Carpal tunnel syndrome refers to compression of the median nerve which travels from the forearm to the palm of the hand. The median nerve controls sensation (feeling) along part of the hand including the thumb, index and longer fingers. The median nerve can become compressed as it passes through the wrist due to inflammation or tendon thickening. This can lead to symptoms of pain, numbness, tingling, itching, and/or burning. This can lead to progressive loss of strength with gripping and atrophy of the muscles in the hand.
There is not one specific underlying cause of carpal tunnel syndrome. Trauma to the wrist and repetitive activities are risk factors for the development of median nerve compression. There are several medical co-morbidities including diabetes, hypothyroidism, rheumatoid arthritis, and pregnancy related hormonal changes that have also been linked to carpal tunnel syndrome.
The diagnosis of carpal tunnel syndrome is usually made by physical examination. There are specific parts of the exam that give the physician a good sense of whether a patient’s symptoms are from median nerve compression. An x-ray may be performed to rule out any type of underlying bony problems and arthritis. A EMG/NCV (Electromyography – Nerve Conduction Velocity) test may be ordered to confirm the presence and severity of carpal tunnel syndrome.
Treatment for carpal tunnel syndrome involves the use of a brace to prevent the wrist from flexing with heavy activities and at night. Non-steroidal anti-inflammatory medication (NSAID) may also be prescribed to decrease pain and inflammation. In some cases, a corticosteroid injection into the carpal tunnel may be performed.
Surgery is reserved for those who fail non-surgical options or those who have developing weakness and/or atrophy. Surgery is performed on an outpatient basis under regional or local anesthesia. There are several different surgical approaches to release the median nerve. Recovery is highly dependent on the chronicity and severity of the compression. Some do not get 100% relief of their symptoms