Carpal Tunnel

carpal tunnelIf you suffer from carpal tunnel syndrome, you may have vague symptoms at first which could include occasional numbness and tingling in the fingers. As the condition progresses, the symptoms worsen. When the symptoms are present most of the time, you could notice you drop things more often. Another complaint you might express is decreasing grip strength or waking up at night with numbness in your hand. You will often report having to shake your hand to get the numbness to go away. If these symptoms are present, then you should consider carpal tunnel syndrome as the possible cause.

So what is carpal tunnel syndrome? Simply, it is a condition in which the median nerve in the wrist is being compressed. There are many nerve compression syndromes, but, by far, carpal tunnel syndrome is the most common type of nerve compression in the upper extremity.

When a nerve is compressed, the function of the nerve is decreased. This leads to the symptoms that direct patients to their physicians. More specifically, symptoms include numbness in the thumb, index, long, and half of the ring fingers. This numbness can be intermittent or constant, and is generally related to the amount of time the nerve has been compressed. If the nerve has been compressed for a longer period of time, you may experience constant numbness. Often, patients will mention a decrease in grip strength because part of the median nerve controls some of the Thenar Muscles in the base of the thumb. The decrease in grip strength is seen mostly in patients who have had carpal tunnel syndrome for a long time. Other patients report dropping items because they cannot feel what they are picking up or do not have the strength to hold onto items.

To help confirm the diagnosis of carpal tunnel syndrome, a nerve conduction study is performed. This is a valuable tool to help confirm the clinical impression obtained when a patient presents for evaluation of carpal tunnel syndrome. Often times, the nerve conduction study will determine if the condition is mild moderate or severe.

Early carpal tunnel syndrome (mild) can be treated conservatively. This involves occupational therapy which often improves the symptoms. Splinting the wrist or steroid injections are other non-surgical treatments that can be useful. For more advanced carpal tunnel syndrome (moderate to severe), surgical intervention is required to release the compression on the nerve, which is done in the operating room. The median nerve is located in the carpal tunnel and compression on the median nerve is the reason for the symptoms. Releasing the compression helps eliminate the symptoms. Injury to the nerve is best avoided in the operating room.

The median nerve is released when the carpal ligament is divided. There are a number of techniques used to release the pressure on the median nerve within the carpal tunnel. The traditional technique uses an incision over the carpal tunnel so that direct vision is used to see the median nerve and it is released as the carpal ligament is divided.

There is also an endoscopic release which uses an endoscope. This method makes an incision in the forearm and/or in the hand. Endoscopic release will also divide the carpal ligament. There are advocates for both the traditional carpal tunnel release and the endoscopic carpal tunnel release. The choice of which to use is a decision the surgeon makes.

The procedure itself is a short procedure and usually takes a few minutes from the time of the skin incision till the incision is closed. The procedure can be done under a Regional Block (a Bier Block) or under local anesthesia and sedation. This is determined by the surgeon’s preference.

Postoperatively, the patient will usually report sensation has returned within a day; however, some patients require a longer time to regain sensation. The length of time required to regain sensation is sometimes dependent upon the severity of the carpal tunnel syndrome.  More severe carpal tunnel requires a longer time to regain sensation  than a patient with moderate or mild carpal tunnel syndrome.

Patients are also required to wear splints postoperatively.  For the first 2 weeks post-surgery, patients are required to wear a gel splint.  Afterwards, patients will switch over to a laser splint for another 2-4 weeks.

The patient will also experience a decreased grip strength after carpal tunnel release. This is only temporary. The grip strength will return within 2-6 weeks in most cases.