Carpal Tunnel Syndrome12/15/10
Carpal Tunnel Syndrome is essentially a pinched nerve in the wrist. It is the most common nerve problem in the upper extremity. Women are affected more frequently then men. The cause of carpal tunnel syndrome is compression of the median nerve in the wrist. The median nerve is the nerve that supplies sensation to the thumb, index, middle and half of the ring finger.
Certain medical conditions such as diabetes, hypothyroidism and pregnancy predispose patients to developing carpal tunnel syndrome. Although it has been extensively researched, there has never been any solid evidence linking heavy typing to the development of carpal tunnel syndrome.
The symptoms of Carpal Tunnel Syndrome includes numbness and tingling in the thumb, index, middle and ring finger, particularly at night. In more severe cases it can cause weakness in the thumb and hand. Some patient may require what are called ‘electrodiagnostic tests’ to determine the severity of the carpal tunnel syndrome, particularly if they are contemplating having surgery. The test is commonly referred to as an EMG and it is performed with small acupuncture-type needles that test the conduction velocity and amplitude of the nerve signal.
Treatments for Carpal Tunnel Syndrome includes both operative and non-operative approaches. The easiest place to start is with a metal wrist splint. I usually have my patients wear it while they sleep at night and for any activities during the day which usually bring about the numbness. If the symptoms persist despite wearing a wrist splint, some patients may benefit from a cortisone injection. The cortisone acts to decrease the inflammation and pressure around the nerve. I usually do not recommend more than three injections into the carpal tunnel.
Some patients require surgery for carpal tunnel syndrome. The surgery involves cutting the transverse carpal ligament to release the pressure off of the nerve. This can be accomplished two ways. One is what is referred to as an “open” carpal tunnel release and the other is an “endoscopic” carpal tunnel release. Speak to your surgeon about which he or she would recommend for you.
For more information about Carpal Tunnel Syndrome check out the following resources:
American Society for the Surgery of the Hand
Sarah Pettrone, MD, specializes in hand and upper extremity and practices in our Reston and Tysons offices.