Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a condition that results in pain and numbness in the wrist and arm as a result of compression of the median nerve at the wrist. The carpal canal is a closed space containing 9 tendons and the median nerve. Increased pressure within the canal can cause poor nerve function resulting in carpal tunnel syndrome.

How is carpal tunnel syndrome diagnosed?

History and physical examination can be very reliable in the diagnosis of carpal tunnel syndrome. Patients with carpal tunnel syndrome often have numbness in the fingers. Additionally they can have pain that radiates up and down the arm. The numbness and pain are often worse at night and usually are alleviated by shaking hands. In advanced cases of carpal tunnel syndrome, weakness and atrophy of the muscles of the hand can develop. When there is a question as to the proper diagnosis, nerve conduction studies that measure the efficiency of conduction of electricity can be performed. These highly accurate tests can be very useful in determining the cause of symptoms in certain patients.

How is carpal tunnel syndrome treated?

Nonsurgical treatment: Changing activities to avoid repetitive motions and to keep the wrist in a neutral position can relieve the symptoms of carpal tunnel syndrome. Splinting of the wrists, particularly at night, and also achieve the same result. Finally, an injection of anti-inflammatory medication into the carpal canal at the wrist can alleviate the swelling within the wrist and therefore alleviate symptoms.

Surgical treatment: Up to half of patients with carpal tunnel syndrome can be treated conservatively, i.e. without surgery. When this fails, however, surgical treatment can be very effective. Surgery for carpal tunnel syndrome involves sectioning the transverse carpal ligament thereby releasing pressure on the nerve. This can performed with either of two techniques, the open carpal tunnel release or the endoscopic carpal tunnel release.

Open carpal tunnel release: The surgeon makes an incision about 1.5 inches in length in the palm and divides the tissues to expose the transverse carpal ligament. The ligament is divided from above allowing the median nerve to be visualized and decompressed. The wound is then sutured shut and healing and recovery takes place over the next 6-8 weeks. Open carpal tunnel release is a procedure that has been used for many years to treat carpal tunnel syndrome with very high rates of success.

Endoscopic carpal tunnel release: By using a small camera with an attached knife, the surgeon is able to perform carpal tunnel release through a smaller incision on the wrist. The typical incision is 10 mm in length. The camera is placed through the incision and beneath the transverse carpal ligament and the ligament is then divided without incising the skin of the palm. Endoscopic carpal tunnel release has been shown to treat carpal tunnel syndrome with a significantly faster recovery time and less postoperative pain.

Which treatment should I select?

Each patient requires individual assessment of their symptoms prior to deciding the optimal treatment. Dr. Harris Rose of Austin, Texas has extensive experience with operative and nonoperative treatment of carpal tunnel syndrome including endoscopic carpal tunnel release.  Please contact us to schedule an appointment.

Carpal Tunnel Syndrome References:

American Academy of Orthopaedic Surgeons Patient Information
American Society for Surgery of the Hand Patient Information