What
Is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is compression or
pressure on the median nerve at the wrist level. Alignment at the
wrist creates a tunnel through which the median nerve and nine tendons
course. The median nerve supplies sensation to the thumb, index, long
finger and half of the ring finger, thus patients' complaints are
altered sensation in these digits. You can test yourself for carpal
tunnel syndrome by simply maximally bending the wrist down and waiting
one minute. If you have increased symptoms of abnormal feeling in
these digits, then you may well have carpal tunnel syndrome.
What Causes Carpal Tunnel Syndrome?
There can be many causes of carpal tunnel
syndrome. Jobs that require excessive bending of the wrist tend to
increase the pressure around the median nerve in the wrist. Similarly,
sleeping with your wrist in an acutely bent position will increase
pressure on the median nerve and cause carpal tunnel syndrome.
Diabetes, alcoholism, hypothyroidism and obesity are also all factors
towards developing carpal tunnel syndrome.
What Is the Best Treatment for Carpal
Tunnel Syndrome?
Carpal tunnel syndrome can vary from just a
small amount of pressure to extreme pressure, and in the late stages
of carpal tunnel syndrome, surgery may be necessary to release a short
ligament at the wrist level. Earlier on, the best treatment will
involve using a splint which keeps your wrist completely flat and is
worn at night. This will decrease the excessive pressure that can
develop at night when the wrist naturally goes into a bent position.
Make sure that the splint you wear at night keeps your wrist
completely flat.
What About Laser Carpal Tunnel Surgery?
There have been no published reports to
suggest that laser can improve or cure carpal tunnel syndrome.
What About Endoscopic Carpal Tunnel
Surgery?
The "classic" surgery for carpal
tunnel syndrome involves an open technique where a small incision is
made over the region of the ligament that compresses the median nerve.
This ligament is released to decompress the median nerve. With the
introduction of endoscopic surgery in other locations in the body,
some hand surgeons are using a similar technique at the wrist. Usually
two small incisions would be substituted for one larger incision at
the wrist level. The incidence of nerve injury is slightly higher with
the endoscopic surgery, but the return to work time may be slightly
earlier. Because of the slight increased risk to the median and ulnar
nerves associated with endoscopic carpal tunnel surgery, the majority
of surgeons prefer an open technique. It is recommended that you
discuss in detail these two types of surgery with the particular
surgeon you have chosen to do your surgery.
I Know Several People Who Have Had Carpal
Tunnel Surgery and It Has Not Improved Their Symptoms. Why Would This
Be?
The likely answer is that these people have
other things going on rather than just carpal tunnel syndrome.
Remember that carpal tunnel syndrome will only produce altered
sensation in the thumb, index, long and half of the ring finger. Any
other symptoms that you have of pain or numbness in the upper
extremity is not due to carpal tunnel syndrome and should be evaluated
for other levels of nerve compression or muscle and tendon problems.
I know one person who following their
carpal tunnel surgery had worse pain with a burning sensation at the
incision and numbness and pain in the ring and long
fingers. What should they do?
This may relate to a small nerve injury of
the median nerve. If is does not resolve over a few months, they
should seek a surgical consultation as this is not the
"normal" course following carpal tunnel surgery.
