Carpal Tunnel Syndrome
What is carpal tunnel syndrome?
Carpal tunnel syndrome is a condition in which
the median nerve is compressed as it passes through
the carpal tunnel in the wrist, a narrow confined
space. Since the median nerve provides sensory
and motor functions to the thumb and three middle
fingers, many symptoms may result.
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Facts About Carpal
Tunnel Syndrome
According to the
National Institute of Neurological Disorders
and Stroke (NINDS), carpal tunnel release
is one of the most common surgical procedures
performed in the US.
Carpal tunnel syndrome
accounts for the highest average number
of days lost at work, when compared to all
other major work-related injuries or illnesses.
About 1 percent of
people with carpal tunnel syndrome may develop
permanent injury to the affected hand.
Although it is rare,
symptoms of carpal tunnel syndrome may reoccur
after surgery, in approximately 5 percent
of patients.
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What causes carpal tunnel syndrome?
Most cases of carpal tunnel syndrome have no
specific cause, although any/all of the following
may serve as a contributing factor:
- frequent, repetitive, small movements with
the hands (such as with typing or using a keyboard)
- frequent, repetitive, grasping movements with
the hands (such as with sports and certain physical
activities)
- joint or bone disease (i.e., arthritis, osteoarthritis,
rheumatoid arthritis)
- hormonal or metabolic changes (i.e., menopause,
pregnancy, thyroid imbalance)
- changes in blood-sugar levels (may be seen
with type 2 diabetes)
- other conditions or injuries of the wrist
(i.e., strain, sprain, dislocation, break, or
swelling and inflammation)
What are the symptoms of carpal tunnel syndrome?
The following are the most common symptoms for carpal
tunnel syndrome. However, each individual may experience
symptoms differently. Symptoms may include:
- difficulty making a fist
- difficulty gripping objects with the hand(s)
- pain and/or numbness in the hand(s)
- "pins and needles" feeling in the fingers
- swollen feeling in the fingers
- burning or tingling in the fingers, especially
the thumb and the index and middle fingers
The symptoms of carpal tunnel syndrome may resemble
other medical conditions or problems. Always consult
your physician for a diagnosis.
How is carpal tunnel syndrome diagnosed?
In addition to a complete medical history and
physical examination, three medical associations
agree that electrodiagnostic tests are the most
accurate tool for diagnosing carpal tunnel syndrome.
The American Academy of Neurology, the American
Association of Electrodiagnostic Medicine, and
the American Academy of Physical Medicine endorse
a guideline that states that electrodiagnostic
tests provide accurate diagnosis. Electrodiagnostic
tests involve the stimulation of muscles and nerves
in the hand.
Treatment of carpal tunnel syndrome:
Specific treatment for carpal tunnel syndrome
will be determined by your physician based on:
- your age, overall health, and medical history
- extent of the disease
- your tolerance for specific medications, procedures,
or therapies
- expectations for the course of the disease
- your opinion or preference
Treatment may include:
- splinting of the hand (to help prevent wrist
movement and decrease the compression of the
nerves inside the tunnel)
- oral or injected (into the carpal tunnel space)
anti-inflammatory medications (to reduce the
swelling)
- surgery (to relieve compression on the nerves
in the carpal tunnel)
- changing position of a computer keyboard,
or other ergonomic changes
Surgery for carpal tunnel syndrome:
In general, the surgery for carpal tunnel syndrome
is performed in an outpatient location under local
or general anesthesia. The surgeon will make an
incision in the wrist area. The tissue that is
pressing on the nerves will then be cut, in order
to decrease the pressure.
After the surgery, the wrist may be immobilized
in a large dressing and wrist brace to help stabilize
the area. The splint is usually worn continuously
for the first two weeks after the surgery, but
then is used intermittently for the next month
or so. There is a moderate degree of pain in the
hand after the surgery, which is usually controlled
with pain medications taken orally. The surgeon
may also have you keep the affected hand elevated
while sleeping at night.
The length of recovery varies for each individual.
If the nerve has been compressed for a long period
of time, recovery may take longer. Movement of
the fingers and wrists are encouraged a few days
following surgery to help prevent stiffness.
Your physician will discuss post-operative activities
and restrictions with you.
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