Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is a common, painful, progressive condition that is caused by compression of the median nerve at the wrist area.

The carpal tunnel is the passageway in the wrist and consists of the arching carpal bones (eight bones in the wrist) and the ligament connecting the pillars of the arch (the transverse carpal ligament). The median nerve and the tendons that connect the fingers to the muscles of the forearm pass through the narrow tunnel.

Symptoms

Common symptoms of carpal tunnel syndrome include numbness and tingling sensation in all the fingers except the little finger; pain and burning sensation in hand and wrist that may radiate up the arm and elbow; and weakness in hand with diminished grip strength.

Causes

Carpal tunnel syndrome occurs when the median nerve is compressed because of swelling of the nerve or tendons or a combination of factors that put pressure on the median nerve. The median nerve provides sensation to the palm side of the thumb, index, middle finger, and the inside half of the ring finger. It also gives power to, or innervates, muscles in the forearm and hand that allow a pincher grasp (the ability to grasp an object between the thumb and forefinger). When this nerve becomes impinged, or pinched, numbness, tingling, and sometimes pain of the affected fingers and hand may occur and radiate into the forearm.

Certain factors increase the risk of developing carpal tunnel syndrome and including repetitive motion of hand and wrists, fractures and sprains, hormonal imbalance, congenital abnormalities, and medical conditions such as hypothyroidism, rheumatoid arthritis, diabetes, obesity, gout, overactive pituitary gland, or the presence of a cyst or tumor in the canal.

Conservative Treatment Options

Carpal tunnel syndrome may be treated using conservative approaches or surgery. The conservative treatments include:

Treating underlying medical conditions
Immobilization of the hand and wrist with a splint or wrist brace for 4-6 weeks
Rest the hand for 2 weeks or more
Ice packs to avoid swelling
Avoid activities that tend to worsen the symptoms
Medications such as non-steroidal anti-inflammatory drugs and steroid injections
Strengthening and stretching exercises once symptoms diminish

Surgery

If conservative treatment options fail to resolve the condition your surgeon may recommend surgical procedure.

Carpal Tunnel Release Surgery

Carpal tunnel syndrome can be treated with carpal tunnel release. Traditional surgery involves up to a 2- inch incision in the palm and wrist area, whereas endoscopic surgery involves a single half-inch incision and the use of an endoscope. During the surgery, the transverse carpal ligament will be divided to release the pressure on the median nerve and enlarge the carpal tunnel. Your surgeon will decide which options are best for you based on your general and medical conditions.

Dr. Grimes uses endoscopic carpal tunnel release for almost every case.

Post-Operative Care

Your surgeon may suggest you to practice certain post-operative procedures for better recovery and to avoid further complications.

Elevate the hand above heart level to reduce swelling.
A splint may be worn
Ice packs to the surgical area to reduce swelling.
Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering.
Physical therapy may be ordered to restore wrist strength.
Eating a healthy diet and not smoking will promote healing

Risks and Complications

The majority of patients suffer no complications following carpal tunnel release surgery. However some patients may suffer from pain, infections, scarring, and nerve damage causing weakness, paralysis, or loss of sensation and stiffness in the hand and wrist area.

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