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Carpal tunnel syndrome is becoming more and more common.  It is a condition that is caused by increased pressure on a nerve in the wrist.  This nerve is called the median nerve.  Below is a picture of a wrist.  The median nerve (nerve affected in carpal tunnel syndrome) lies within a tunnel along with nine other tendons.  For various reasons, this nerve becomes squeezed in this tunnel.  The compression of this median nerve causes symptoms consistent with carpal tunnel syndrome.

carpal tunnel - compression of the median nerve
Symptoms may include numbness, tingling, pain in the hand, wrist and arm.  Sometimes, the pain may radiate up the arm to the shoulder.  The numbness or tingling most often involves the thumb, index, middle and ring fingers.  These symptoms are often worse at nighttime or during the morning time.  Some people complain of either pain or numbness or tingling when they are at the computer or driving a car.  It is important to remember that carpal tunnel syndrome is not always associated with pain.  As carpal tunnel syndrome worsens, some patients develop a weaker grip, occasional clumsiness, and may drop things.  In severe cases, the sensation may be permanently lost and the muscles at the base of the thumb may shrink (thenar atrophy).

The cause of carpal tunnel syndrome is still elusive.  We do know that pressure on the nerve cause carpal tunnel syndrome.  But, we do not know what causes the pressure on the median nerve.  Theories include swelling of the lining of the flexor tendons (flexor tenosynovitis), fractures of the hand or wrist, arthritis, joint dislocations, and keeping the wrist bent for a long period of time.  Fluid retention during pregnancy can cause swelling in the tunnel and symptoms of carpal tunnel syndrome (which may improve after delivery).  Other conditions, such as thyroid disease, rheumatoid arthritis and diabetes can be associated with carpal tunnel syndrome.

Diagnosis.  A detailed history and physical examination is crucial in diagnosing carpal tunnel syndrome.  X-rays will be done in the office to rule out other causes for these symptoms.  Typically,
carpal tunnel - compressed median nerve
we will order an EMG-NCV (electromyogram nerve conduction study) to corroborate the diagnosis of carpal tunnel syndrome.  This study will eliminate some other nerve problems, which may mimic carpal tunnel syndrome.  If you do not already have the EMG-NCV study, we will help send you to an neurologist who will perform this study.

Treatment.  Symptoms can often be relieved without surgery.  Identifying and treating medical conditions, changing the patterns of hand use, adjusting the ergonomics at work, using carpal tunnel supports at nighttime may relieve some symptoms from carpal tunnel injections.  At times, we will consider anti-inflammatory medications to improve carpal tunnel syndrome.  In certain cases, a cortisone injection may be utilized to improve carpal tunnel syndrome.

When the symptoms are advanced, surgery may be needed to make more room in the carpal tunnel for the median nerve.  There are many different options to perform this surgery.  Many of us utilize the mini-open technique.  This is performed under either a local block or regional anesthesia.  This means that in most cases, general anesthesia is not employed during the surgery.  The surgery takes less than 30 minutes.  It is an outpatient surgery.  Some of our doctors use a splint for a couple of weeks after surgery.  Some patients experience some soreness in the wrist area for 3-6 months after the surgery.  It may take several months for strength in the hand and wrist to return to normal.  After the surgery, many patients will feel improvement in the numbness or tingling and pain.  However, for patients with severe carpal tunnel syndrome, these symptoms may not abate.  The design of the surgery is to decrease the chance of the carpal tunnel syndrome worsening, and to give the patient a chance for improvement.

Please consult your doctor for any additional questions.  For symptoms that are left untreated, permanent nerve damage, weakness and muscle atrophy may ensure.  Therefore, if you have any of the above-mentioned symptoms, please let your doctor know.