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Carpal Tunnel Syndrome

    Carpal Tunnel Syndrome

    Carpal tunnel syndrome results from pressure on the MEDIAN NERVE at the wrist.  People usually note NUMBNESS in the finger tips, NUMBNESS OR ACHING PAIN that awakens then from sleep, a sense of CLUMBSYNESS with use of the hand, or more rarely PAIN in the palmar aspect of the wrist and or forearm.  Although there is a common misconception that it is related to computer use, it is most frequently associated with obesity, diabetes, aging and genetic predisposition.   It is also frequently seen during pregnancy.  Later people note WEAKNESS in the hands as the muscles in the thumb weaken, then atrophy from lack of nerve input.

    What is it?

    The medical term for the wrist bones is the carpal bones.  The carpal bones form three sides of a tunnel that is roofed by the transverse carpal ligament which is a very thick unyielding band of tissue.  If the synovium, or lining on the tendons, thickens then the nerve becomes pinched at the carpal tunnel.  The reason for the increased symptoms at night is that most people sleep with their wrists bent which causes further pressure on the nerve.

    The best test for carpal tunnel syndrome is a EMG/NCV (electromyelogram/nerve conduction study).  By testing the way the nerve carries a standardized electrical impulse we can test how well it is functioning.  The EMG/NCV can help determine if you have carpal tunnel syndrome or pressure on the nerve elsewhere (neck, shoulder) or some other condition such as diabetic neuropathy.

    Treatment options

    Treatment often begins with splinting the wrists at night to keep them from being bent during sleep.  Anti-inflamatory medications (NSAIDS) can reduce the swelling and help relieve the pressure. Various therapy regimens have been utilized and can be helpful but long term studies are tending to show they do not permanently resolve the problem.  Likewise steroid injections have been very popular but long term studies are now suggesting they do not resolve the condition though they often provide temporary benefit.  Surgery involves releasing the tight band across the top of the tunnel (the transverse carpal ligament) which usually permanently releases the pressure on the nerve.  If the nerve has been compressed for too long release of the band can fail to improve nerve function.  

    Surgery is performed on an out-patient basis.  The procedure takes about 15 minutes.  Following surgery  the wrist may be splinted for 2 weeks for comfort but the thumb and fingers can be used for light activities.