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This drawing is a cross-section of the carpal tunnel taken at the level of the wrist.
The boundaries of the carpal tunnel are rigid, made of bone or thick ligament.
There are 9 flexor tendons traveling through the carpal tunnel.
Carpal Tunnel Syndrome is a very common problem affecting both men and women of all ages, although it is more prevalent with advancing age. There are many possible causes of carpal tunnel syndrome, and the majority of patients have multiple contributing factors instead of only one cause. The end result is increased pressure in a small, rigid space located at the wrist. This space contains nine tendons and one nerve. The nerve is called the median nerve, and it supplies feeling to the thumb through ring fingers. It also innervates the small muscles of the thumb. When increased pressure occurs in the space of the carpal tunnel, the blood supply to the median nerve becomes affected, and symptoms of carpal tunnel syndrome result.
Symptoms include the following:
- Numbness and tingling in the thumb in the thumb through ring fingers, usually sparing the small finger. Sometimes, however, it will seem like all the fingers or only a few of the fingers are affected. The numbness is often associated with activities such as driving, reading (while holding the book or newspaper), using a phone, and bicycle riding. It is often most prevalent at night, and can cause the patient to waken because of the pain and tingling.
- Pain is often present, and may be experienced in the palm and thumb. The pain can radiate all the way to the shoulder.
- Swelling in the fingers and hand is common.
- A tendency to drop, or almost drop, objects.
- Weakness, especially of grip and pinch
Treatment programs are divided into 3 broad levels:
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Non-operative Treatment
- A wrist splint
is used to limit wrist motion. This splint can be worn as much as desired, but is particularly useful while sleeping. The splint will resolve or greatly reduce wakening because of numbness and tingling. It is often also useful during activities that may precipitate symptoms, such as many repetitive motion jobs.
- Anti-inflammatory medications
may be of some help. These range from over-the-counter medications such as Advil to more expensive prescription medications that may be easier on the stomach. Patients with a history of ulcer disease, patients on coumadin, and patients with asthma may not be able to take these medications. A reasonable dose for Advil would be two tablets 3 times a day with food or milk.
- Vitamin B6.
There is some anecdotal evidence that this vitamin may promote nerve healing, and many patients feel it is helpful. There is no scientific evidence yet that it helps. The recommended dose is 50 mg twice a day or 100 mg once a day. This is more than is found in multivitamins, so a specific supplement is needed. This dose should not be exceeded, though.
- Activity modicationsmay be helpful if there are job or home activities that cause or aggravate the symptoms. For example, keyboard users can employ padded wrist supports and insure that the keyboard is not too high. Other examples would include rotating job positions, or using specially designed tools.
- Wrist stretching exercises
have been proven to help, and are done by gently flexing and extending the wrist for several minutes, twice daily.
- Cortisone Injection
A cortisone injection is occasionally given into the carpal tunnel. This works best in mild case of relatively short duration. Relief is usually temporary, but it can be permanent in approximately 10% of patients as shown in scientific studies.
- Surgical Release
The goal of surgery is to cut the ligament which forms the roof of the carpal tunnel. This increases the space for the carpal tunnel, thereby taking pressure off the median nerve. It is successful in approximately 80 to 85% of cases. There are several surgical techniques, with the two most common being “open” carpal tunnel release and “endoscopic” carpal tunnel release. Cedar Valley Hand Surgery uses a “limited incision” technique which combines the advantages of those two techniques. The surgery is done as an outpatient surgery, usually under a regional “block” anesthetic, or under local anesthesia. A wrist splint is worn full-time for two weeks after surgery, then gradually less over the following month.
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