Hand / Wrist Injuries, Carpal Tunnel

Condition

Definition: Carpal tunnel syndrome is a hand and arm condition that causes numbness, tingling and other symptoms. Carpal tunnel syndrome is caused by a pinched nerve in your wrist. A number of factors can contribute to carpal tunnel syndrome, including the anatomy of your wrist, certain underlying health problems and possibly patterns of hand use. Bound by bones and ligaments, the carpal tunnel is a narrow passageway located on the palm side of your wrist. This tunnel protects a main nerve to your hand and the nine tendons that bend your fingers. Compression of the nerve produces the numbness, tingling and, eventually, hand weakness that characterize carpal tunnel syndrome. Fortunately, for most people who develop carpal tunnel syndrome, proper treatment usually can relieve the tingling and numbness and restore wrist and hand function.

Definition: Carpal tunnel syndrome usually starts gradually with numbness or tingling in your thumb, index and middle fingers that comes and goes. This may be associated with discomfort in your wrist and hand. Common carpal tunnel syndrome symptoms include:

  • Tingling or numbness. You may experience tingling and numbness in your fingers or hand, especially your thumb and index, middle or ring fingers, but not your little finger. This sensation often occurs while holding a steering wheel, phone or newspaper or, commonly, waking you from sleeping. The sensation may extend from your wrist up your arm.Many people “shake out” their hands to try to relieve their symptoms. As the disorder progresses, the numb feeling may become constant.
  • Weakness. You may experience weakness in your hand and a tendency to drop objects. This may be due to the numbness in your hand or weakness of the thumb’s pinching muscles, which are controlled by the median nerve.

Causes: Carpal tunnel syndrome occurs as a result of compression of the median nerve.

The median nerve runs from your forearm through a passageway in your wrist (carpal tunnel) to your hand. It provides sensation to the palm side of your thumb and fingers, with the exception of your little finger. It also provides nerve signals to move the muscles around the base of your thumb (motor function). In general, anything that crowds, irritates or compresses the median nerve in the carpal tunnel space can lead to carpal tunnel syndrome. For example, a wrist fracture can narrow the carpal tunnel and irritate the nerve, as can the swelling and inflammation resulting from rheumatoid arthritis. In many cases, no single cause can be identified. It may be that a combination of risk factors contributes to the development of the condition.

From: Mayo Clinic

Treatments

Carpal Tunnel Injection: A common mononeuropathy due to entrapment of the median nerve in the carpal tunnel. Symptoms include hand paresthesia, numbness, and pain in the median nerve distribution of the hand. Conservative treatment options, in addition to carpal tunnel steroid injection, include rest, splinting, oral steroids, ultrasound, yoga, physical therapy, and ergonomic modification. Surgical intervention is reserved for severe symptoms. Clinical testing for carpal tunnel syndrome includes the Tinel test, which is performed by lightly tapping the median nerve eliciting paresthesia in the nerve distribution of the hand. Additional testing includes the Phalen test, which increases pressure in the carpal tunnel by forced wrist flexion for several minutes. Carpal tunnel steroid injection has been shown to reduce short-term symptoms prior to definitive surgical intervention. Local steroid injection and surgical decompression both are effective treatments at 2-year follow-up, with surgical intervention having some additional benefit.

From: Medscape

Wrist Splint: A brace that looks like a fingerless glove. It stabilizes your wrist in a straight and sometimes slightly bent-back position. Wearing a wrist splint minimizes pressure on the median nerve and allows you a period of “relative rest” from movements that make carpal tunnel syndrome worse.

Think about these guidelines when you use a wrist splint:

  • When worn to stabilize the wrist during sleep, a wrist splint can reduce pain and pressure on the median nerve.
  • A wrist splint isn’t a substitute for good workplace design and proper body mechanics. Some experts advise against wearing a wrist splint while working, because doing so can strain the hand’s tendons.
  • A wrist splint is a helpful short-term treatment for carpal tunnel syndrome. But long-term use can cause your muscles to weaken. During and after a period of splint use, exercise and slowly increase your hand and wrist movements. This will help prevent your wrist muscles from weakening.

From: WebMD

Surgery: If your symptoms are severe or persist after trying nonsurgical therapy, surgery may be the most appropriate option.

The goal of carpal tunnel surgery is to relieve pressure on your median nerve by cutting the ligament pressing on the nerve. The surgery may be performed with two different techniques. Discuss the risks and benefits of each technique with your surgeon before surgery. Surgery risks may include incomplete release of the ligament, wound infections, scar formation, and nerve or vascular injuries. The final results of endoscopic and open surgery are similar.

    • Endoscopic surgery. In endoscopic surgery, your surgeon uses a telescope-like device with a tiny camera attached to it (endoscope) to see inside your carpal tunnel and cut the ligament through one or two small incisions in your hand or wrist. Endoscopic surgery may result in less pain than does open surgery in the first few days or weeks after surgery.
    • Open surgery. In open surgery, your surgeon makes a larger incision in the palm of your hand over the carpal tunnel and cuts through the ligament to free the nerve. This procedure may also be conducted using a smaller incision, which may reduce the risk of complications.

From: Mayo Clinic

Staff

Raul Cortes, MD FACS
Surgical Director / Plastic and Reconstructive Surgery
Risa Ravitz, MD
Neurology / Pain Medicine

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