Carpal tunnel syndrome is a painful condition characterized by wrist pain, numb fingers and tingling fingers. A procedure called open carpal tunnel release usually relieves the symptoms, and restores function in the wrist and hand, if conservative measures do not provide adequate relief.
The primary signs of carpal tunnel syndrome are numbness and tingling, which is a “pins and needles” sensation, in the fingers. The pain and lack of feeling often are more intense at night, which can make it difficult to sleep; this is called “night pain”. Patients also report burning or tingling of the thumb, index finger and middle fingers. Pain can radiate into the forearm and elbow. Hand weakness is another symptom.
Women are more susceptible than men, and there is a disproportionate number of cases involving the elderly. Experts believe “medical conditions (such as) diabetes, rheumatoid arthritis and thyroid gland imbalance can play a role,” according to the American Academy of Orthopaedic Surgeons. In most cases, multiple causes are responsible.
The syndrome is a progressive condition (ie, symptoms get more severe over time) unless a patient receives treatment. In some cases, when therapy begins early, the pain and loss of function can be reduced or eliminated. Some people find that altering their activities, perhaps even changing jobs, relieves their suffering.
Patients are often advised to wear a wrist brace or splint at night and during certain activities, to limit pressure on the median nerve. Among other nonsurgical treatments are anti-inflammatory, rehabilitation (physical therapy or acupuncture), and injections of corticosteroids.
When these methods are ineffective, surgical “open release” might be warranted. The procedure entails cutting the carpal ligament to give the nerve and tendons more space, so the nerve is not irritated. This is typically an outpatient operation, in which patients receive local anesthesia.
“Significant improvements” have been reported for “the general population, regardless of age, medical (conditions) or workers’ compensation status,” according to a paper drafted by the Department of Orthopaedic Surgery at the University of Minnesota in Minneapolis and the TRIA Orthopaedic Center in Bloomington, Minn.
The paper, “Outcomes Protocol for Carpal Tunnel Release: A Comparison of Outcomes in Patients With and Without Medical Comorbidities,” was published online in the Journal of Hand Surgery in September.
The researchers analyzed the outcomes of 950 open carpal tunnel procedures involving 826 patients (between the ages of 21 and 100 years of age) at an orthopedic surgery center. They compiled symptom and function assessments reported by the patients, who filled out questionnaires two, six and 12 weeks following surgery.
“Patients demonstrated a significant improvement in symptom severity scores at two weeks and functional severity scores at six weeks,” the report concluded. “Documented patient medical (conditions) did not affect improvement after surgery. Patients with diabetes improved more slowly, but were not significantly different at six weeks. Patients with workers’ compensation insurance were significantly worse at baseline, two weeks and six weeks, but were not significantly different at three months. The risk of negative postoperative endpoints was slightly higher in patients with a medical (condition), though not statistically different.”
The syndrome, a common condition, occurs when synovium tissues around the flexor tendons in the wrist become swollen. That puts excess pressure on the median nerve, which passes through the carpal tunnel. Synovium lubricates tendons that make it possible to flex the fingers.
Researchers have determined that heredity is the primary risk factor for the syndrome. People with small carpal tunnels, due to their genetics, are more vulnerable. Those who overuse their hands by taking part in repetitive-motion activities, and pregnant women experiencing hormonal changes, also are more likely to develop the condition.
The carpal tunnel is a narrow passageway in the wrist, with carpal bones on the sides and the bottom. The transverse carpal ligament is found on the top of the tunnel. The median nerve, which connects the hand and forearm, makes it possible to have feeling on the inner side of all the hand’s digits other than the little finger. The nerve is also essential for muscle function at the base of the thumb. Flexor tendons, also found within the tunnel, allow bending of the thumb and fingers. The carpal tunnel provides a protective space for the median nerve and flexor tendons.
Some patients experience recurrences of the syndrome, requiring further surgery.
If you have wrist pain or finger number and tingling, contact our orthopedic experts for evaluation today at Orthopedic Surgery San Diego.