Carpal Tunnel Syndrome

Carpal tunnel syndrome is a painful condition caused by compression of a key nerve in the wrist.   It occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist.

 

You should know what’s causing your Carpal Tunnel Syndrome (CTS); it’s the result of overworking your hands - performing repetitive (motion) task all day long.

Carpal Tunnel Syndrome Signs and Symptoms:

With CTS, there will be pain and/or tingling, burning, and numbness in the hand along the distribution of the median nerve in one or both hands.  Patients often complain of the hand "going to sleep" or a feeling of "needles and pins" in the thumb, index, long, and ring fingers.  The symptoms are usually most marked in the early morning hours and often awaken sufferers from sleep.  They may also experience pain in the elbow or shoulder, as fibers of the median nerve originate from the spinal cord in the neck and travel through the shoulder and elbow areas.  Repetitive use activities involving the hands often initiate or worsen the symptoms.  Such activities often reported by patients as initiating the symptoms include:  keyboarding, driving, talking on the phone, crocheting, and other activities which involve maintaining a certain wrist position for prolonged time periods.  The hand will most often look normal; however, if the process is long-standing, there may be some atrophy (loss of mass) in the thenar muscles (group of muscles at the base of the thumb).

 

Possible Cause?

Anything which increases the pressure within the carpal tunnel may bring on Carpal Tunnel Syndrome (CTS).  The most commonly thought of factor is repetitive trauma to the contents of the tunnel, caused by repetitive movements at the wrist due to jobs or hobbies which involve these movements (keyboarding, playing a musical instrument, etc.). 

Carpal Tunnel Syndrome Treatment Options

There are many different treatment options for Carpal Tunnel Syndrome.  Which option is employed is based on your physician's clinical judgment.  Options include:

Steroid/Anesthetic injection into the carpal tunnel - A mix of a steroid (a drug which decreases inflammation) and a local anesthetic (numbs the area after the injection) are injected directly into the canal in an attempt to decrease the inflammation and swelling in the canal.

Night Splinting - The wrist is splinted in a straight or slightly extended position to prevent flexing the wrist which can compress the canal and bring on symptoms.
 

Open decompression - An incision is made in the palm under local (only the area involved is numbed) or general anesthesia (patient sleeping), the transverse carpal ligament (the roof of the carpal tunnel) is visualized and cut.

Endoscopic decompression - Two smaller incisions are made in the wrist and palm, and an endoscope (a small lighted tube containing a camera) is passed through the carpal tunnel through these incisions.  The surgeon then visualizes the transverse carpal ligament (the roof of the carpal tunnel) and cuts it, freeing the contents of the carpal tunnel from the compression.

R. Y. MANABAT, R.N.