Carpal tunnel syndrome is the most common nerve entrapment disorder of the body, occurring in up to ten percent of the general population. People who suffer from this condition often report intermittent numbness or tingling in the portion of the hand which is innervated by the median nerve. The median nerve supplies feeling to the thumb, index finger, middle finger and half of the ring finger. Two other major nerves that provide feeling to the remaining portion of the hand are the radial and ulnar nerves. Damage to any one of these three major nerves of the hand will result in a specific pattern of sensory and motor loss. This is analogous to blowing a fuse which controls the electricity to a specific portion of a home. Once nerve function is compromised, then a predictable pattern of numbness and tingling, as if the hand has “gone to sleep,” is experienced.
Carpal tunnel syndrome involves compression of the median nerve as it crosses the wrist. The median nerve as it crosses the wrist. The median nerve is approximately one centimeter wide and resides at the wrist joint within a tunnel composed of the eight wrist (carpal) bone and a very strong fibrous band of tissue called the transverse carpal fascia. If the limited carpal tunnel space becomes tight, as with inflammation or repetitive flexion of the wrist, the median nerve will be compressed and may malfunction. Night pain that awakens the patient from sleep is common initially. As the condition worsens, there may be muscle weakness and “wasting” which manifests as clumsiness or trouble grasping objects such as a coffee cup.
Carpal tunnel syndrome can be clinically diagnosed based on history and physical examination. Physical examination such as decreased sensation or reproducible tingling in the thumb, index finger and middle finger with percussion of the median nerve as it crosses the wrist can help support the diagnosis. Certain risk factors associated with this condition include obesity, hypothyroidism, diabetes, pregnancy, advancing age, smoking and repetitive or extreme wrist flexion at work. The majority of cases however are idiopathic, meaning there are not specific reasons for why it occurs. Once the diagnosis of carpal tunnel syndrome is suspected, electrodiagnostic studies (called nerve conduction studies and electromyography) can be ordered to confirm the presence and the severity of the condition.
Nonsurgical treatment of carpal tunnel syndrome includes activity modification, wrist splinting with a brace, and oral anti-inflammatory medication such as ibuprofen. Steroid injections into the carpal tunnel can also be considered. The cortisone injection or oral anti-inflammatory medication is intended to reduce the swelling within the carpal tunnel and relieve the pressure on the median nerve. These various non-operative treatments have been shown to have a short term (less than one year) success rate of over eighty percent.
Surgical treatment is indicated for those patients who do not respond to the nonsurgical treatment or who experience sever weakness, muscle wasting or advance electrodiagnostic evidence of nerve damage. The surgery consists of a small incision in the palm through which the wrist fascia is split in order to release the tension within the carpal tunnel. The incidence of persistent symptoms after carpal tunnel release ranges from one to twenty-five percent. Incomplete release of the carpal fascia is the most common cause of recurrent symptoms.
If you suspect the presence of carpal tunnel syndrome, you should contact your physician for a complete evaluation. If recognized early, treatment can be initiated to help relieve the symptoms and prevent permanent nerve or muscle damage.
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Author Luis M. Espinoza MD Dr. Espinoza served as the AAA Team Doctor for the the New Orleans Zephyrs/BabyCakes since joining the Orthopedic Center for Sports Medicine in 2003. He is double board certified in General Orthopedic Surgery and Sports Medicine.