Do you often feel numbness or tingling in your hand, especially at night? Maybe you experience clumsiness in handling objects and sometimes you feel a pain that goes up the arm to as high as the shoulder. These may be the symptoms of carpal tunnel syndrome
The median nerve travels from the forearm into your hand through a “tunnel” in your wrist. Wrist bones form the bottom and sides of this tunnel and a strong band of connective tissue called aligament covers the top of the tunnel. This tunnel also contains nine tendons that connect muscles to bones and bend your fingers and thumb. These tendons are covered with a lubricating membrane called synovium, which may enlarge and swell under some circumstances. If the swelling is sufficient it may cause the median nerve to be pressed up against this strong ligament which may result in numbness, tingling in your hand, clumsiness or pain described above.
How is it diagnosed?
- Numbness and tingling in the hands, especially when these symptoms occur at night and after use of the hands
- Decreased feeling in your thumb, index, and long finger
- The presence in your hand of an electric-like shock or tingling (like hitting your “funny bone”) when your doctor taps over the course of the median nerve at the wrist
- The reproduction of your symptoms by holding your wrists in a bent down position for one minute
In some cases your doctor may recommend a special test called anerve conduction study. This test, done by a specialist, determines the severity of the pressure on the median nerve and may aid your orthopaedic surgeon in making a diagnosis and forming a treatment plan.
What causes it?
Anything that causes swelling, thickening or irritation of the synovial membrane around the tendons in the carpal tunnel can result in pressure on the median nerve.
Some common causes and associated conditions are:
- Repetitive and forceful grasping with the hands
- Repetitive bending of the wrist
- Broken or dislocated bones in the wrist which produce swelling
- Arthritis, especially the rheumatoid type
- Thyroid gland imbalance
- Sugar diabetes
- Hormonal changes associated with menopause
Although any of the above may be present, most cases have no known cause.
How is it treated?
Applying a brace or splint, which is usually worn at night and keeps your wrist from bending, may treat mild cases. Resting your wrist allows the swollen and inflamed synovial membranes to shrink; this relieves the pressure on the nerve. These swollen membranes may also be reduced in size by medications taken by mouth called non-steroidal anti-inflammatories. In more severe cases, your doctor may advise a cortisone injection into the carpal tunnel. This medicine spreads around the swollen synovial membranes surrounding the tendons and shrinks them, and in turn, relieves the pressure on the median nerve. The dosage of cortisone is small and when used in this manner it usually has no harmful side effects. The effectiveness of non-surgical treatment is often dependent on early diagnosis and treatment.
In those patients who do not gain relief from these non-surgical measures it ma be necessary to perform surgery. The site of the operation is made pain-free by local anesthesia injected either into the wrist and hand or higher up in the arm. The surgery itself is called a “release” – cutting the ligament that forms the roof of the carpal tunnel to relieve the pressure on the median nerve. The surgery is usually performed in an outpatient facility and you are generally not required to stay over night.
For mild cases, a splint or brace may be adequate. The usage of a splint or brace during the night could reduce the swelling, thereby reducing the pain. There are also oral medications that reduce the size of the swollen membranes.
For more severe cases, an anti-cortisone injection into the carpal tunnel may be the best solution. If none of these methods provide relief the next step would be surgery.
The site of operation would be numbed by a local anesthesia either injected into the upper arm or the wrist by your anesthesiologist. Then the surgeon “releases” the tension in your wrist by cutting the top of the carpal tunnel to relieve the pressure.
Another method has proven to have a 99% success rate. We perform a flexor tenosynovectomy with a median neurolysis. This means that the surgery includes:
- The removal of the flexor tenosynovium, which may be inflamed to cause discomfort for the patient.
- The removal of the crushed median nerve trunk, which causes the numbness most patients with carpal tunnel syndrome complain about.
- Either surgery technique can be done on an outpatient basis. No overnight hospital stay is required.
Your symptoms may be relieved immediately or in a short period of time. Recovery period is about 10 days. Tenderness at the incision site may persist until healing is complete. Numbness may remain for a period of time. It may be several weeks before you can return to your normal level of physical activities.
You will be given hand exercises to do at home to help rebuild circulation, muscle strength and joint flexibility in your hand and wrist.