Carpal Tunnel Syndrome

  • Carpal tunnel syndrome is caused by pressure on a nerve (the median nerve) in the wrist. The symptoms include tingling, numbness, weakness, or pain felt in the fingers, thumb, hand, and sometimes into the forearm.

    Conditions that may contribute to the development of carpal tunnel syndrome include pregnancy, hypothyroidism, diabetes, arthritis, and obesity. Improper or prolonged use of the hands or wrist can also put pressure on the median nerve by causing swelling or thickening of tissues close to or within the carpal tunnel. Prior wrist injuries (especially fractures) make a person more likely to develop carpal tunnel syndrome.

    Both work and recreational activities can cause carpal tunnel syndrome if done over a long period of time. Some of these activities include:
    • Use of tools, especially those that vibrate (such as sanders).
    • Assembly work, such as working on a food-processing line.
    • Typing, using a computer mouse, or bar-code scanning.
    • Prolonged knitting or needlework.
    • Prolonged twisting of the wrist.

    Carpal tunnel syndrome can often be treated by avoiding activities that irritate the wrist, applying ice, wearing a night splint, and taking anti-inflammatory medicines. Avoiding caffeine, alcohol, and tobacco may help. Strengthening the arms and shoulders and increasing vitamin B6 intake may also help. In some cases, surgery may help.

    Carpal Tunnel Syndrome - Surgery

    Surgery is considered only when:
    • Symptoms have not improved after a long period of nonsurgical treatment. In general, surgery is not considered until after several weeks to months of nonsurgical treatment. But this assumes that you are having ongoing symptoms but no sign of nerve damage. Nerve damage would make surgery more urgent.
    • Severe symptoms restrict normal daily activities, such as when there is a persistent loss of feeling or coordination in the fingers or hand, no strength in the thumb, or when sleep is severely disturbed by pain.
    • There is damage to the median nerve (shown by nerve test results and loss of hand, thumb, or finger function) or a risk of damage to the nerve.

    Carpal tunnel release surgery is used to reduce the pressure on the median nerve in the wrist. This is done by cutting the ligament that forms the top of the carpal tunnel. Cutting this ligament relieves pressure on the median nerve. Any other tissue (such as a tumor) that may be putting pressure on the median nerve can also be removed during surgery.

    Carpal Tunnel Syndrome: Should I Have Surgery?

    After surgery, it is important to avoid any activities that may have caused carpal tunnel syndrome-or change the way you do them.

    Surgery Choices

    The most common surgery for relieving carpal tunnel symptoms involves cutting the transverse carpal ligament to relieve pressure on the median nerve in the wrist. Two approaches for this surgery are:
    • Open carpal tunnel release surgery, which allows the doctor to see more of the inner tissues, including the full width of the transverse carpal ligament where it is to be cut. Open surgery requires an incision in the palm and wrist, which disturbs more of the tissues in the hand, and requires a longer recovery period. It leaves a larger scar than does endoscopic surgery. But there may be less chance of other complications. See a picture of open carpal tunnel surgery .
    • Endoscopic carpal tunnel release surgery, which requires only a small incision at the wrist (single-portal technique) or at the wrist and palm (two-portal technique), and which disturbs less tissue in the hand. Recovery is quicker than with open surgery. And the scars heal more quickly, are smaller, and tend to be less painful at 3 months after surgery. There may be a slightly higher rate of reoperation after endoscopic carpal tunnel surgery. See a picture of endoscopic carpal tunnel surgery .

    Some surgeons are now doing small- or mini-open release surgery. This requires a smaller incision than standard open carpal tunnel release surgery to minimize healing time and scar formation. But it also allows the surgeon to view the ligament directly during the surgery to minimize danger to the nerve itself. This procedure may be promising, but there are few studies comparing it to the open carpal tunnel or endoscopic procedures at this time.