We Treat Carpel Tunnel Syndrome

Carpal tunnel syndrome is a hand and arm condition that causes numbness, tingling and other symptoms. Carpal tunnel syndrome is caused by a pinched nerve in your wrist.

A number of factors can contribute to carpal tunnel syndrome, including the anatomy of your wrist, certain underlying health problems and possibly patterns of hand use.

Bound by bones and ligaments, the carpal tunnel is a narrow passageway located on the palm side of your wrist. This tunnel protects a main nerve to your hand and the nine tendons that bend your fingers.

Compression of the nerve produces the numbness, tingling and, eventually, hand weakness that characterize carpal tunnel syndrome.

Fortunately, for most people who develop carpal tunnel syndrome, proper treatment usually can relieve the tingling and numbness and restore wrist and hand function.
Carpal tunnel syndrome usually starts gradually with numbness or tingling in your thumb, index and middle fingers that comes and goes. This may be associated with discomfort in your wrist and hand. Common carpal tunnel syndrome symptoms include:

•Tingling or numbness. You may experience tingling and numbness in your fingers or hand, especially your thumb and index, middle or ring fingers, but not your little finger. This sensation often occurs while holding a steering wheel, phone or newspaper or, commonly, waking you from sleeping. The sensation may extend from your wrist up your arm.

Many people “shake out” their hands to try to relieve their symptoms. As the disorder progresses, the numb feeling may become constant.

•Weakness. You may experience weakness in your hand and a tendency to drop objects. This may be due to the numbness in your hand or weakness of the thumb’s pinching muscles, which are controlled by the median nerve.

When to see a doctor

If you have persistent signs and symptoms suggestive of carpal tunnel syndrome, especially if they interfere with your normal activities and sleep patterns, see your doctor. If you leave the condition untreated, permanent nerve and muscle damage can occur.

Carpal tunnel syndrome occurs as a result of compression of the median nerve.

The median nerve runs from your forearm through a passageway in your wrist (carpal tunnel) to your hand. It provides sensation to the palm side of your thumb and fingers, with the exception of your little finger. It also provides nerve signals to move the muscles around the base of your thumb (motor function).

In general, anything that crowds, irritates or compresses the median nerve in the carpal tunnel space can lead to carpal tunnel syndrome. For example, a wrist fracture can narrow the carpal tunnel and irritate the nerve, as can the swelling and inflammation resulting from rheumatoid arthritis.

In many cases, no single cause can be identified. It may be that a combination of risk factors contributes to the development of the condition.

Safe and Effective Treatment

Carpal tunnel syndrome should be treated as early as possible after you begin to experience symptoms.

Some people with mild symptoms of carpal tunnel syndrome can ease their discomfort by taking more frequent breaks to rest their hands, avoiding activities that worsen symptoms and applying cold packs to reduce occasional swelling.

If these techniques don’t offer relief within a few weeks, additional treatment options include wrist splinting, medications and surgery. Splinting and other conservative treatments are more likely to help you if you’ve had only mild to moderate symptoms for less than 10 months.

Nonsurgical therapy

If the condition is diagnosed early, nonsurgical methods may help improve carpal tunnel syndrome. Methods may include:
•Wrist splinting. A splint that holds your wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness. Nocturnal splinting may be a good option if you’re pregnant and have carpal tunnel syndrome.

•Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs such as ibuprofen (Advil, Motrin IB, others) may help relieve pain from carpal tunnel syndrome in the short term.

There isn’t evidence, however, that these drugs improve carpal tunnel syndrome.

•Corticosteroids. Your doctor may inject your carpal tunnel with a corticosteroid such as cortisone to relieve your pain.

Corticosteroids decrease inflammation and swelling, which relieves pressure on the median nerve. Oral corticosteroids aren’t considered as effective as corticosteroid injections for treating carpal tunnel syndrome.

If carpal tunnel syndrome results from an inflammatory arthritis, such as rheumatoid arthritis, then treating the arthritis may reduce symptoms of carpal tunnel syndrome, but this hasn’t been proved.

Surgery

If your symptoms are severe or persist after trying nonsurgical therapy, surgery may be the most appropriate option.

The goal of carpal tunnel surgery is to relieve pressure on your median nerve by cutting the ligament pressing on the nerve.

The surgery may be performed with two different techniques. Discuss the risks and benefits of each technique with your surgeon before surgery. Surgery risks may include incomplete release of the ligament, wound infections, scar formation, and nerve or vascular injuries. The final results of endoscopic and open surgery are similar.

•Endoscopic surgery. In endoscopic surgery, your surgeon uses a telescope-like device with a tiny camera attached to it (endoscope) to see inside your carpal tunnel and cut the ligament through one or two small incisions in your hand or wrist.

Endoscopic surgery may result in less pain than does open surgery in the first few days or weeks after surgery.

•Open surgery. In open surgery, your surgeon makes a larger incision in the palm of your hand over the carpal tunnel and cuts through the ligament to free the nerve. This procedure may also be conducted using a smaller incision, which may reduce the risk of complications.

During the healing process after the surgery, the ligament tissues gradually grow back together while allowing more room for the nerve than existed before.

In general, your doctor will encourage you to use your hand after surgery, gradually working back to normal use of your hand while avoiding forceful hand motions or extreme wrist positions.

Soreness or weakness may take from several weeks to a few months to resolve after surgery. If your symptoms were very severe before surgery, symptoms may not go away completely after surgery.

Courtesy of Mayoclinic.org

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