Carpal Tunnel Syndrome

By Garry S. Kitay, MD

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

Carpal Tunnel Syndrome

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, one of the two major nerves, at the level of the wrist.  Carpal Tunnel Syndrome can be caused by a variety of mechanical, vascular, or metabolic disorders.

The median nerve normally provides sensation to the palm and the majority of the digits, as well as strength for thumb positioning and grasp.  All of this can be effected with Carpal Tunnel Syndrome.

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

Illustration of the carpal tunnel.

Anatomy of the Carpal Tunnel

The carpal tunnel, or canal, is an passageway whose the arched floor 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 are related 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 extended period of time.
  • Hand and wrist position – Performing activities that involve extreme flexion or extension of the hand and wrist for a prolonged period 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 that are performed that 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 considered 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.

Dr. Doward analyzing and EMG/NCV test

Nerve conduction studies are helpful in confirming the diagnosis. This test is performed 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 slowed and may even become absent in 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 is performed on an outpatient basis, and can be performed either endoscopically or with an open incision.

After surgery, the patient can expect soreness for approximately four to six weeks and some discomfort about the palm which can last longer. However, the symptoms of carpal tunnel are usually fully relieved, and full activities are possible, four to six weeks following surgery. The great majority of patients are very pleased 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. It can often be cured with conservative therapy. 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

Image of Dr. Garry Kitay, Hand/Elbow/Shoulder Specialist

If you think you may have Carpal Tunnel Syndrome, or any other orthopedic issue, Call JOI-2000, schedule online, or click the banner below to see a JOI Orthopedic Specialist. 

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