Redwood Orthopaedic Surgery Associates | Santa Rosa, CA

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a common condition involving numbness, pain, and tingling in the wrist, hand, and fingers. It results from continuing pressure on a nerve in the wrist, which controls motor function in the thumb.

At Redwood Orthopaedic Surgery, we treat carpal tunnel syndrome with conservative methods and surgery, if necessary. Here’s some more information on this condition.

 

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What is carpal tunnel syndrome?

Carpal tunnel syndrome is named for the path the median nerve takes through the wrist into the hand, the carpal tunnel. When this passageway narrows, the nerve becomes compressed causing pain, tingling, and numbness in the hand, wrist, and lower arm.


What are the symptoms of carpal tunnel syndrome?

You don’t wake up one day and have carpal tunnel syndrome — the condition will progress. The first signs are usually numbness or tingling in your thumb, index, and middle fingers. This will come and go. As the nerve compression advances, you’ll likely start to have pain in your wrist and the palm of your hand.

These are common symptoms:

    • Tingling, burning, numbness — This is common. The tingling sensations will usually be in the thumb through ring finger, but not the pinky (the pinky and the outer half of your ring finger are served by another nerve). These can feel like an electric shock. The sensations can move up from your hand and wrist into your arm; they will occur when closing the fingers of your hand, such as when holding your phone or gripping a pen.
  • Weakness — As the median nerve becomes more compressed, you may find that you’re dropping objects. This weakness in your hand is causing weakness in your pinching muscles, which are controlled by the median nerve.

What causes carpal tunnel syndrome?

The compression through the carpal tunnel is often caused by a thickening of a ligament on the palm side of the wrist, called the transverse carpal ligament. Although not fully understood, it’s thought this occurs through a combination of the person’s anatomy, physiology, and stresses such as repetitive movement.

Anything that causes squeezing or irritation of the median nerve in the limited space of the carpal tunnel can lead to carpal tunnel syndrome. A wrist fracture or inflammation from rheumatoid arthritis can create this.Here are other risk factors for developing carpal tunnel syndrome. They may not directly cause the problem, but increase a person’s chances of developing it:

  • Wrist anatomy — Some people simply have a narrower carpal tunnel. Other physical issues with the wrist, such as a dislocation, can also narrow the tunnel.
  • Sex — Women tend to develop carpal tunnel syndrome more than men, probably due to an inherently smaller carpal tunnel.
  • Obesity — Obesity significantly increases your odds.
  • Body fluid changes — Fluid retention can increase the pressure in the carpal tunnel. This is common with pregnancy and menopause.
  • Workplace factors — It’s thought that working with vibrating tools, on an assembly line, or repetitive flexing of the wrist can create pressure on the nerve.
  • Inflammatory conditions — Illnesses such as arthritis can affect the lining around the tendons in the wrist.
  • Nerve-damaging conditions — Some chronic illnesses, such as diabetes, increase the risk of nerve damage.

How can I avoid developing carpal tunnel syndrome?

Nothing has been proven to prevent this condition, but if you can minimize certain stresses placed on your wrists and hands, it can limit the opportunities for inflammation of the ligaments that then compress the median nerve.

  • Take breaks — Take breaks to bend your hands and wrists. Gently stretch them. Alternate tasks, if possible.
  • Reduce your grip — Hit the keys on the keyboard softly. Use a larger pen for prolonged handwriting.
  • Use Good Form — Keep your keyboard at elbow height or slightly lower. Avoiding bending your wrist to full extension.
  • Change your mouse — Get an ergonomic mouse that doesn’t strain your wrist.
  • Keep your hands warm — Working in a cold environment makes it more likely you’ll develop hand pain and stiffness. If you need to, wear fingerless gloves that keep your hands and wrists warm.

How is carpal tunnel syndrome diagnosed?

At Redwood Orthopaedic Surgery, we have extensive experience with carpal tunnel syndrome. Here’s how we diagnose it:

  • Pattern of symptoms — We’ll weigh your progression of symptoms through a series of questions.
  • Physical exam — We’ll test the feeling in your fingers, and the strength of your hand muscles. If we bend the wrist or tap or press on the median nerve, this often triggers pain sensation.
  • X-rays — If necessary, we may take an x-ray to look for an anatomical cause, such as arthritis.
  • Electromyogram — This measures electrical discharges produced in the muscles. This can eliminate other conditions and identify if you have muscle damage.
  • Nerve conduction study — This test passes a small shock through the median nerve. It tells if the electrical impulses slow as they pass through the carpal tunnel.

How is carpal tunnel syndrome treated?

At Redwood Orthopaedic Surgery, we use conservative treatments if you’ve come to us presenting only mild to moderate symptoms. These include:

  • Corticosteroids — These decrease inflammation and swelling, which relieves pressure on the median nerve.
  • Behavior changes — We advocate changes in your workplace setup, stretching exercises, and other ways to limit possible inflammation.
  • Wrist splinting — A splint on your wrist, while you sleep, can keep your symptoms from waking you up, but this doesn’t necessarily correct the condition.
  • Anti-inflammatory drugs — Again, these relieve your pain but don’t correct the condition.

Surgical options
When carpal tunnel syndrome has continued for 10 months or more, it’s likely you’ll need surgery to correct the condition. The goal is to relieve pressure by cutting the ligament that is pressing on the median nerve.

We use two different techniques:

  • Endoscopic surgery — An endoscope is inserted through a tiny incision in your hand or wrist. This has a camera on the end. We then cut the ligament through a second small incision.
  • Open surgery — An incision is made in the palm of your hand, directly over the carpal tunnel and the ligament is cut.

Are there risks with this surgery?

While this surgery is usually very successful at eliminating or substantially decreasing the patient’s numbness, pain, and muscle weakness, it does have some risks:

  • Incomplete release of the ligament
  • Nerve damage
  • Scarring
  • Infection

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