Carpal Tunnel Syndrome
An article by Dr. Daniel Fowler
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Carpal tunnel syndrome is caused by compression of the median nerve in the carpal tunnel at the wrist. The carpal tunnel is a space at the wrist that is formed by the carpal bones dorsally and the transverse carpal ligament on the palmar side. In addition to the median nerve, it also contains the eight flexor tendons of the fingers and the long flexor tendon to the thumb. the carpal tunnel can be a fairly tight space for all these important structures. In some people, this space can be tight enough that it begins to squeeze the median nerve. The median nerve is responsible for sensation of the palmar aspect of the thumb, index finger, and the radial half of the ring finger. It is also responsible for the motor function of the thumb via it's recurrent motor branch.
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Common symptoms of carpal tunnel syndrome include tingling and numbness in the thumb, index, index, long and ring fingers. Sometimes numbness is less prominent, and patients may complain of a deep ache in the thenar muscles. Many patients describe being woken from sleep by their sypmtoms, needing to "shake the hand awake" for relief. Patients also report weakness of grip, or dropping things ("clumsy hand" symptoms). Diabetes, thyroid disease and pregnancy can be associated with carpal tunnel syndrome, Symptoms may accompany repetitive work such as typing, or use of vibration-inducing tools (saws, drills, jackhammers). If carpal tunnel syndrome is left untreated, it can lead to permanent damage of the small nerves and muscles of the hand, leading to significantly decreased function of the thumb and hand.
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If a patient has symptoms of carpal tunnel syndrome, the doctor may recommend what we call "conservative therapy" (nighttime splinting, NSAIDS's) for a period of time before considering other treatment options. If there is any question about the diagnosis, an EMG (electromyelography with nerve conduction velocities) may be obtained to show the location of any nerve pinches in the arm. If these measures are unsuccessful, then surgery is generally the next step. Steroid injections may provide temporary relief. Carpal tunnel surgery, on the other hand, allows for definitive release of the tight ligament that is squeezing the nerve, and it is done under direct vision with minimal risk of tendon or nerve damage. It takes most people about a week to be able to go back to work, although it can take up to six to eight weeks for a grip strength to fully return to normal. The surgery is well tolerated and most people report immediate relief of the tingling/numbness symptoms. The most common problem that people may have is a sensitive scar in the palm which may last several months before the sensitivity improves.
- Dr. Daniel Fowler
- Dr. Daniel Fowler
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Think you have CTS? Call today and schedule your consultation with Dr. Daniel Fowler.
865-671-3888
