Common Hand Problems :: Carpal Tunnel Syndrome
Carpal Tunnel Syndrome (CTS) is an extremely common cause of disabling hand pain and is the most frequently diagnosed and best understood nerve compression injury. Carpus is the Latin word for wrist. The carpal tunnel is a tunnel which passes through the wrist and connects the forearm to the hand. Through the carpal tunnel pass the tendons that flex the thumb and fingers, as well as the median nerve. The median nerve is a large nerve which gives branches to the thumb and some of the fingers, to provide sensation. It also gives a branch which provides for function of the group of muscles which lie in the palm, at the base of the thumb. Injury to the median nerve can cause loss of all of these functions.In CTS, the pressure within the carpal tunnel becomes elevated and causes a constriction of the median nerve. When this occurs, the patient will generally notice a fairly common group of symptoms. Usually people with CTS will complain of pain, numbness and tingling involving the thumb, index, middle and ring fingers. The patient will also complain of weakness in the hand and inability to use tools, or do lifting or gripping with the hand. These symptoms are often pronounced when using the hand and when sleeping at night. In fact, people with CTS are often awakened at night due to the numbness in the hand. Although CTS has been commonly associated with "cumulative trauma disorders" and frequently is ascribed to specific activities, these associations are not firmly established by medical studies.
The diagnosis of carpal tunnel syndrome is often made by listening to the patient's description of symptoms and a thorough examination of the hand. Sometimes electrical tests of the nerves and muscles are used to help with the diagnosis. Occasionally, x-rays or other studies may be needed as well.
The treatment of carpal tunnel syndrome is, like most problems, initially non operative. The physician will often recommend a change in work place or recreational activities if these seem to have contributed to the symptoms. Usually, a trial of a splint to rest the wrist and hand in a good position will be recommended. Frequently, the use of the splint can greatly improve the night time symptoms. If the pain, numbness, tingling or weakness continue despite an adequate course of non operative treatment, then surgical treatment will often be recommended.
Traditionally, surgery for CTS involved a long incision from the far end of the palm, extending all the way up onto the wrist. While this treatment was very effective in relieving the symptoms of CTS, it left a large scar which was frequently unsightly and occasionally tender. Surgeons have begun to develop ways to decrease the size of the incisions and still maintain the excellent results of carpal tunnel surgery.
In the recent past, a technique of using and endoscope has been developed. The endoscope is a small telescope type instrument which can be placed through small incisions to allow the surgeon to see into the carpal tunnel. A small knife can then be placed through an incision at the wrist or hand, and the tissues compressing the nerve can be released. Initial enthusiasm for this procedure was based on the smaller size of the incision and the thought that it might allow patients to return to work or other activities more quickly. Many surgeons now believe the endoscopic carpal tunnel release offers very little in the way of advantages, but has the potential for higher rates of failure and complications.
The newest development in carpal tunnel surgery has been the use of the "mini-carpal tunnel release". This procedure involves a small incision in the palm, which allows direct access to the carpal tunnel, but still heals very quickly and generally requires only one stitch for closure. At Beaver Dam Orthopaedic Clinic we employ the mini-carpal tunnel release procedure routinely.
After surgery, the wrist and hand are placed in a small bandage and, often, a light splint to rest the hand and wrist until the stitch is removed. After a period of exercise, most patients have the ability to return to normal activities, with excellent improvement in symptoms.
While carpal tunnel syndrome remains a very common problem, I hope the information presented above is encouraging to those experiencing these symptoms. The diagnosis is generally quite straight forward and treatment is, in most cases, extremely effective in returning patients to activity.
