CARPAL TUNNEL SYNDROME

Carpal Tunnel Syndrome is a commonly diagnosed and misdiagnosed condition affecting the wrist and hand. Compression or irritation of the median nerve at the wrist is the cause of Carpal Tunnel Syndrome. The median nerve is one of three nerves which supply the hand. The median nerve is known as the mixed nerve, meaning that it carries signals that relate to sensation and muscle function in the hand. At the level of the wrist the median nerve and nine tendons controlling finger motion pass through a relatively narrow passage called the carpal tunnel. It is at this point that irritation or compression of the nerve results in the symptoms of Carpal Tunnel Syndrome.

Patients with Carpal Tunnel Syndrome complain of numbness or tingling in the hand, clumsiness, and sometimes of pain extending into the forearm, elbow or shoulder. The numbness usually involves one or more of the following digits; thumb, index finger, long finger or ring finger. The small finger is not involved with Carpal Tunnel Syndrome. Symptoms are usually the worst at night, while driving, or while holding reading materials. Relief can often be gained by changing wrist positions, shaking the hands, or hanging the affected hand over the side of the bed.
Carpal Tunnel Syndrome can be related to a number of systemic conditions such as pregnancy, diabetes, rheumatoid arthritis, and thyroid disease. When these conditions are responsible for the development of Carpal Tunnel Syndrome treatment of the underlying problems often results in resolution of symptoms. Pregnancy induced Carpal Tunnel symptoms usually resolve within a few weeks after delivery.

Much has been written regarding the relationship between working conditions and the development of Carpal Tunnel Syndrome. Certain risk factors have been identified. These include use of vibrating tools or machinery, exposure to cold conditions, and repetitive hand and wrist movements. Some occupations, such as, meat processing and data entry have a particularly high occurrence of Carpal Tunnel Syndrome. Awareness of these risk factors and workplace modification appear to be having an effect in reducing the rate of occupationally induced Carpal Tunnel Syndrome.

Diagnosis of Carpal Tunnel Syndrome is made based on the patient's description of symptoms and examination of the patient by the physician. Occasionally blood tests are done to rule out other conditions. Studies of nerve functions such as electromyography (EMG) or nerve conduction testing (NCT) can help to establish or confirm the diagnosis. These are tests which measure how well the nerve is conducting information and how the small muscles served by the nerve are functioning.
Once the diagnosis of Carpal Tunnel Syndrome is established treatment can begin. In most cases modification of activities and night wrist splinting are effective. The splinting attempts to prevent flexion of the wrist and compression of the nerve while sleeping. Physical therapy does not significantly impact the course of Carpal Tunnel Syndrome. Occasionally an injection of anti-inflammatory steroids, most commonly Cortisone, can be helpful. There is little evidence that vitamins or nutritional supplements are helpful in treatment.

Surgery is indicated when symptoms persist for more than six months or when weakness is noted in the small muscles controlling the thumb. Often patients request surgery out of frustration with symptoms or the perception that the condition is worsening despite treatment.

Carpal tunnel release is the most commonly performed hand surgical procedure in the United States. The goal of the surgery is to divide a ligament overlying the nerve and create increased space for the nerve. There are two techniques of carpal tunnel release in common use. Open carpal tunnel surgery involves a small incision in the palm with direct access to the nerve and tendons. Endoscopic carpal tunnel release is performed through one or two small incisions using small instruments and a television camera to visualize and divide the ligament. The long term results of both procedures are about the same. The only advantages of the endoscopic technique are less pain following surgery and a slightly quicker recovery. Not all patients are well suited for the endoscopic technique.