Carpal Tunnel Syndrome


 

Carpal Tunnel Syndrome (CTS) is due to pressure on a specific nerve, the Median nerve, as it enters the wrist and palm from the forearm. The nerve and the tendons to the fingers all pass through a tunnel of fixed size (the carpal tunnel). If there is a significant increase in pressure inside the tunnel, then the nerve may become compressed and injured.

 

Common Causes

Repetitive hand activities, unusual prolonged wrist flexion or extension, frequent gripping or squeezing, exposure to vibratory or pneumatic equipment. Certain medical conditions, including pregnancy, thyroid disease, and diabetes have an increased incidence of this injury.

 

Symptoms

Numbness, tingling, or pain in the hand; generally involving the thumb, index, and middle finger. May radiate up the arm to the shoulder. Waking at night with the hand asleep, or ‘shaking out’ the hand is common. Dropping of objects and weakness in advanced cases.

 

Physical Findings

Positive provocative testing on physical examination. Atrophy of the thumb muscles, and sensory loss in advanced cases.

 

Workup

The diagnosis is primarily based on history and physical examination. Electrodiagnostic studies are occasionally indicated, especially in confusing or difficult cases.

 

Non-operative Treatment

Night-time wrist splints, anti-inflammatory medication, and avoidance or modification of the aggravating activity is helpful in early cases. A trial of a single corticosteroid injection is of value for both diagnosis and treatment.

 

Surgical Treatment

Carpal Tunnel Release. This can be done either as an open procedure, or as an Endoscopic Carpal Tunnel Release, with only a tiny incision under local anesthesia.

 

Injury Comment

The goal of all treatment options for this injury is to take the pressure off of the nerve, and allowing it to heal on its own. This is much like taking a ‘pot-bound’ plant, and repotting it in a larger pot. The goal of surgery is to prevent progression, and allow for the nerve to recover. Prolonged compression of a nerve may cause permanent damage. Think of a garden hose after your car has parked on it for a very long time.