Peripheral Nerve Surgery


About carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is a condition that can cause pain, tingling, numbness, and weakness in the fingers and thumb.

How serious is it?

CTS can begin suddenly or gradually. It often affects both hands. If not treated, it can lead to permanent nerve and muscle damage. With early diagnosis and treatment, however, there is an excellent chance of complete recovery.

Carpal tunnel syndrome may improve with rest and splinting or may require surgery. It is important that it be treated before permanent nerve and muscle loss take place.

Who gets CTS?

Carpal tunnel syndrome can occur at any age. CTS from non-work causes usually affects people in their 50s, while CTS from work causes is highest between the ages of 20 and 40. The condition is more common in women than in men.

Causes and Symptom

If you have CTS you might feel some or all of the following symptoms.

Common symptoms

  • pain, tingling, and numbness in the thumb, index, middle, and ring fingers

  • tingling in your entire hand

  • pain that shoots from the hand up the arm as far as the shoulder

  • a swollen feeling in your fingers–even though they may not be visibly swollen

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    Other symptoms
    You may also notice that:

  • your symptoms are worse at night

  • your hands feel weak in the morning

  • you drop objects more than usual

  • you have trouble grasping or pinching objects

  • you have trouble using your hands for certain tasks, such as buttoning a shirt, writing with a pen, or opening a jar lid

  • the muscles at the base of your thumb are smaller and weaker than they used to be

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    Intensity Varies

    At first the symptoms come and go, usually affected by excessive use of the hand. When the hand is rested, there may be no symptoms. As the condition worsens and pressure on the nerve becomes greater, the person may experience numbness all the time.

    Diagnosis and Related Conditions

    How is CTS diagnosed?
    Your doctor will review your medical history and examine your hand and wrist. One or all of the following tests may be done to help confirm a diagnosis of CTS.

    • Tinel’s sign test: Your doctor will gently tap the front of your wrist. If this causes tingling or pain in your hand or forearm, you may have carpal tunnel syndrome.

    • Phalen’s sign test: Your doctor will ask you to bend your wrist down as far as it will go and to hold this position from 15 seconds to three minutes. If you feel tingling or pain, you may have carpal tunnel syndrome.

    • Nerve conduction velocity (NCV) study: This measures the nerve’s ability to send electrical impulses to the muscle. If the electrical impulses are slowed down in the carpal tunnel, then you probably have CTS.

    • X-rays of the hands and blood tests may be used to find out if there are any other medical problems that are causing CTS.

    Related Conditions
    Other conditions that may be associated with CTS include the following:

    • pregnancy or use of birth control pills (both may cause swelling in your hands)

    • diabetes

    • thyroid diseases

    • amyloidosis, a disease in which a protein substance collects in body organs

    Treatment and Management

    Splints
    A wrist splint (see figure 2) may be used to keep the wrist in a straight position while you sleep. You may be requested to wear a daytime splint if the symptoms persist during your daily activities. The splint helps reduce swelling that may be causing CTS. An occupational therapist can make a splint that will meet your needs.

    Medications
    Injections of corticosteroids, or cortisone-like medications, into the wrist can may reduce the swelling that causes pressure on the median nerve. These injections often bring significant relief for many people with CTS. Aspirin or other nonsteroidal anti inflammatories NSAIDS may also be used to reduce swelling and relieve pain.

    Adjusting Daily Activities
    Adjusting your daily work activities may help prevent and/or relieve CTS symptoms. Here are some ways you can do this:

    • Rest your wrists and hands from time to time

    • Alternate tasks to reduce the pressure on your wrist

    • Delegate tasks that bother your hands to co-workers or family members

    • Modify or change any daily activities, including hobbies, that put too much pressure on your wrist.

    If you think your CTS may be due to activities at your job, talk to your doctor and your manager. They may be able to help you make some changes that will relieve the problem. This could include adjusting your work area or reducing the amount of time you spend at particular tasks. An occupation therapist can help you find ways to modify your activities or suggest tool modifications to put less stress on your wrists.

    Surgery
    If medicines are not successful and you continue to have problems, surgery may be required to relieve symptoms and avoid permanent nerve or muscle damage. The procedure, called carpal tunnel release, relieves the pressure on the median nerve. This is usually a simple operation that can be done on an outpatient basis.

    After surgery, you will probably have some use of your hand within two weeks or so. Usually, you will regain full use of your hand about six to 10 weeks after surgery. (Recovery time may be three to four months for those people who do a lot of manual labor.)

    Results from surgery are generally quite good if severe weakness has not developed. You will probably be able to resume your normal activities, but you should avoid activities that put too much stress on your wrist.


    Median Nerve Function

    The numbness, tingling, and weakness from CTS are due to pressure on the median nerve. This nerve carries signals between the hand and brain.

    In the wrist, the median nerve and several tendons that allow the fingers and thumb to bend pass through the carpal tunnel, a “tunnel” created by the carpal (wrist) bone and other tissue.

    The most common cause of CTS is swelling or inflammation around the tendons and nerve, which increases the pressure within the carpal tunnel.
    This increased pressure affects median nerve function, causing the symptoms of CTS.

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