In the words carpal tunnel syndrome, the anatomy of the diagnosis is implied. Carpal, meaning wrist, and tunnel referring to a channel in the wrist conceptually formed by the bones of the wrist on three sides and the roof made of the thick transverse carpal ligament is the space in which the median nerve passes into the hand.
Carpal tunnel syndrome is a very common condition which usually is not caused by injury and most often occurs in “middle aged” people. It is more common in women and some other conditions are known to predispose some people to develop it such as diabetes, rheumatoid arthritis, and thyroid disorders. Sometimes it occurs in pregnant women and is thought to be caused by additional pressure on the median nerve related to the fluid retention which occurs during pregnancy.
Characteristic symptoms include numbness and or tingling on the palm side of the hand involving the thumb, index finger, long finger, and part of the ring finger which is the sensory distribution of the median nerve. Symptoms may be worse during certain use activities such as holding a book, newspaper, or driving, and it may cause night awakening symptoms.
Diagnosis can, if needed, be confirmed by nerve electrical testing commonly referred to as an EMG or Electromyelogram. This is done in combination with NCV or Nerve Conduction Velocity testing done by placement of small needles through the skin.
The most common ways to treat carpal tunnel syndrome includes use of anti-inflammatory medications, wrist splints sometimes worn at night for patients with night symptoms, carpal tunnel cortisone injections and surgery.
In general, the best published results for the treatment of carpal tunnel syndrome are through surgery. This is “elective” surgery but not “cosmetic” surgery so it is usually covered under peoples’ health plans. Surgery is done as an outpatient procedure and can be performed under just local anesthetic injecting the wrist. For patient comfort and perhaps anxiety, anesthesia staff can offer intravenous sedative medication or do the procedure under a “regional block” anesthetic referred to a Bier block which “numbs” the entire arm only for the duration of the procedure.
Risks and potential complications are low in frequency and include risk of infection, wound healing problems, and injury to the median nerve or its branches. Afterwards, the wrist is usually swollen, somewhat red, and sometimes bruised for a short time post operatively. Although there are no “guarantees” about surgical outcomes, in most cases, the patient’s symptoms are improved after release (cutting) of the transverse carpal ligament.
After the transverse carpal ligament is released and pressure is reduced on the median nerve, then we hope that the median nerve now has a chance to recover and symptoms to improve. The skin is sutured and patients can use the hand and fingers for light activities of daily living postoperatively within the constraints of the surgical bandage. Avoid jewelry on the wrist and hand, especially rings, postop and for comfort sake, avoid hard pushing, pulling and strenuous lifting for 4 – 6 weeks after surgery.