSAID medications have shown equivocal results in scientific trials, some patients may find them beneficial for managing symptoms.

Moreover, cortisone injections can aid in confirming the diagnosis in uncertain cases and have been associated with successful symptom resolution following surgical release. Furthermore, endoscopic carpal tunnel release offers a minimally invasive approach, employing an endoscopy camera the size of a small pen inserted through a small incision at the wrist crease. Conversely, open carpal tunnel release involves a traditional surgical approach with an incision made in the palm over the carpal tunnel ligament.

If you would like to speak to a Texas Orthopedic Hand and Wrist Specialist, give us a call at 817-697-4038, or contact us over the web. Tele-medicine appointments are also available.

REFERENCES

“Carpal tunnel syndrome” by Kyle Bickel published in the Journal of Hand Surgery Jan 2010. https://pubmed.ncbi.nlm.nih.gov/20117319/
“The negative effect of carpal tunnel syndrome on sleep quality” by Ashish Patel et al published in the Journal of Sleep Disorders Feb 2014. https://pubmed.ncbi.nlm.nih.gov/24693441/
“A clinical questionnaire for the diagnosis of carpal tunnel syndrome” by Kamath and Stothard published in the Journal of Hand Surgery: British and European Volume Oct 2003. https://pubmed.ncbi.nlm.nih.gov/12954256/