Carpal Tunnel Treatment
By Dania DeGrace, MD
If you have numbness, tingling, or pain in your hand, fingers or arm, you may be suffering from Carpal tunnel syndrome (CTS). You’re not alone either, more than 3 million people in the U.S. suffer from this condition which is caused by compression of the median nerve that runs from the forearm through a passageway in your wrist and to your hand (known as the carpal tunnel). The carpal tunnel may become compressed or irritated due to various factors that can include a wrist fracture, trauma, and certain medical conditions. Many times the exact cause is unknown.
Symptoms of CTS include the sensation of pins and needles in the hand, primarily affecting the thumb, index, and middle fingers. Many people also experience night pain that wakes them from sleep. Difficulty with fine motor tasks and weakness are also common complaints. The pain usually targets the palmar side of the wrist and may radiate to the forearm and fingers. In general, the nerve compression tends to get worse over time, but people may experience symptom-free intervals, and the rate of progression is variable. Initial treatment that may be very helpful includes wearing a wrist splint at night to help with the night pain. Many with CTS find that a wrist splint is beneficial in relieving their symptoms. However, if the pain, numbness and other symptoms do not subside, further testing may be requested. Standard tests to diagnose CTS include an EMG (electromyogram) which measures the electrical activity of muscles at rest and when in use, and a nerve conduction study, which measures the speed and quality of the electrical signals conducted by the nerves of the upper extremity. These studies help to define the presence and severity of the compressive neuropathy and help to guide further treatment. If these studies are positive for CTS, surgery may be recommended.
Depending on the severity of the compression, carpal tunnel release surgery may be effective. In general, the goal of surgery is to prevent progression of the compressive neuropathy and eliminate night pain altogether. It is an outpatient day procedure - the patient would be in the hospital for about half a day and sent home with a soft dressing over the incision. A follow-up appointment scheduled for 10 – 14 days after for suture removal is standard. During the procedure, your surgeon will make a small incision in your palm and divide the transverse carpal ligament to take the pressure off the median nerve and enlarge the tunnel, giving the nerve more space. Usually patients experience their night pain has resolved within a few days of surgery. Depending on the severity of the pre-existing compression, the numbness, tingling, and weakness may get better, but this is not guaranteed. However, surgery can keep these problems from getting worse. In general, early surgery has a more reliable outcome. People with intermittent symptoms have a better recovery than people with constant symptoms. People with a sensory deficit and no weakness do better than people with a sensory deficit and weakness.
In the end, this is an elective procedure – patient and doctor should work together to determine the best course of action. The decision for operative versus non-operative management is an individual decision. That determination is based on the level of discomfort and subjective disability as well as the severity of the compressive neuropathy as determined by the nerve studies. If you have pain or routinely notice numbness, tingling, or pain in your hand or wrist area, make an appointment with your local orthopedic hand specialist. You may have carpal tunnel syndrome and may benefit from the various treatment options available.