Carpal Tunnel Syndrome

Carpal Tunnel Syndrome 2017-01-29T07:57:35+00:00

Discomfort in the hand, particularly with use, is common. Carpal tunnel syndrome is a common reason for this discomfort and is often associated with numbness of the hand. Most patients will have problems at night and wake up feeling like there is no blood flow in the hand. The condition is more common in women than men.

The carpal tunnel is a narrow, tunnel-like structure in the wrist, carpal tunnel anatomy.The bottom and sides of this tunnel are formed by wrist (carpal) bones. The top of the tunnel is covered by a strong band of connective tissue called the transverse carpal ligament.

The median nerve passes through a tunnel going from the forearm to the hand. The median nerve provides sensation to the palm side of the thumb, index finger, and long fingers. The nerve also provides motor function to the muscles at the base of the thumb. There are nine flexor tendons also traveling through the carpal tunnel with the nerve. Swelling around the tendons plays a role in most cases of carpal tunnel syndrome.

Early in the course of carpal tunnel syndrome, use of a splint for activities or at night can be very helpful. Vitamin B complex provides nutritional support for the nerve. Certain devices for using the mouse of a computer or the keyboard can be helpful. Avoiding repetitive tasks, taking timely breaks, avoidance of vibratory tools can also help alleviate the symptoms. If these measures fail, or there is severe pressure on the nerve with increasing numbness and weakness, a steroid injection or surgery may be indicated. The surgery to relieve the pressure is a simple procedure. We usually perform this as a day surgery procedure at the hospital so that the anesthesiologist can provide sedation. Then, local numbing agent is injected into the skin of the palm and a small mini-incision allows for visualization of the transverse carpal ligament. With protection of the nerve the ligament is released to provide relief. The skin is closed with 3 or 4 nylon sutures, and a splint applied. This is worn for about 3 or 5 days until the hand is comfortable. The fingers and thumb can be used for daily activities. The initial dressing can then be removed, the hand showered, and use the ACE wrap or wrist splint if needed for comfort. The sutures are removed at 10 to 14 days after surgery and the hand is allowed normal activities as tolerated. If significant nerve compression has occurred full nerve return can be limited and take months to occur. Significant relief of the pain from the carpal tunnel compression of the median nerve is more immediate.

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