Raleigh Hand Center
3701 Wake Forest Rd
Raleigh, NC 27609
What is carpal tunnel syndrome?
Carpal tunnel syndrome (CTS) is the most common compression neuropathy in the upper extremity. It results from increased pressure on the median nerve at the wrist, within the carpal tunnel. Basically, it is a type of "pinched nerve."
The word "carpus" is derived from the Greek word karpos, which means "wrist." The carpal tunnel is a passageway in the wrist through which the median nerve and flexor tendons of the hand travel. The carpal tunnel is a narrow, confined space: the floor of the tunnel is made up by the carpal bones of the wrist, and the roof is created by the transverse carpal ligament. The median nerve is at risk for compression within this tunnel. If there is abnormal swelling, altered wrist anatomy, or injury to this area, median nerve function may be affected. Patients may experience symptoms such as numbness, tingling, weakness, and pain. The median nerve is responsible for providing sensation to the thumb, index, middle, and half of the ring finger. The median nerve also innervates most of the muscles at the base of the thumb (thenar muscles).
What causes carpal tunnel syndrome?
In most cases, the cause of CTS is unknown. Thyroid disorders, rheumatoid arthritis, pregnancy, vitamin deficiencies, diabetes, and fluid retention can be associated with CTS. Wrist fractures and swelling of the tendons (flexor tenosynovitis) can cause carpal tunnel syndrome. Women are more commonly affected than men. Repetitive forceful gripping and heavy use of vibratory tools may increase a person's risk of CTS. To date, prolonged computer use has not been proven to be a cause of CTS.
How do I know if I have carpal tunnel syndrome?
Patients with CTS commonly report "numbness" and "tingling" in the fingers. Some patients notice that the fingers feel cold, swollen, "asleep" or report "poor circulation" in the hands. Symptoms can awaken patients at night and patients tend to shake their hands for relief. Some patients report increased symptoms while gripping a steering wheel or reading a book in bed. Dropping objects, clumsiness with the hands, or a weak grip are also common complaints. In severe or long-standing cases, the muscles at the base of the thumb (thenar muscles) can become weak and atrophy, sometimes permanently. If you think you may have carpal tunnel syndrome, please visit www.raleighhand.com or call 919-872-3171 to be evaluated at the Raleigh Hand Center.
Often the diagnosis can be made on the basis of your symptoms, medical history, and physical examination. During the office visit, I routinely examine the neck, shoulder, elbow, wrist, sensation in the hand, and muscle function in the hand. I also test the irritability of the median nerve. This involves tapping along the course of the nerve (Tinel's test), holding the wrist flexed (Phalen's test), and gently pressing on the carpal tunnel (carpal compression test). When surgical treatment is being considered, an electrodiagnostic study (nerve conduction study and/or electromyogram) is often recommended. This test is valuable to confirm the diagnosis, assess the severity of median nerve compression, and rule-out other potential causes of hand numbness.
Not all hand pain or numbness is caused by carpal tunnel syndrome. The nerves of the upper extremity can be compressed or "pinched" anywhere along their pathway from the cervical spine (neck) to the fingers. Therefore it is important to identify the location of the nerve compression. In some cases, a nerve is compressed at two separate locations along its course, known as the "double-crush" syndrome, which can make the symptoms worse.
What are the treatment options?
Not everyone with carpal tunnel syndrome needs surgery. Fortunately, many people with CTS improve with non-operative treatment. Many people sleep with the wrist bent, which puts more pressure on the median nerve. Wearing a wrist brace at night supports the wrist in neutral alignment and takes pressure off the nerve. Modifying daily activities – particularly avoiding prolonged wrist flexion, forceful and repetitive gripping or vibratory tools – may help. Corticosteroid injections in the carpal tunnel ("cortisone shot") provide an anti-inflammatory effect and can be effective in over 60% of patients. Some patients may benefit from tendon gliding exercises, range of motion exercises, and stretching programs. Taking B6 vitamins may also help some patients.
Should these measures fail to improve the condition, or if nerve compression is severe, surgery may be recommended. A carpal tunnel release (CTR) is performed to decrease pressure on the median nerve. During this procedure, the "roof" of the carpal tunnel (transverse carpal ligament) is divided through an incision at the base of the palm. Cutting the tranverse carpal ligament increases the size of the carpal tunnel and provides more room for the median nerve.
What is the recovery from surgery?
The surgery is performed on an outpatient basis usually under local anesthesia (numbing medicine). Patients may use their hands for light activities immediately, and I encourage gentle finger and thumb range of motion. Most people can return to light duty work in a few days. Normal use of the hand is resumed as comfort permits. Pain medication is often weaned in a few days. The soft surgical bandage can be removed after 5-7 days. Afterwards the wound should be covered with a large band-aid and kept dry. The skin sutures are removed in clinic in 10-14 days. Most patients do not require physical therapy or a brace after surgery. I recommend avoiding heavy lifting, pulling, pushing or gripping for approximately 3-4 weeks after surgery.
What are the results from carpal tunnel surgery?
Most patients are satisfied with their result after carpal tunnel surgery. Many patients report dramatic improvement in their numbness, tingling and pain in just a few days, but others may take longer to heal. Some patients do not have complete relief of symptoms, especially in severe or long-standing cases. In some severe cases, the nerve may not recover and the numbness does not improve, even with surgery. Soreness in the palm at the incision is common after surgery for several weeks.
What are the complications from surgery?
No surgery is risk-free. However, major complications from carpal tunnel release are uncommon. Possible complications include persistent symptoms, pain, bleeding, infection, hand stiffness, poor wound healing, and damage to the median nerve. Other complications are possible but uncommon.
What does the incision look like?
The length and type of incision varies among surgeons; however, the common goal is to reduce pressure on the median nerve. The length of incision needed to perform this procedure has decreased in size since CTR was initially described decades ago due to advancement in surgical techniques. Some surgeons use an endoscope to perform this procedure.
The photos below demonstrate the less-invasive incision I typically use for open carpal tunnel release. The hand on the left is 2 weeks after carpal tunnel release surgery. The hand on the right is 8 weeks after surgery. The scar often fades with time.
Dr. Erickson treats patients with carpal tunnel syndrome from the NC Triangle area including Raleigh, Durham, Cary, Wake Forest, Garner, Clayton, Fuquay-Varina, Apex, Morrisville, and Chapel Hill, North Carolina. If you have hand numbness, tingling, hand pain, or weakness, please call the Raleigh Hand Center at 919-872-3171 to schedule a consultation with a hand and upper extremity specialist.
Read more about Dr. Erickson on the AAOS website A Nation in Motion
Updated on 12/20/2012
For additional information
There are thousands of websites related to carpal tunnel syndrome on the internet. Feel free to visit these reliable websites for accurate information:
American Academy of Orthopedic Surgeons (AAOS) current guidelines for CTS
American Society for Surgery of the Hand: www.assh.org
American Academy of Orthopaedic Surgeons (AAOS): www.orthoinfo.org
Copyright 2014 Erickson Hand Surgery
Raleigh Hand Center
3701 Wake Forest Rd
Raleigh, NC 27609