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Carpal Tunnel Syndrome

A common problem, carpal tunnel syndrome affects the use of one or both hands and is caused by the compression of the median nerve at the wrist. It most often occurs when the median nerve becomes inflamed after being aggravated by repetitive movements such as typing on a computer keyboard or playing the piano. It also affects professional artists, particularly sculptors and printmakers.

Bones, tendons and ligaments that surround the median nerve form the carpal tunnel. Any repetitive motions that cause significant swelling, thickening or irritation of membranes around the tendons in the carpal tunnel can result in pressure on the median nerve, disrupting transmission of sensations from the hand up to the arm and to the central nervous system.

Diseases or conditions that may increase your chances of developing carpal tunnel syndrome include pregnancy, diabetes, menopause, broken or dislocated bones in the wrist and obesity. Other causes are repetitive and forceful grasping with the hands, bending of the wrist and arthritis.

Because the median nerve supplies sensation to the thumb, index and middle finger and part of the ring finger, and provides motion to the muscles of the thumb and hand, you might notice numbness and weakness in these areas.

Common Symptoms

  • Hand and wrist pain
  • A burning sensation in the middle and index fingers
  • Thumb and finger numbness
  • An electric-like shock through the wrist and hand


Diagnosis

Be sure to seek medical advice as soon as you notice persistent symptoms. Your doctor will perform a thorough evaluation, including a medical history, physical examination and diagnostic testing, before recommending treatment. The physical examination will include an assessment of sensation, strength and reflexes in your hand.

If conservative treatment – medication or physical therapy – doesn’t provide sufficient relief, your doctor may perform diagnostic studies to determine if surgery is an option. These studies may include:

  • An x-ray that shows the bones of the wrists and any abnormalities
  • An electromyogram (EMG) and nerve conduction studies (NCS) to measure the electrical impulse along nerve roots, peripheral nerves and muscle tissue


Treatment

Your doctor may recommend conservative treatment to reduce or eliminate repetitive injury to the median nerve. Immobilizing the wrist in a splint to minimize or stop pressure on the nerves works in some cases. We sometimes prescribe anti-inflammatory medications or cortisone injections in the wrist to reduce swelling or suggest hand and wrist exercises, which may be helpful. Treatment for carpal tunnel syndrome may include rest, the use of a wrist splint during sleep or physical therapy.

Only a small percentage of patients who don’t respond to conservative treatment require surgery when symptoms persist. Patients with severe pain that is not relieved by rest, rehabilitation or nonsurgical treatment may be candidates for one of several surgical procedures to relieve pressure on the median nerve. The most common procedure we perform is carpal tunnel release, which can be done using an open incision or endoscopic techniques.

To perform carpal tunnel release, your neurosurgeon will open your wrist and cut the ligament at the bottom of the wrist to relieve pressure. The endoscopic carpal tunnel release procedure involves a smaller incision and a tiny camera to assist the surgeon in viewing the carpal tunnel.

Recurrence of symptoms after surgery is rare, occurring in less than 5 percent of patients.

Source: American Association of Neurological Surgeons

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