Carpal Tunnel Syndrome
What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome (CTS) is a hand and arm condition causing pain, numbness, and other symptoms. It is, quite simply, a pinched nerve in the wrist. It is one of the most common soft tissue pathologies, affecting 0.6-2% of the population. While it occurs most frequently in people over 40, it can affect anyone performing repetitive or forceful movements that induce wrist tissue inflammation. Some people are simply more prone to carpal tunnel syndrome due to obesity or small wrist structure.
The carpal tunnel is a passageway through which flexor tendons and the median nerve reach the fingers. When this passageway becomes constricted due to thickening of irritated tendons or other swelling of tissues, the pressure on the median nerve can create the trademark pain, weakness, and numbness of CTS.
Fortunately, CTS is becoming more treatable, allowing patients to rapidly return to normal life.
Carpal tunnel syndrome is generally an overuse syndrome. Assembly line workers, musicians, and others who use their hands in a repetitive motion over long periods of time, particularly when pressure is applied, are most prone to carpal tunnel irritation. Workers who use vibrating power tools are also prime candidates for CTS problems. But many others are susceptible for other reasons, such as obesity and gender (women are more prone due to their smaller anatomy).
A computer mouse can even be a culprit. Though studies have not yet proven that general computer use (keyboard-based) causes CTS, anecdotal evidence of a link is building as more people with computer-based jobs visit our practices.
Signs & Symptoms
Numbness or tingling are most common in the thumb, index, middle, and adjacent half of the ring fingers. Patients often suffer particularly severe nighttime pain, making sleep difficult.
In severe cases, sensation may be permanently damaged and the muscles at the base of the thumb shrink (thenar atrophy), creating an inability to pinch.
- Pain in the wrist, particularly upon flexing wrist or fingers (downward motion)
- Severe nighttime pain
- Weakness of grip
- Tingling or numbness of certain fingers (thumb, index, middle and ring fingers)
- Referred pain in the arm, neck, and shoulder
- Occasional clumsiness, dropping items
Diagnosis & Treatment
A syndrome, by definition, is a group of symptoms that may indicate a disease process. With the case of carpal tunnel syndrome, diagnosis is not automatic when numbness or pain are reported. To assess the pressure on the median nerve and its origins, we examine our patients using several tests, from electromyograms to hand manipulation to provoke symptoms. Combining these tests with patient history enables a diagnosis and points toward the most effective treatment options.
Once CTS is diagnosed, depending on severity and the time elapsed since onset, one or more therapies may be recommended, including stretching exercises, reduction in the movements that exacerbate the condition, oral NSAIDs, and/or cortisone shots.
If symptoms continue unabated for six months or more, surgery should be considered.
Timing is important. People who decide to put up with the pain and limited movement for too long risk muscle atrophy that can lead to more weakness and poorer recovery from the postponed surgery.
Traditionally, the Open Carpal Tunnel Release procedure, wherein a 3–4 inch incision is made into the base of the palm, has been the procedure of choice.
However, the physicians at the Hand Surgery Specialists of Texas offer the No-Stitch Carpal Tunnel Release (CTR), an innovative surgical treatment for CTS that is minimally invasive. We have performed this minimally invasive No-Stitch procedure thousands of times over the last 15 years, with a success rate that matches that of the Open CTR procedure, but with fewer side effects.
Our surgeons have perfected the arthroscopic No-Stitch release for carpal tunnel syndrome and other nerve entrapment conditions. It is a same-day procedure that takes just 10 minutes.
If we opt for the “No Stitch” release, this is a minimally invasive procedure that results in little or no scarring, no stitches are required, and patients resume normal activity within about three weeks.