March 12, 2018

What is Carpal Tunnel Syndrome?

By Dr. Todd Parry

If you experience numbness and tingling in your hand, especially at night, you may have carpal tunnel syndrome. This nerve compression at the wrist can cause weakness of grip and pinch, as well as clumsiness with manipulating small objects.

The median nerve travels from the forearm into your hand through a “tunnel” in your wrist. The bottom and sides of this tunnel are made up by the carpal, or wrist, bones. The roof of this tunnel is made of a dense tissue band called the transverse carpal ligament. When this tunnel gets too narrow, it’s like wearing a belt that is too tight. The nerve is getting squeezed and it is unhappy. Nerves are very sensitive and when pressed upon, can cause numbness or pain.

This tunnel can be made tighter by arthritis, tendon swelling, injury and/or repetitive activities.

How is it Diagnosed?

Several quick physical tests that are done in the office can usually tell if symptoms are caused by carpal tunnel syndrome. Occasionally, a nerve conduction study is done in order to see if the nerve may be getting pinched higher up as it exits out of the neck (cervical radiculopathy).

How it is Treated?

Mild cases can be treated by applying a brace, which immobilizes the wrist. This immobilization, as well as anti-inflammatory medicines (like ibuprofen), can decrease the inflammation of the issues. In some cases, steroid injections into the wrist can also be helpful.

When relief is not gained through these measures, it may be necessary to perform surgery to enlarge the carpal tunnel. This is done by cutting (releasing) the ligament, which increases the size of the carpal tunnel and takes the pressure off the nerve.

The endoscopic method allows this release to be done through a small incision at the base of the wrist. The camera and fiber optic cable provide an inside view of the carpal tunnel and allow it to be safely released from the inside-out. This procedure is usually made pain-free by a local anesthetic injected into the arm and can be performed in an outpatient facility.

Endoscopic Advantages

This minimally invasive technique provides many benefits over the open surgical procedure, including early return to daily activities and work, improved cosmetic appearance, faster recovery time and less scarring.

After Surgery

After surgery, your symptoms may be relieved immediately or in a short period of time. If the pressure has been severe and ignored for a prolonged period of time, then a full recovery may not occur. After the procedure, you are allowed to use your fingers and hand right away, letting pain be your guide.

Should you see your doctor?

If you are having numbness or pain into your fingers with sleep, driving, sewing or talking on the phone, schedule an appointment. A good nights sleep and better finger dexterity may be a quick procedure away.

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