By Katie Fultz, PA-C, ATC
Blanchard Valley Orthopedics and Sports Medicine
Carpal tunnel syndrome can be a debilitating condition, affecting several facets of a patient’s daily life.
This condition is named after the area of the body that is affected: the wrist. The small rock bones of the wrist, called the carpal bones, make up the floor of the tunnel. A ligament, called the “transverse ligament,” makes up the roof of the tunnel. The tendons that flex the fingers, wrist and median nerve run through the tunnel.
None of these tunnel structures have much flexibility, and when the internal tendons and nerves inflame, there is little room for those structures to swell or enlarge. When inflammation occurs surrounding the median nerve, it becomes irritated and carpal tunnel syndrome develops.
Typically, swollen tendons and nerves within the tunnel result from repetitive or vibratory activities requiring mostly upper extremity duties such as lawn mowing, construction work, driving, hair styling, factory work and more. Occasionally, the swelling can result from trauma, such as a recent fracture of a neighboring bone, or an acute onset of fluid, such as pregnancy.
Symptoms of carpal tunnel syndrome include numbness and tingling, particularly of the thumb, index and middle fingers. However, as time goes on, all five fingers can be affected.
Patients may experience sharp “shooting” pain from the hand into the forearm and occasionally up into the shoulder. Additionally, patients can develop weakness of the hand, especially during grasping or gripping activities, and find themselves dropping objects frequently. Patients may experience one or all of these symptoms, and some will report their symptoms worsening during sleep and certain activities, particularly vibration and grip activities.
Treatment of carpal tunnel syndrome depends on the severity of the patient’s syndrome. Often, the orthopedic provider will order a test called an electromyography (EMG) to confirm the diagnosis and determine the level of severity. Nonsurgical treatment is typically recommended when a patient’s syndrome is found to be mild or acute.
This type of treatment may consist of oral anti-inflammatories or steroids, topical anti-inflammatory cream, occupational therapy, night bracing, and/or corticosteroid injection. Surgical intervention is typically recommended when a patient’s condition is categorized as moderate to severe and/or the nonsurgical treatment has failed to reduce symptoms.
For most patients, a minimally invasive approach is an option to release the transverse ligament and lift the pressure off the median nerve. Two small incisions of about one centimeter each are used to allow a camera and small tool inside to perform the procedure. This allows for a faster recovery time and less restrictions after surgery.
If you are concerned that you may have carpal tunnel syndrome, talk to your orthopedic provider today.
