Carpal Tunnel Syndrome
At the Hand Center of Louisiana, we often treat patients with carpal tunnel syndrome. One of the most common hand conditions treated at our New Orleans, LA facility, it can diminish your quality of life by making it difficult to perform routine activities, hobbies, professional responsibilities, and other tasks. Carpal tunnel can also disrupt sleep. Understanding this injury, including its causes, symptoms, and resulting treatments, can help you decide if you need to see an orthopaedic surgeon for evaluation.
What is carpal tunnel syndrome?
Carpal tunnel syndrome (CTS) is a condition brought on by increased pressure on the median nerve at the wrist. In effect, it is a pinched nerve at the wrist. Symptoms may include numbness, tingling, and pain in the arm, hand, and fingers. There is a space in the wrist called the carpal tunnel where the median nerve and nine tendons pass from the forearm into the hand. Carpal tunnel syndrome happens when pressure builds up from swelling in this tunnel and puts pressure on the nerve. When the pressure from the swelling becomes great enough to disturb the way the nerve works, numbness, tingling, and pain may be felt in the hand and fingers.
What causes carpal tunnel syndrome?
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. Usually, the cause of CTS is unknown. The following factors are often associated with CTS:
- Swelling of the lining of the flexor tendon (tenosynovitis)
- Joint dislocations
- Wrist positioning
- Fluid retention during pregnancy
- Thyroid conditions
- Rheumatoid arthritis
Tenosynovitis, joint dislocations, fractures, and arthritis can place pressure on the median nerve and cause CTS, as well as keeping the wrist bent for long periods. Fluid retention during pregnancy can cause swelling in the tunnel and symptoms of carpal tunnel syndrome, which often go away after delivery. Thyroid conditions, rheumatoid arthritis, and diabetes also can be associated with carpal tunnel syndrome.
Signs and symptoms of carpal tunnel syndrome
The signs and symptoms of CTS can often impose on daily activities and disrupt sleep. They usually include one or more of the following symptoms:
- Weak grip
- Loss of sensation
Numbness or tingling most often takes place in the thumb, index, middle, and ring fingers. The symptoms usually are felt during the night but also may be noticed during daily activities such as driving or reading a newspaper. Patients may sometimes notice a weaker grip, occasional clumsiness, and a tendency to drop things. In severe cases, sensation may be permanently lost and the muscles at the base of the thumb slowly shrink (thenar atrophy), causing difficulty with pinch.
Diagnosis of carpal tunnel syndrome
A detailed history including medical conditions, how the hands have been used, and whether there were any prior injuries is important. An X-ray may be taken to check for the other causes of the complaints such as arthritis or a fracture. In some cases, laboratory tests may be done if there is a suspected medical condition that is associated with CTS. Electrodiagnostic studies (NCV–nerve conduction velocities and EMG–electromyogram) may be done to confirm the diagnosis of carpal tunnel syndrome as well as to check for other possible nerve problems.
Treatment of carpal tunnel syndrome
Symptoms may often be relieved without surgery. Identifying and treating medical conditions, changing the patterns of hand use, or keeping the wrist splinted in a straight position may help reduce pressure on the nerve. Wearing wrist splints at night may relieve the symptoms that interfere with sleep. A steroid injection into the carpal tunnel may help relieve the symptoms by reducing swelling around the nerve.
When symptoms are severe or do not improve, surgery may be needed to make more room for the nerve. Pressure on the nerve is decreased by cutting the ligament that forms the roof (top) of the tunnel on the palm side of the hand (see Figure 3). Incisions for this surgery may vary, but the goal is the same: to enlarge the tunnel and decrease pressure on the nerve. Following surgery, soreness around the incision may last for several weeks or months. The numbness and tingling may disappear quickly or slowly. It may take several months for strength in the hand and wrist to return to normal. Carpal tunnel symptoms may not completely go away after surgery, especially in severe cases.
The prognosis of carpal tunnel syndrome
Carpal tunnel syndrome can be surgically corrected by a carpal tunnel release. The carpal tunnel release is a procedure in which the surgeon cuts through the carpal ligament (the thick ligament that forms the top of the carpal tunnel) to make more space for the nerve and tendons. This ensures that any swelling does not pinch the nerve and cause pain.
The carpal tunnel surgery is performed through a series of steps:
- First, you receive anesthesia (usually local) to numb the surgical site during operation
- A small incision is made at the palm of your hand near the wrist
- The carpal tunnel ligament is cut, easing the pressure on the median nerve. In some cases, the surgeon may also remove the tissue around the nerve
- The tissue and skin is closed with stitches
The carpal tunnel release is performed in an outpatient setting, such as the Hand Center of Louisiana, and stitches are removed within 7 to 10 days. After undergoing the procedure, you can expect pain for up to two months and light use of the hand for four weeks.
Relieve Your Hand Pain
CTS is one of the most common hand conditions and can impose on daily activities and disrupt sleep. The condition is often caused by repetitive motions, bending at the wrist, pregnancy, or other medical conditions. And it can be treated through non-surgical and surgical interventions. The condition treated can provide relief and allow patients to return to daily activities.
To find out if you have CTS, contact us to schedule a consultation with one of our experience physicians, who can find the best course of treatment for you. We bring more than 40 years of experience serving the Gulf South region and provide integrated care that includes medical evaluation and treatment, diagnostic capabilities, and therapeutics – all under one roof.