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Orthopedic
Carpal Tunnel Syndrome - Syndrome Carpel Tunnel
Description
Carpal tunnel syndrome is a common condition that causes numbness, tingling, and pain in the hand and forearm. The condition occurs when one of the major nerves to the hand — the median nerve — is squeezed or compressed as it travels through the wrist. In most patients, carpal tunnel syndrome gets worse over time. If untreated for too long, it can lead to permanent dysfunction of the hand, including loss of sensation in the fingers and weakness. For this reason, it is important to diagnose and treat carpal tunnel syndrome promptly. Early symptoms can often be relieved with simple measures like: Wearing a wrist splint while sleeping Exercises to keep the nerve mobile Avoiding certain activities that aggravate your symptoms A steroid injection into the carpal tunnel If pressure on the median nerve continues, however, it can lead to nerve damage and worsening symptoms. To prevent permanent damage, surgery to take pressure off the median nerve may be recommended for some patients. Anatomy The carpal tunnel is a narrow passageway in the wrist, about an inch wide. The floor and sides of the tunnel are formed by small wrist bones called carpal bones. The roof of the tunnel is a strong band of connective tissue called the transverse carpal ligament. Because these boundaries are very rigid, the carpal tunnel has little capacity to stretch or increase in size. The median nerve is one of the main nerves in the hand. It originates as a group of nerve roots in the neck; these roots then come together to form a single nerve in the arm. The median nerve travels down the upper arm, across the elbow, and into the forearm, then passes through the carpal tunnel at the wrist on its way to the hand and fingers. It separates into several smaller nerves along the way, particularly once it reaches the palm. These nerves allow for feeling in the thumb, index finger, middle finger, and half of the ring finger (the thumb side). The median nerve also controls the muscles around the base of the thumb. The nine tendons that bend the fingers and thumb also travel through the carpal tunnel with the nerve. These tendons are called flexor tendons because they flex the fingers and thumb. Description Carpal tunnel syndrome occurs when the tunnel becomes narrowed or when the tissue surrounding the flexor tendons (known as synovium) swells, putting pressure on the median nerve and reducing its blood supply. This abnormal pressure on the nerve can result in numbness, tingling, pain, and weakness in the hand. Cause Most cases of carpal tunnel syndrome are caused by a combination of factors. Studies show that women and older people are more likely to develop the condition. Other risk factors for carpal tunnel syndrome include: Heredity. This is likely an important factor. The carpal tunnel may be naturally smaller in some people, or there may be anatomic differences that change the amount of space for the nerve — and these traits can run in families. Repetitive hand use. Repeating the same hand and wrist motions or activities over a prolonged period of time may aggravate the tendons in the wrist, causing swelling that puts pressure on the nerve. Hand and wrist position. Doing activities that involve extreme flexion or extension of the hand and wrist for a prolonged period of time can increase pressure on the nerve. Pregnancy. Hormonal changes during pregnancy can cause swelling that results in pressure on the nerve. Health conditions. Diabetes, rheumatoid arthritis, and thyroid gland imbalance are conditions that are associated with carpal tunnel syndrome. Symptoms Symptoms of carpal tunnel syndrome may include: Numbness, tingling, burning, and pain — primarily in the thumb and index, middle, and ring fingers. This often wakes people up at night. Occasional shock-like sensations that radiate to the thumb and index, middle, and ring fingers Pain or tingling that may travel up the forearm toward the shoulder Weakness and clumsiness in the hand — this may make it difficult to perform fine movements such as buttoning your clothes Dropping things — due to weakness, numbness, or a loss of proprioception (awareness of where your hand is in space) In most cases, the symptoms of carpal tunnel syndrome begin gradually, without a specific injury. Many patients find that their symptoms come and go at first. However, as the condition worsens, symptoms may occur more frequently or may persist for longer periods of time. Nighttime symptoms are very common. Because many people sleep with their wrists bent, symptoms may awaken you from sleep. During the day, symptoms often occur when holding something for a prolonged period of time with the wrist bent forward or backward, such as when using a phone, driving, or reading a book. Many patients find that moving or shaking their hands helps relieve their symptoms. Physical Examination During your evaluation, your doctor will talk to you about your general health and medical history and will ask about your symptoms. They will carefully examine your hand and wrist and perform a number of physical tests. During these tests, your doctor may: Press down or tap along the median nerve on the palm side of your wrist and hand to see if it causes any tingling into your fingers (Tinel's sign). Bend and hold your wrists in a flexed position to test for numbness or tingling in your hands. Test sensitivity in your fingertips and hands by lightly touching them with a special instrument while your eyes are closed. Check for weakness in the muscles around the base of your thumb. Look for atrophy in the muscles around the base of your thumb. In severe cases, these muscles may become visibly smaller. Tests In some cases, you will need other tests. Electrodiagnostic tests. Your doctor may order electrodiagnostic testing of your nerves to measure how well your median nerve is working and help determine whether there is too much pressure on the nerve. These tests will also help your doctor determine: The severity of your carpal tunnel syndrome Whether the nerve is compressed in other locations Whether other nerves are affected Whether you have a medical condition (e.g., neuropathy) affecting your nerves in addition to carpal tunnel syndrome Electrodiagnostic tests may include: Nerve conduction studies (NCS). These tests measure the signals travelling in the nerves of your hand and arm and can detect when a nerve is not conducting its signal effectively. Nerve conduction studies can help your doctor determine how severe your problem is and help to guide treatment. Electromyogram (EMG). An EMG measures the electrical activity in muscles. EMG results can show whether you have any nerve or muscle damage. Ultrasound. An ultrasound uses high-frequency sound waves to help create pictures of bone and tissue. Your doctor may recommend an ultrasound of your wrist to evaluate the median nerve for signs of compression. X-rays. X-rays provide images of dense structures, such as bone. If you have limited wrist motion or wrist pain, your doctor may order X-rays to exclude other causes for your symptoms, such as arthritis, ligament injury, or a fracture. Magnetic resonance imaging (MRI) scans. MRI scans provide better images of the body's soft tissues than X-rays. Your doctor may order an MRI to help determine other causes for your symptoms or to look for abnormal tissues that could be impacting the median nerve. An MRI can also help your doctor determine if there are problems with the nerve itself, such as a tumor or scarring from an injury. Surgical Treatment If nonsurgical treatment does not relieve your symptoms or provides only temporary relief, your doctor may recommend surgery. The decision of whether to recommend surgery is based on: The severity of your symptoms Physical exam findings Response to non-operative treatment Results of testing In long-standing cases with constant numbness and wasting of your thumb muscles, surgery may be recommended to prevent irreversible damage. Surgery may also be recommended if you do not get relief with non-operative treatments and/or demonstrate significant nerve changes on testing. Surgical Procedure The surgical procedure performed for carpal tunnel syndrome is called a carpal tunnel release. Most surgeons perform this procedure using one of two different surgical techniques, but the goal of both is to relieve pressure on your median nerve by cutting the ligament that forms the roof of the tunnel (transverse carpal ligament). Release of this ligament increases the size of the tunnel and decreases pressure on the median nerve, allowing for appropriate blood flow to the nerve and function of the nerve. In most cases, carpal tunnel surgery is done on an outpatient basis. The surgery can be done under general anesthesia, which puts you to sleep, or under local anesthesia, which numbs just your hand and arm. In some cases where local anesthesia is used, you will also be given a light sedative through an intravenous (IV) line inserted into a vein in your arm.
Key Specification Carpel Tunnel
Syndrome