Carpal Tunnel Syndrome Video

By Garry S. Kitay, MD

 Carpal Tunnel Syndrome

Watch this VIDEO of Dr. Garry Kitay explaining Carpal Tunnel Syndrome, or read more below.

Carpal tunnel syndrome has become the most common condition treated by hand surgeons. This is a disease that usually involves an abnormal compression of the median nerve. The median nerve is one of the two major nerves in the wrist.  Carpal Tunnel Syndrome can occur due to a variety of mechanical, vascular, or metabolic disorders.

The median nerve normally provides sensation to the palm and the majority of the digits.  It also provides strength for thumb positioning and grasp.  Carpal Tunnel Syndrome can effect all of these aspects.

Carpal tunnel syndrome is a common injury treated by orthopedic surgeons.

Illustration of the carpal tunnel.

Anatomy of the Carpal Tunnel

The carpal tunnel is a passageway which is composed of the small bones of the wrist. The ceiling is formed by a tough ligament, the transverse carpal ligament. The tunnel contains nine flexor tendons that travel to the digits. The median nerve which lies directly beneath the transverse carpal ligament.

Any condition that increases the volume of the contents within the carpal tunnel, or decreases the tunnel space, can lead to excessive pressure on the median nerve. For instance, wrist fractures and dislocations commonly diminish the size of the canal. Alternatively, fluid retention, as seen in pregnancy, will increase the contents of the canal and can lead to carpal tunnel syndrome.

There is strong evidence that certain occupations correlate to carpal tunnel syndrome. Tasks that require repetitive and forceful gripping are particularly implicated.

Causes of Carpal Tunnel May include:

  • Trauma or injury to the wrist.
  • Heredity – This syndrome may be smaller in some people, or there may be anatomic differences that affect the nerve’s amount of space.
  • Pregnancy- Hormonal changes may cause swelling.
  • Health Conditions- Rheumatoid arthritis, Diabetes, Overactive pituitary gland, Underactive thyroid gland
  • Repetitive hand use – Repeating the same wrist motions or using vibratory tools for an long periods of time.
  • Hand and wrist position – Performing activities that involve extreme flexion or extension of the hand and wrist for a long periods of time.
  • Sleeping with the wrist in extremes of flexion or extension

Diagnosis of Problems in the Carpal Tunnel

The typical patient will complain of:

  • Numbness
  • Burning
  • Tingling

These symptoms happen in the thumb, index, middle and half of the ring finger. The symptoms often occur at night and can awaken the patient from sleep. At times, there is an aching pain over the region of the palm which can extend up the elbow and even as far up as the shoulder.

In severe cases, carpal tunnel syndrome can cause:

  • Decreased sensation
  • Clumsiness
  • Tendency to drop objects.

Tests for Carpal Tunnel Syndrome

There are several provocative tests to establish a hypersensitivity, or irritability, of the carpal tunnel nerve. One simple test involves tapping directly over the nerve. If this causes tingling into the thumb through ring fingers, this is a positive test. As a result, it is consistent with a diagnosis of carpal tunnel syndrome.

Dr. David Doward analyzing an Electromyography test. He performs EMG and NCV tests at JOI.

EMG/NCV test

Nerve conduction studies are helpful in confirming the diagnosis. Clinicians perform this test with a special device that measures the conduction of signals along the median nerve as it travels through the carpal tunnel. In CT Syndrome, the normal conduction of nerve signals are slower and may even become absent in a severe disease. Whenever CTS is suspected other conditions that can cause similar symptoms are considered as well. These include “pinched nerves” in the neck or arm.

How Do You Treat Carpal Tunnel Syndrome or CTS?

If the diagnosis and treatment starts early, the quick answer is relief can occur without surgery using conservative treatment.  Occupational Therapist, Kim Segler, explains the treatments of Carpal Tunnel Syndrome below.

  • Splinting – a splint that keeps your wrist in a straight position to avoid bending your wrist while sleeping and to avoid movements that increase your pain and numbness.
Carpal Tunnel braces are the first line of treatment for carpal tunnel syndrome in most people.

Carpal Tunnel Brace

  • Non-steroidal anti-inflammatories – Medications can reduce pain and inflammation.
  • Activity modification – Changing the way you perform activities keeps your wrist flexed or extended for too long.
  • Nerve gliding – Specific movement patterns where recommendations come from your doctor or therapist that allow the nerve to glide more easily through the carpal tunnel
  • Steroid injections – Cortisone is an anti-inflammatory that may decrease swelling to decrease pain and numbness.
  • Surgery- A carpal tunnel release involves severing the ligament around the wrist to increase the carpal tunnel’s size and reduce pressure on the median nerve.

Carpal Tunnel Surgery

Surgical treatment for Carpal Tunnel Syndrome is recommended for those patients who fail conservative therapy or who have severe disease. This surgery takes place on an outpatient basis, and can be either endoscopic or with an open incision.

After surgery, the patient can expect soreness for approximately four to six weeks.  Some discomfort about the palm which can last longer. However, the symptoms of carpal tunnel are usually gone and full activities are possible, four to six weeks following surgery. The great majority of patients are very happy with their outcome and the relief of their pain and numbness.

Dr. Kitay prefers the endocopic approach with carpal tunnel release when appropriate.

Carpal tunnel syndrome endoscopy

Recent studies show that patients who receive the Endoscopic Carpal Tunnel Release procedure are able to return to work up to 8 days faster then after the open procedure.

To watch an animated video of Endoscopic Carpal Tunnel Release, click HERE.

CTS Summary

Carpal tunnel syndrome is a very prevalent disease which is due to compression of the median nerve at the wrist. Conservative therapy can often help decrease the symptoms. However, in more serious cases, surgical options are available which can relieve the symptoms and allow return to normal function and occupation.

Dr. Garry Kitay

If you think you may have Carpal Tunnel Syndrome, Dr. Kitay and the team at the Jacksonville Orthopaedic Institute can help! Call 904-JOI-2000, schedule online, or click the banner below. To see a JOI Rehab Therapist is 1 of our 12 locations, call (904)858-7045.

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