Medicine, surgery can relieve carpal Tunnel'

Tingling, numbness and pain in the hands are common symptoms of carpal tunnel syndrome. Sometimes when awakened at night or on awakening in the morning, people shake their hands in an attempt at bringing back what they feel is poor circulation to one or both hands. However, carpal tunnel syndrome is not a circulation problem.

Symptoms often progress to daytime as well and may include weakness or pain of one or both arms. Carpal means wrist and tunnel refers to the channel that the median nerve (the main nerve of the hand) must travel to give sensation and motion ability to the fingers. When the nerve at the wrist gets pinched by extra pressure or swelling, the symptoms and syndrome of carpal tunnel occurs.

This fairly common condition, more common in women, can be caused by swelling in the area from a wrist fracture, gout, infection, tumor, pregnancy, rheumatoid arthritis, thyroid condition, diabetes or other condition. There may be a family history as well. Mostly, however, it is caused by nonspecific swelling of the lining of the nine tendons that also occupy the wrist canal.

Diagnosis of the condition is by understanding the symptoms, examining the hands, and reproducing the symptoms. By tapping over the undersurface of the wrist, this can reproduce the symptoms and is called Tinel’s test. When placing the wrist in a bent down or flexed position, this can also reproduce the symptoms and is called Phalen’s test.

Sometimes, a “nerve conduction test” is done which measures the speed and action of the hand nerves and muscles to determine if there is a delay of activity at the wrist level. This also could differentiate the syndrome from a pinch at the elbow, shoulder or neck or from a generalized nerve condition. Sometimes an x-ray or an MRI may help differentiate other causes.
 
Treatment includes splinting with a brace to be worn at night and sometimes during the day and medication to decrease swelling and inflammation of the nerve and contents. The common type of medication given is called NSAIDS or non-steroidal anti-inflammatory drugs.

Sometimes an injection in the wrist canal of cortisone, a stronger medication to decrease localized swelling or inflammation, is used. Often instruction in modifying home or work conditions or positions the hand is in, helps this condition. Physical therapy that includes strengthening, range of motion, stretching and ultrasound is of benefit.

Sometimes symptoms progress to where surgery is necessary. Fortunately surgery for carpal tunnel syndrome is a fairly simple procedure which is very successful. This common procedure, called carpal tunnel release, involves releasing the tight ligament on the palm side of the wrist to allow more space and lessen the tension or pressure on the nerve. 

The outpatient surgery is done usually at an ambulatory surgical facility and takes less than half-an-hour. You go home within an hour of the surgery and can move your fingers right away. The splint applied at surgery and the stitches are usually removed in 7-10 days. The procedure is performed by a hand surgeon (orthopedic, plastic or general surgeon) with specialized hand training. Occasionally some sensitivity at the surgical scar site may require some hand therapy to lessen the sensitivity felt there.
 
The better informed you are about a medical condition, the better you are able to work with your physician to improve your condition.


Dr. Ronald Scheinzeit is a board certified orthopedic surgeon, in practice with Orthopedic Associates of Dutchess County since 1979.  He has a particular interest in hand surgery and pediatric orthopedics.