Carpal Tunnel Syndrome
Carpal tunnel syndrome is the most common compression or entrapment neuropathy of the hand. Compression neuropathy means that a nerve or branch of a nerve gets compressed. Entrapment neuropathy means that a nerve or its branches can get entrapped by surrounding tissues. As a result muscular weakness occurs and also loss of sensitivity over the areas supplied by the compressed or entrapped nerve.
Carpal tunnel syndrome refers specifically to the compression of the media nerve at the level of the wrist. The median nerve is one of the three main nerves that provide motor and sensory innervation of the hand. The other two major nerves are the ulnar and radial nerves.
Typically the median age for carpal tunnel syndrome is 50 years of age.
However I have seen the incidence of carpal tunnel rise in younger people who perform repetitive motions with their hands for work.
Carpal tunnel syndrome most often occurs due to a thickened inflamed compressive transverse carpal ligament at the volar surface of the wrist.
Carpal tunnel symptoms most commonly include the following: numbness and tingling of the palm, wrist, thumb, index and long fingers. Additional symptoms also include weakness of the grip in the affected hand. Patients will often mention to me that they are awaken at night because of pain in their affected hand.
Carpal tunnel initial therapy is non-steroidal anti inflammatory medicines, splinting and rest. Carpal tunnel cortisone injections can be used for treatment carpal tunnel syndrome as a subsequent step.
Carpal tunnel treatment though is mainly surgical and represents the mainstay of therapy. Surgical therapy entails a small incision extending from the wrist to the palm. It is a7-8 centimeter incision. The transverse carpal ligament that constricts the nerve is divided. The nerve is examined and freed from any potential constricting adhesions. All potential tissues that can potentially cause future compression are released. Then the wounds are closed and a soft dressing is applied. Surgical treatment can also be endoscopic. Sutures and dressings are removed at 14 days after surgery. Relief of symptoms is immediate.
Carpal tunnel release can be done under general anesthesia or Intravenous sedation.
Carpal tunnel operative release can also be done under local anesthesia only. This is a unique technique I offer in my practice so that patients who are afraid to go under general anesthesia do not have too.