The physicians of Muir Orthopaedic Specialists believe good medical care is a result of mutual understanding, respect and trust.  In today's fast paced world, we recognize the importance of communication and spend as much time as possible to provide information explaining condition and treatment options so that our patients can make informed decisions about their care.

CARPAL TUNNEL SYNDROME

What is it?
Carpal tunnel syndrome (CTS) refers to irritation of the median nerve in the forearm and hand. The median nerve passes from the forearm into the hand though the carpal tunnel, which is formed by the bones of the wrist. The wrist is U-shaped; the legs of the U are spanned by a tough ligament called the transverse carpal ligament (TCL). The nerve shares the tunnel with nine separate tendons which move the fingers. When the tendons swell, they compress the median nerve against the TCL. The nerve does not tolerate this pressure and the result is tingling, numbness and pain into the hand and digits. With prolonged pressure, the symptoms will increase resulting in weakness, clumsiness or nighttime symptoms.

If left untreated, CTS can lead to permanent nerve damage. This can result in weakness and thinning of the hand muscles, loss of manual dexterity and diminished sensation at the fingertips.

What Causes CTS?
Medical conditions such as fractures, diabetes, thyroid disorders and menopause can result in carpal tunnel syndrome. Inflammatory conditions such as rheumatoid arthritis are prone to develop CTS. Any condition which results in fluid retention such as pregnancy or use of birth control pills can increase the likelihood of CTS.

The most common cause of CTS in the workplace is repetitive motion. Use of vibration tools and activities which directly place pressure on the palm of the hand such as resting the hands on a key board of steering wheel will aggravate the condition.

Prevention
In the event that prevention is unsuccessful, additional options for treatment include a thorough history and physical examination by a physician. Treatment can be individualized and includes wrist splints, medications, occupational therapy and ergonomic evaluation. Mild cases of CTS usually respond very well to these treatments.

A cortisone injection can be indicated for therapeutic and diagnostic purposes in some patients. It can provide benefit for patients with mild symptoms or who desire temporary relief. The cortisone acts as a high dose local anti-inflammatory and helps to relieve pressure on the nerve, but usually lasts only a few months. Injections should not be used to delay unnecessarily when surgery can provide lasting relief.

In those patients who are still not improved, surgery is usually recommended. Preoperative nerve conduction studies are usually obtained to document the severity of nerve irritation. The goal of surgery is to decompress the carpal tunnel by cutting the ligament pressing on the nerve. Surgery is performed as an outpatient. There are two surgical techniques to choose from which can be discussed in more detail with your physician. The recovery time depends on the individual circumstances. Most patients are able to resume their normal activities once recovery is complete

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