Carpal Tunnel

Carpal tunnel syndrome is a common problem that affects the use of your hand, and is caused by compression of the median nerve at the wrist.

It most often occurs when the median nerve in the wrist becomes inflamed after being aggravated by repetitive movements such as typing on a computer keyboard or playing the piano.

The "carpal tunnel" is formed by the bones, tendons and ligaments that surround the median nerve. The median nerve supplies sensation to the thumb, index and middle finger, and part of the ring finger, and provides motion to the muscles of the thumb and hand; you might notice numbness and weakness in these areas.

These symptoms are often exaggerated when the wrist is bent forward. This numbness or pain may be worse at night, and may actually keep you awake. During the day, it may occur more often when you are participating in activities that involve bending of your wrist.

Common Causes of Carpal Tunnel Syndrome

Diseases or conditions that may increase your chances of developing carpal tunnel syndrome include pregnancy, diabetes, menopause, broken or dislocated bones in the wrist, and obesity. Additional causes include repetitive and forceful grasping with the hands, bending of the wrist, and arthritis. Any repetitive motions that cause significant swelling, thickening or irritation of membranes around the tendons in the carpal tunnel can result in pressure on the median nerve, disrupting transmission of sensations from the hand up to the arm and to the central nervous system.

Menopause	Diabetes

Diagnosing Carpal Tunnel Syndrome

Before your doctor can recommend a course of treatment, he or she will perform a thorough evaluation of your condition, including a medical history, physical examination and diagnostic tests. Your doctor will document your symptoms and ask about the extent to which these symptoms affect your daily living. The physical examination will include an assessment of sensation, strength and reflexes in your hand.

If conservative treatment such as medication or physical therapy does not provide sufficient relief, your doctor may perform diagnostic studies to determine if surgery is an effective option. These diagnostic studies may include:

X-ray: An x-ray will show the bones of the wrist and determine if any abnormalities may be contributing to carpal tunnel syndrome or another disorder.
	Electromyogram and Nerve Conduction Studies (EMG/NCS): These tests primarily study how the nerves and muscles are working together. They measure the electrical impulse along nerve roots, peripheral nerves and muscle tissue.

Conservative (Nonsurgical) Treatments

The main purpose of conservative treatment is to reduce or eliminate repetitive injury to the median nerve. In some cases, carpal tunnel syndrome can be treated by immobilizing the wrist in a splint to minimize or stop pressure on the nerves. If that does not work, patients are sometimes prescribed anti-inflammatory medications or cortisone injections in the wrist to reduce swelling.

Your doctor may suggest specific types of hand and wrist exercises, which may be helpful.

Treatment for carpal tunnel syndrome may include rest, the use of a wrist splint during sleep, or physical therapy. Conservative treatment methods may continue for up to eight weeks.

When Surgery is Necessary

The most common procedure is called carpal tunnel release, which can be performed using an open incision or endoscopic techniques. The open incision procedure or carpal tunnel release, involves the doctor opening your wrist and cutting the ligament at the bottom of the wrist to relieve pressure. The endoscopic carpal tunnel release procedure involves making a smaller incision and using a miniaturized camera to assist the neurosurgeon in viewing the carpal tunnel. The possibility of nerve injury is slightly higher with endoscopic surgery, but the patient's recovery and return to work is quicker.

Recovery After Surgery

You will notice that the pain and numbness begins to improve after surgery, but you may have tenderness in the area of the incision for several months. Recurrence of symptoms after surgery for carpal tunnel syndrome is rare, occurring in less than 5 percent of patients. A majority of patients recover completely. To avoid injuring yourself again, it may help to change the way you perform repetitive movements, the frequency with which you perform the movements, and the amount of time you rest between periods when you must perform these movements.