Carpal Tunnel Syndrome

The National Center for Health Statistics states that approximately 260,000 carpal tunnel release surgeries are performed each year. Nearly 47% of all cases of carpal tunnel syndrome are caused by work-related activities, and approximately 1% of people with carpal tunnel syndrome may develop permanent injury to the affected hand. Carpal tunnel syndrome also accounts for the highest average number of days lost at work, when compared to all other major work-related injuries or illnesses.

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a condition in which the median nerve is compressed as it passes through the carpal tunnel, a narrow confined space in the wrist. The median nerve provides sensory and motor functions to the thumb and three middle fingers, and pressure to this nerve many cause many symptoms such as pain, tingling and other problems in your hand.

Causes

Carpal tunnel syndrome is caused by pressure on the median nerve. This pressure may have a number of contributing factors, including:

• Frequent, repetitive, small movements with the hands (such as with typing or using a keyboard)
• Frequent, repetitive, grasping movements with the hands (such as with sports and certain physical activities)
• Joint or bone disease (i.e., arthritis, osteoarthritis, rheumatoid arthritis)
• Hormonal or metabolic changes (i.e., menopause, pregnancy, thyroid imbalance)
• Changes in blood-sugar levels (may be seen with type 2 diabetes)
• Other conditions or injuries of the wrist (i.e., strain, sprain, dislocation, break, or swelling and inflammation)

Symptoms

Each individual experiences the symptoms of carpal tunnel syndrome differently, and some symptoms may resemble other medical conditions or problems. The following are the most common symptoms of carpal tunnel syndrome:

• Difficulty making a fist
• Difficulty gripping objects with the hand(s)
• Pain and/or numbness in the hand(s)
• Pins and needles" feeling in the fingers
• Swollen feeling in the fingers
• Burning or tingling in the fingers, especially the thumb and the index and middle fingers

Treatments

We will work with you to determine a specific treatment plan that’s right for you based on the following factors:

• Your age, overall health and medical history
• Extent of the disease
• Your tolerance for specific medications, procedures or therapies
• Expectations for the course of the disease

Your treatment may include:

• Splinting of the hand - To help prevent wrist movement and decrease the compression of the nerves inside the tunnel
• Anti-inflammatory medications - Taken orally or injected into the carpal tunnel space, to reduce the swelling
• Changing position of a computer keyboard or other ergonomic modifications
• Surgery - To relieve compression on the nerves in the carpal tunnel

In general, surgery for carpal tunnel syndrome is performed as an outpatient procedure under local and/or sedation. An incision is made in the wrist area, and the tissue that is pressing on the nerves is cut in order to decrease the pressure. This can be done using an endoscope or open technique.

After surgery, your wrist may be immobilized in a large dressing and/or wrist brace to help stabilize the area. We may also recommend that you keep your hand elevated while sleeping at night.

Your recovery time will depend on the severity of your condition. If the nerve has been compressed for a long period of time, your recovery may take longer. Moving your fingers and wrist a few days after surgery will help to prevent stiffness. To ensure proper healing in your hand, you will also need to restrict certain post-operative activities for a period of time.