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San Diego, CA 92123

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Coast Surgery Center

Carpal Tunnel Syndrome

1323700028The carpal tunnel is a narrow, rigid passageway of ligament and bones at the wrist through which eight flexor tendons and the median nerve pass. Carpal tunnel syndrome develops when the median nerve, which runs from the forearm into the hand, becomes compressed within this tunnel. The median nerve transmits sensory impulses from the thumb, index, middle and ring finger and also innervates the small muscles in the thumb that coordinate its movement. In some cases, inflamed tendons or other swelling within the carpal tunnel compress the median nerve. This results in pain, weakness or numbness in the hand and wrist that occasionally radiates up the arm. Though other medical conditions can cause these symptoms, carpal tunnel syndrome is the most common and widely known of the entrapment neuropathies in which the body’s peripheral
nerves are compressed or traumatized.

Signs and symptoms of carpal tunnel syndrome:

– Burning, tingling or numbness in the palm and fingers (particularly the thumb, index and middle fingers)
– Fingers feeling swollen with no apparent swelling
– Desire to “shake out” discomfort in hand or wrist, especially in the early morning
– Decrease in grip strength with difficulty grasping small objects.

Treatment options usually begin with:

– Nighttime use of a wrist splint
– Anti-inflammatory medications that help to relieve swelling and decrease pain and numbness
– Corticosteroid injections into the carpal tunnel that reduce swelling and relieve symptoms
– Exercise programs, often supervised by a trained physical or occupational therapist, involving stretching and
strengthening once symptoms have subsided

If the patient’s symptoms fail to respond to these non-operative measures, surgery may be indicated. Carpal tunnel release surgery can be performed with the traditional open technique or endoscopically.

What are the causes of carpal tunnel syndrome?

Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve within the carpal tunnel. This disorder is more common in women, possibly due to their smaller carpal tunnel as well as hormonal influences.

Other contributing factors include:

– Trauma or injury to the wrist that cause swelling, such as a sprain or fracture
– Hypothyroidism
– Rheumatoid arthritis
– Wrist arthritis or other mechanical wrist problems
– Work-related repetitive use
– Repeated use of vibrating hand tools
– Fluid retention during pregnancy or menopause
– Development of a cyst or tumor in the carpal tunnel

In many cases, no specific cause can be identified.
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How is carpal tunnel syndrome diagnosed?

Early diagnosis and treatment are important to avoid permanent median nerve damage. A thorough physical examination of the hands, arms, shoulders and neck can help determine if the patient’s complaints are related to carpal tunnel syndrome or to other pathology in the upper extremity or neck that may mimic carpal tunnel syndrome. The wrist is examined for tenderness, swelling, warmth, and discoloration. Each finger should be tested for sensation and the muscles at the base of the thumb should be examined for signs of atrophy. Routine laboratory tests and x-rays can reveal diabetes, hypothyroidism, arthritis and fractures. Physicians can also use specific tests, such as the Tinel’s or Phalen’s tests, to try to reproduce the carpal tunnel symptoms. It may be necessary to confirm the diagnosis with electrodiagnostic tests, which can also help determine the severity of median nerve damage.

Who is at risk of developing carpal tunnel syndrome?

The risk of developing carpal tunnel syndrome is not confined to people within a single industry or job. Greater age, female gender, relative overweight, cigarette smoking, and vibrations associated with job tasks significantly increase the risk of developing carpal tunnel syndrome. Pregnancy, diabetes, hypothyroidism, and rheumatoid arthritis are predisposing factors for carpal tunnel syndrome. Women are three times more likely than men to develop carpal tunnel syndrome for reasons mentioned above.

How is carpal tunnel syndrome treated?

Treatment for carpal tunnel syndrome should begin as soon as possible under a physician’s supervision. If underlying medical conditions such as diabetes and rheumatoid arthritis are playing a role, they should be addressed by the patient’s primary care physician. Early treatment involves avoiding activities that may worsen symptoms as well as night splinting and anti-inflammatory medication. A cortisone injection into the carpal tunnel may provide several months of relief. Ultimately, if symptoms persist in spite of these non-operative measures, surgery is successful in greater than 90% of patients.

How can carpal tunnel syndrome be prevented?

At the workplace, workers can do on-the-job conditioning, perform stretching exercises, take frequent rest breaks, use correct posture and wrist position, and wear wrist splints in the early stages of the disease. Another preventable measure for employers is to develop programs that allow ergonomic assessment and adjustment of the workstation to avoid unnatural postures and ver-repetitive exertion. However, research has not  conclusively shown that these workplace changes prevent the development of carpal tunnel syndrome.

Carpal Tunnel Release

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One of the most common ailments of the hand is carpal tunnel syndrome. Both of these conditions most commonly result from overuse or increased pressure to the wrist. Symptoms include pain, numbness and tingling in the fingers, hand or wrist, which seems to get worse at night. If this condition is treated in its early stages, most cases resolve through the use of anti-inflammatory medication and bracing of the wrist. If the condition goes untreated or if patient do not respond to conservative treatment, a carpal tunnel release may be required. The surgery itself involves cutting the ligament that forms the roof of the carpal tunnel to relieve the pressure on the median nerve. The procedure takes approximately one hour and patients go home after about an hour of recovery. Because Coast Surgery Center only performs orthopedic and pain management procedures, we are equipped with state-of-the-art arthroscopic equipment used for these types of procedures.