Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is a hand and wrist condition that is characterized by numbness, weakness, and pain. While a number of factors may contribute to the development of this disorder, exhaustive and repetitious movements are amongst the most common culprits. Women are more frequently diagnosed than men. Likewise, individuals with the following professions and/or predominant behaviors may be more susceptible to development:

• Typists and computer-centric workers
• Tennis players, cyclists, and similar athletes
• Musicians
• Truck, bus, and taxi drivers

The Anatomy of Carpal Tunnel Syndrome

Within the wrist, there is a narrow tunnel formed by the carpal bones and transverse carpal ligament, a band of connective tissue that covers the top of the structure. Passing through this tunnel is the median nerve, which extends from the forearm into the hand. This nerve is important to muscle movement within the thumb’s base, as well the sense of touch within your palm and fingers. Also traveling through the carpal tunnel are the flexor tendons, which enable successful bending of the thumb and finger joints.

The presence of the median nerve and flexor tendons makes carpal tunnel health imperative in the maintenance of appropriate hand and wrist function. Damage to this structure will not only cause pain and discomfort, but may also render some basic day-to-day activities impossible.

Causes and Symptoms

Surrounding the flexor tendons are synovium, tissues that lubricate the tendons and enable movement of the finger joints. Should the synovium become swollen, they will often overfill the already narrow carpal tunnel and place detrimental pressure on the median nerve. As the result of this pressure, you may experience the following symptoms:

• Hand numbness, pain, and/or tingling
• Unusual sensitivity and sensations within the fingers and thumb
• Extended discomfort through the arm and shoulder

The symptoms of carpal tunnel syndrome often emerge over time, rather than appearing as the result of a specific traumatic event. While discomfort may begin as mild and sporadic in nature, pain will likely intensify and become more frequent as the condition persists. With this increase in severity, basic activities, such as tying your shoes or holding a phone, may become more difficult.

In addition to general wear-and-tear, the following factors may contribute to the emergence of carpal tunnel syndrome:

• Heredity
• Hormonal changes (i.e. pregnancy, menopause, etc.)
• Aging
• Diabetes, arthritis, and glandular imbalances

The Examination Process

Diagnosis of carpal tunnel syndrome involves the completion of a physical examination, which will include strength tests, as well as pain and sensitivity assessments. In some cases, electrophysiological, x-rays, and other non-invasive tests may be recommended for a more in-depth analysis of contributing factors and case severity. Based on the findings of this exam, your orthopedic upper extremity surgeon will prescribe a comprehensive treatment approach.

Treating Carpal Tunnel Syndrome

In initiating a treatment plan, your physician will likely begin with non-surgical and therapy based approaches. If your carpal tunnel issues are the result of repetitive and exhaustive activities, behavioral modification will be recommended to relieve ongoing irritation. Should these activities be unavoidable, braces may be worn to help prevent further injury and the worsening of your condition. Additional anti-inflammatory drugs and/or steroid injections may be recommended to relieve pain and general discomfort.

Should these non-invasive techniques prove ineffective in providing the desired result, your orthopedic surgeon may suggest surgical intervention. During the typical carpal tunnel syndrome operation, through an incision in the palm, the transverse carpal ligament will be split to increase tunnel size and reduce pressure on the median nerve. As the area heals, the ligament will be less intrusive, allowing more space for both the nerve and flexor tendons.

Post-Op Recovery

In cases of either traditional or arthroscopic surgery, you will need to take special care not to re-injure the hand and wrist area, avoiding both sudden and strenuous motions. Minimal pain and swelling may be present, and it will be recommended to keep your hand elevated while encouraging slight finger movements. While a level of discomfort should be expected, if any of the following complications arise, you should contact your orthopedic surgeon immediately:

• Bleeding
• Infection within the treatment area
• Significant pain
• Excessive swelling or redness
• Full recovery may take up to a year, and it will be important to continue regular visits to your orthopedic surgeon throughout.

As experts in carpal tunnel syndrome care, our board certified hand and plastic surgeons at the RPSC Hand Surgery Center and Regional Plastic Surgery Center, can help you. If you would like to schedule an appointment, contact our office.