Nerve Compression & Carpal Tunnel Syndrome

Nerve Compression and Carpal Tunnel Syndrome

Carpal tunnel syndrome is a disorder that causes pain, weakness and numbness in the hand and wrist. It occurs due to increased pressure on the median nerve at the wrist. The pain may radiate to the forearm and shoulder but rarely to the neck. Patients with carpal tunnel syndrome will classically note numbness and tingling in their thumb, index and ring fingers. Some patients may note numbness about the entire hand. These symptoms may occur with activities during the day or while at rest during the night. In addition to numbness and pain, patients may complain of weakness of the hand and dropping objects. With a more severe carpal tunnel syndrome, atrophy of the muscles at the base of the thumb may be noted.

The physician can often make the diagnosis after the patient has explained their symptoms and the extremity has been examined. The strength of the muscles of the hand are evaluated as well as the sensation. An EMG / NCV, electromyography and nerve conduction velocity is often performed to confirm the diagnosis and determine severity. X-rays are not routinely obtained.

Patients with Carpal Tunnel are treated with wrist splints that are used at night and during the day during activities that may exacerbate the symptoms. Non-steroidal anti-inflammatory medications may be of benefit but have the risk of gastritis. Alteration of activities is important. This includes taking frequent breaks from repetitive activities, and stretching before and after activities. A therapist may be helpful in reviewing ergonometric tips or performing a work place evaluation. A corticosteroid injection of the carpal canal often provides temporary relief. Approximately 25% of patient treated with an injection will have long-term relief of their symptoms. Non-operative treatment modalities are tried for months and if the symptoms persist or progress surgical treatment is considered. Those patients with a severe carpal tunnel syndrome are considered for surgery more promptly since the non-operative modalities typically are not helpful at this stage.

Carpal tunnel release is the most common procedure performed in the upper extremity. In general surgical procedures for carpal tunnel syndrome cut the ligament over the canal to take the pressure off of the median nerve. The surgery is performed on an outpatient basis under local anesthesia and often in conjunction with intravenous sedation. The majority of patients undergoing carpal tunnel release note an improvement in their symptoms. Some patients may notice persistent numbness and tingling. This will occur particularly in patients that have a more severe carpal tunnel syndrome. At this stage more permanent changes may have occurred within the nerve due to longstanding compression. Other patients may notice persistent or recurrent symptoms due to other factors for example nerve compression in the neck (cervical radiculopathy), or a polyneuropathy due to diabetes. Most patients are capable of performing their activities of daily living soon after the procedure. Pain about the about the palm is often noted initially that is treated with scar massage. This scar pain is one reason full grip strength does not often return until three months after the procedure.