Carpal Tunnel Syndrome
What is it?
One of the most important structures in the wrist is the Carpal Tunnel, and Carpal Tunnel Syndrome, or CTS, is a common and often debilitating condition that affects legions of people worldwide. Essentially, the carpal tunnel is the passageway through which the median nerve, and the tendons that flex or bend the fingers, travel on their way from your arm to your hand. The tunnel is on the palmar side of the hand, or what some might consider the “inside” of the wrist.
What Causes it?
As with many nervous problems in the arm and hand, the mechanism of CTS is not perfectly understood, but studies and experience show that it is most likely the result of a combination of genetic and environmental factors. The anatomy of the wrist itself can be altered by outside factors, such as fractures or other injuries, and this in turn can negatively affect the path of the median nerve through the carpal tunnel. Chronic conditions such as obesity, diabetes, hypothyroidism, and even pregnancy can make you more susceptible to CTS, but you also have to take into account the environmental factors. CTS is most often seen in people whose occupations require them to work with consistent vibrating tools, or in more sedentary jobs, the constant use of computer keyboards and mice. These overuses cause inflammation in the carpal tunnel, exacerbating the problem. As a result, CTS is prevalent among people in clerical positions, especially secretarial and data-entry jobs.
Symptoms of CTS
When the median nerve is compressed within the carpal tunnel, the most common symptoms are numbness, pain, or burning, as well as paresthesia, which can be characterized as tingling, prickling, or “pins and needles.” Classically, the symptoms are nocturnal, and can often keep you awake throughout the night. In addition to these sensations (or lack of sensations), CTS can also cause weakness in the hands and wrist as the nerve that operates them loses function. This, in turn, makes it difficult for you to use your hands in everyday tasks, and can adversely affect your ability to work.
How do I know if I have CTS?
In order to determine if you suffer from CTS, it is important to see a hand specialist who can take a detailed and comprehensive history, so that any underlying factors that may have led to the problem can be identified. In addition to this history, electrodiagnostic testing, in the form of an EMG (electromyograph) or NCV (nerve conduction velocity) test, is the major component of diagnosis in regards to CTS. Through these tests, the doctor can assess the overall health of the muscles and nerves in the upper extremity. Because CTS is directly related to the malfunction of a nerve, it is easy to detect using these tests. In some cases where the diagnosis is not clear, diagnostic imaging, in the form of MRI or ultrasound, may be utilized to look inside the wrist and help the doctor visualize the problem before a path of treatment is selected.
Treatment of CTS
If a non-surgical path of treatment is deemed most appropriate for your CTS, a variety of remedies may be brought into play. The doctor usually will have you wear a ready-made splint, available at almost any drug store, at night in order to immobilize the wrist joint to keep it from bending while sleeping, which reduces pressure on the nerve and aids in the healing process. Corticosteroids are also a common non-surgical treatment, but these tend to be short-term solutions, largely meant as stop-gap measured until you are able to find a more permanent solution. This permanent solution most often involves modification of work, especially through the use of ergonomic tools to create a healthier work environment that will not contribute to the exacerbation of CTS symptoms.
What if I need surgery?
In the event that you do require surgical intervention to relieve your CTS, there are currently two surgical techniques used to treat CTS by “releasing” the carpal tunnel and freeing the nerve from compression. The first is a minimally invasive Endoscopic Carpal Tunnel Release, or ECTR, and the other is an open carpal tunnel release.
Endoscopic Carpal Tunnel Release (ECTR)
Endoscopy is the use of small cameras to aid the physician in surgical repair of injured body parts, especially those delicate structures of the hand. In ECTR, an incision is made in the affected wrist, and a miniscule camera, is inserted into this incision. The image it captures is broadcast to a screen where the doctor and the surgical team can see inside the carpal tunnel. This enlarged image allows the surgeon to precisely place the tools he needs to engage in this detailed procedure.
The surgeon will then use a small cutting tool next to the camera and use its retractable blade to slice open the ligament or roof of the carpal tunnel, in order to relieve pressure on the nerve. All this time, the procedure is visible to the team on the screen, which means that the surgeon is able to keep his eye on the cutting blade at all times, lowering the incidence of accident exponentially and increasing precision.
Because of the nature of this procedure, the incision, and subsequent scar, is almost invisible, and while you may experience tenderness for a time after surgery, it is likely that you will be able to return to your customary activities in days, and may have to wait no more than a month to engage is more taxing activities.
Open Carpal Tunnel Release Surgery
Open carpal tunnel release is a more traditional surgery, but is just as effective as ECTR in remedying the problems of CTS in patients. In this method, an incision is made in the wrist (in a similar position to the ECTR incision, but much larger, about three inches), that allows the surgeon to see into the interior of the wrist, and visualize the workspace as it needs to be repaired.
This surgery is performed with standard surgical implements, so a larger view of the area is necessary. One the wrist is opened, the doctor will do essentially the same thing as in the ECTR, using a cutting tool to open the carpal tunnel from the outside in to relieve pressure, which then serves to relieve pain and other symptoms of CTS. After surgery, the wound will be stitched up like any other incision, and you will be fitted for a splint to immobilize the arm and aid in healing.
Generally, physical or occupational therapy is recommended after an open CTR, and if you stick to the regimen suggested by the surgeon and the therapist, you can expect to return to work or your life with greatly increased function and reduced symptoms. In some cases, it may take several months for full functionality to return, but in cases as delicate as the wrist and hand, it is better to take additional time to ensure full healing.
- 1/4 inch scar
- Little to no scar sensitivity
- Small dressing
- May get dressing wet
- Usually no therapy
- Light activities Immediately
- Return to strenous work at 1 month
- 3 inch scar
- Tender scar for months, possible permanent
- Splint for 3 weeks
- Must keep dry for 3 weeks
- 4-8 weeks of therapy
- Light activities at 3 weeks
- Return to strenous work at 3 months