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Carpal Tunnel Syndrome
Sometimes people may experience numbness or tingling in the hand, especially 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 all be due to what's known as Carpal Tunnel Syndrome - the most common form of entrapment neuropathy, affecting3-6%of the general adult population.
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. At our occupational therapy center, we understand how important these muscles in the hand are - the result of this condition can be minor to a major disability.
If left untreated, gradual impairment of the nerve function can occur to the point where permanent damage can be sustained. This could result in hand weakness so severe that 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.
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.
In some cases, the occupational therapist may want to carry out a special test called a nerve conduction study. This 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, taking 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. This injection spreads 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.
Treatment - Surgical
For the patients for whom the non-surgical treatment didn't relieve the pain and symptoms as expected, 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 local anesthesia that is injected into the wrist, 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 surgery is performed as a day-surgery and can quite often be performed without requiring the patient to go to sleep. Occasionally, however, it does require general anesthetic, but as mentioned above, this can usually be avoided.
Currently, the release can be performed arthroscopically so that a smaller incision and a shorter recovery period can be obtained. Most of the time this surgery is performed in an outpatient facility, so an 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.
After the surgery, 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:
damage to nerves, blood vessels, or tendons
Do not be alarmed! Before any surgery takes place, your occupational therapy specialist will discuss all the risks with you, and the likelihood of them affecting you. We understand that surgery is stressful, therefore we always make sure our patients go to the operating room fully informed and as comfortable as possible.
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.
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
- Sugar diabetes
- Thyroid gland imbalance
- Menopause (hormonal changes)
- High blood pressure
Orthopaedic surgeon/surgery/care near me!
At Pinnacle, we utilize the most up-to-date technologies and surgical techniques to provide our patients with the highest quality orthopaedic care. We have Fellowship Trained Specialists who tackle issues from acute injuries to chronic problems. They diagnose musculoskeletal disorders including the hand, foot and ankle, trauma and fractures, joint replacement and reconstruction, sports medicine and many more.
Our orthopaedic team performs non-surgical and surgical procedures, treats sports injuries and repairs trauma to the knee, using the most advanced knowledge, treatment and methods.
We are one with the community. Not only do our doctors get involved in promoting awareness at numerous schools and sporting events, but they also provide exceptional orthopeadic services at 5 convenient locations. With offices in Canton, Hiram, Marietta (East Cobb), Marietta, and Woodstock, and a Surgery Center in Woodstock, you know you can reach our occupational therapist with ease.
If you still have any questions or wish to consult a member of our staff, pleasecontactour headquarters:
- Phone: 770-427-5717
Visit us at 300 Tower Road, Suite 101, Marietta, GA 30060
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The material contained on this site is for informational purposes only and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE, and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions or concerns you may have regarding your health.