Carpal Tunnel Syndrome
Carpal Tunnel Syndrome is a common cause of numbness and tingling in the hand. This is caused by compression of the median nerve, which provides sensation to the thumb, index, long, and ring fingers. Typically the symptoms are worse at nighttime and when driving, and often patients will shake their hand to wake it up. As the disease progresses, patients may have difficulty handling small objects and drop things.
Anatomy:
The carpal tunnel consists of 9 different tendons to flex the fingers with one nerve (median nerve). The ligament that causes compression of the nerve, which leads to numbness and tingling, is called the transverse carpal ligament.
Diagnosis:
Typically, the diagnosis of carpal tunnel syndrome can be made in the office by your provider. Often, your provider may order a nerve conduction study, which is done at a neurologist’s office, to confirm your diagnosis.
Treatment:
Nonsurgical Treatment
- Nighttime Brace will keep your wrist straight and prevents nerve compression while you sleep.
- Steroid injections, such as cortisone, are very effective anti-inflammatory medicines to reduce the inflammation surrounding the nerve.
Surgical Treatment
If your carpal tunnel is severe, you are losing function, or if symptoms do not respond to the above non-operative treatments, surgery may be indicated and is very effective at reducing symptoms. You can choose to do one side at a time, or both sides at once. There are two different techniques, which both have great outcomes:
- Endoscopic: minimally invasive surgery with a 1.5cm incision in the wrist crease, using a camera, usually done with patient asleep.
- Open: A 3cm incision in the palm, can be done with patient awake — great for people with other medical problems who need to avoid anesthesia. I also use an “open” technique for any revision surgery.