Carpal Tunnel Syndrome

 
Definition:
Carpal tunnel syndrome is a progressively painful hand and arm condition caused by a pinched nerve in your wrist.

Bound by bones and ligaments, the carpal tunnel is a narrow passageway located on the palmar side of the wrist. This tunnel protects a main nerve to your hand and tendons to your fingers. Compression of the nerve produces the numbness, pain and, eventually, hand weakness that characterize carpal tunnel syndrome.

Early and proper treatment can relieve the pain and numbness and restore normal use of their wrists and hands.

What are the symptoms
The typical history of carpal tunnel syndrome starts with night symptoms of tingling , pain and numbness in the hand, often on both sides. It may wake the patient up at night and the patients finds relief in shaking his or her hands for the numbness to go away.

Symptoms most often occur in the thumb, index finger, middle finger, and half of the ring finger. It can progress to having the same symptoms during the day and eventually , to having constant numbness and paraesthesia. Weakness of thumb muscles develops in the later stages of the problem

When to see a doctor
If you have persistent signs and symptoms suggestive of carpal tunnel syndrome, especially if they interfere with your normal activities and sleep patterns, see your doctor. If you leave the condition untreated, nerve and muscle damage can occur. What to expect during treatment:

Some people with mild symptoms of carpal tunnel syndrome can ease their discomfort by avoiding extreme bending or extending the wrist during sleep . Normal activites that involve a lot of repetitive wrist motion should also be avoided. If these techniques don't offer relief within a few weeks, additional treatment options include wrist splinting, medications and surgery. Splinting and other conservative treatments are more likely to help you if you've had only mild to moderate symptoms for less than 10 months.
Nonsurgical therapy

If the condition is diagnosed early, nonsurgical methods may help improve carpal tunnel syndrome. Methods may include:

  • Wrist splinting. A splint that holds your wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness. Nocturnal splinting may be a good option if you are pregnant and have carpal tunnel syndrome.
  • Corticosteroids. Your doctor may inject your carpal tunnel with a corticosteroid, such as cortisone, to relieve your pain. Corticosteroids decrease inflammation and swelling, which relieves pressure on the median nerve. Oral corticosteroids aren't considered as effective as corticosteroid injections for treating carpal tunnel syndrome.
If carpal tunnel syndrome results from an inflammatory arthritis, such as rheumatoid arthritis, then treating the underlying condition may reduce symptoms of carpal tunnel syndrome, but this hasn't been proved.

Surgery

If your symptoms are severe or persist after trying nonsurgical therapy, surgery may be the best option.

The goal of carpal tunnel surgery is to relieve pressure on your median nerve by splitting the ligament pressing on the nerve. During the healing process after the surgery, the ligament tissues gradually grow back together while allowing more room for the nerve than existed before. The surgery can be done as a mini-open procedure or via minimally invasive endoscopic surgery. Discuss this with your doctor before proceeding.

  • Endoscopic surgery. Carpal tunnel surgery can be done using an endoscope, a telescope-like device with a tiny camera attached to it that allows your doctor to see inside your carpal tunnel and perform the surgery through small incisions in your hand or wrist.
  • Open surgery. In other cases, surgery involves making a larger incision in the palm of your hand over the carpal tunnel and cutting through the ligament to free the nerve.
After surgery, you are encouraged to gradually increase usage of your hands, working back to normal use, while avoiding forceful hand motions or extreme positions of your wrist. Soreness or weakness may take from several weeks to as long as a few months to resolve after surgery. If your symptoms were very severe before surgery, symptoms may take a few months to subside.

Postoperative Care

Following carpal tunnel release surgery, your hand will remain in a bandage for a couple of days and you may need to wear a sling. You should keep your hand elevated for 48 hours to help reduce any swelling and stiffness in your fingers.
To help prevent stiffness, gently exercise your fingers, shoulder and elbow. You may be able to start these gentle exercises on the day of your operation.