Version II
 Sometimes
people may experience numbness or tingling in the hand, more
so at night, and clumsiness handling objects such as glasses
or cups. Also there tends to be a pain that goes up the entire
arm, in some cases all the way to the shoulder. These symptoms
may be all due to what’s known as Carpal Tunnel Syndrome.
What is it?
The carpal tunnel is an anatomical region in the wrist through
which a major nerve (the median nerve) travels. When this tunnel
(through which the nerve travels) becomes compressed there
gradually builds up pressure on the nerve itself. When the
nerve is compressed it causes symptoms of numbness, tingling,
and weakness of the affected muscles supplied by this nerve.
These are important muscles in the hand and the result can
be minor to major disability, depending on the severity.
Prognosis
If left untreated, gradual impairment of the nerve function
can occur to the point where permanent damage can be sustained
if left too long. This could result in hand weakness to the
point where objects can no longer be grasped firmly and fine
detail work is impossible. Occasionally, if the underlying
cause of the carpal tunnel is an acute incident, such as a
hard blow to the hand, it can subside with simple treatment.
Commonly, however, it has to be surgically released especially
if it has built up over a period of time and is of unknown
cause.
Some underlying causes of carpal tunnel are pregnancy, rheumatoid
arthritis, any inflammatory condition, and repetitive trauma
to the hand such as heavy manual labor. Quite often, however,
no underlying cause is found.
Diagnosis
The diagnosis is often made from the following symptoms and
signs :
Numbness and tingling in the hands
Decreased feeling in your thumb, index, and long finger
An electric-like shock feeling in your hand when the doctor
taps over the course of the median nerve at the wrist
Reproduction of symptoms when holding wrists in a bent down
position for one minute.
Also in some cases the doctor may want a special test performed
called a nerve conduction study, which will determine the severity
of the pressure on the median nerve and finalize the diagnosis.
Treatment
Non-Surgical
A brace or splint may be applied to mild cases which are usually
worn at night to keep the wrist from bending. Resting the wrist
allows the swollen and inflamed synovial membranes to shrink;
which takes some of the pressure off of the nerve. Also the
use of anti-inflammatory medications can take away some of
the inflammation and swelling. In more severe cases the treatment
may entail the use of a cortisone injection into the carpal
tunnel. What the injection does is spread medicine around the
swollen synovial membranes and shrinks them, again relieving
the pressure on the nerve. The usual dosage of cortisone is
small and has no harmful side effects. Non-surgical treatment
is effective if diagnosis is early, thus treatment is relatively
soon after onset.
Other non-surgical methods of treatment include putting up
with the problems, changing jobs, anti-inflammatories, physiotherapy,
rest, etc.
Surgical
In some patients non-surgical treatment doesn’t relieve
the pain and symptoms, so the next step is to operate. The
operation is called a "release" because the ligament
that forms the roof of the carpal tunnel is cut to relieve
the pressure on the median nerve. The operation is performed
under a local anesthesia that is injected into either the wrist
or hand, or higher up the arm. The ligament, which forms the
roof of the carpal tunnel is the volar carpal ligament. This
has to be sectioned through a small incision which then relieves
the pressure on the nerve and allows it to recover. This is
performed as a day surgery and can quite often be performed
under a local or regional anesthesia without involving the
patient going to sleep. Occasionally, however, it does require
general anesthetic, but as mentioned above, this can usually
be avoided. The release can now be performed arthroscopically,
so that a smaller incision and a shorter recovery period can
be obtained.
Most of the time the surgery is performed in an outpatient
facility and overnight stay at the hospital isn’t required.
Outcome of Surgery
The long-term surgical results are usually excellent. It must
be remembered, however, that the length of time for the nerve
to recover depends on how long the nerve has been compressed.
If extensive damage has been done to the nerve through a long
period of pressure over several months, it may take as many
months for the nerve to fully regain its function. During this
period of time the hand will gradually get stronger and sensation
will return to the hand. If there has been no underlying permanent
damage to the nerve, however, 100% function should return to
the hand. Occasionally there is such severe damage that there
may be only partial or no improvement.
Risks to Surgery
There are risks to any surgical procedure, some of which are
infection, damage to nerves, blood vessels, or tendons, persistent
symptoms, anesthetic problems, etc. Make sure you understand
the risks and alternatives prior to surgery.
Prognosis
As stated previously early recognition and treatment are optimal,
but treatment is the key even if it’s later rather than
sooner. If left untreated, gradual impairment of the nerve
function can occur to the point where permanent damage can
be sustained. This can result in hand weakness to the point
where objects can no longer be grasped firmly and fine detailed
work will be impossible.
Prevention
In order to prevent something from happening one must know
the etiology, and since there isn’t a single specific
reason for Carpal Tunnel Syndrome there really isn’t
a good way to prevent it. What we do know is that anything
that causes swelling, thickening, or irritation of the synovial
membranes around the tendons in the carpal tunnel can result
in pressure on the median nerve.
Some associated conditions are the following:
Grasping with the hands forcefully and repetitively
Constant bending of the wrist
Broken or dislocated bones in the wrist which produce swelling
Arthritis
Sugar diabetes
Thyroid gland imbalance
Menopause (hormonal changes)
Pregnancy
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