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Carpal Tunnel Syndrome

Boyd W. Haynes III, MD

Carpal tunnel syndrome is one of the most common compressive neuropathies seen in America.   It is three times more likely in women than in men and usually presents between the ages of 30-60.   Most often, the dominant hand is affected first and usually is the most painful.
Although it is widely believed that CTS (Carpal Tunnel Syndrome) is caused by repetitive and/or forceful motion, either at work or during leisure, not all data supports this.  Rather, it seems that a combination of factors might contribute to the development of CTS.  Some people are predisposed to CTS because their carpal tunnel canal is small and does not allow much room for the tendons and medial nerve.  In others, it may be a mechanical wrist problem and an environmental factor, such as using vibrating power tools, which may be to blame. Pregnancy can cause its onset, due to the swelling in the narrow carpal tunnel caused by fluid retention, which compresses the median nerve.  The good news is that it usually resolves after the baby is delivered.

What exactly is CTS?

It is caused by the compression of the median nerve in the hand, which results in paresthesias (tingling), numbness or weakness of the first four digits. The median nerve carries sensation and motion to the 4 fingers and palm closest to the thumb.   The patient has an insidious onset of symptoms without any specific injury or event.  A commonly reported complaint from those with CTS is that they tend to wake up at night from the numbness and tingling in their hand and that they must shake their hand in order to “awaken” the fingers.  Sometimes, the fingers go to sleep when the patient is driving or reading.  For most patients, the most annoying symptom is the waking at night, which disturbs their sleep pattern and makes for a difficult time staying alert during normal daytime activities.

How do we diagnose and treat CTS?

Once in the office, the patient is evaluated with x-rays, physical examination, and a subsequent nerve conduction velocity study.  If there is evidence of carpal tunnel syndrome, multiple non-surgical interventions can be done to try to alleviate the patient’s symptoms.  Those consist of taking Ibuprofen or Naproxen, bracing, doing stretching and strengthening exercises and the administration of cortisone injections into the affected area.  Unfortunately, studies show that more than 50% of those diagnosed with CTS will eventually require surgical intervention to take the compression off the median nerve and to try to prevent further damage.

There are two ways to surgically treat carpal tunnel syndrome.  One is through an open carpal tunnel release, and the second is through an endoscopic carpal tunnel release, both of which are performed as outpatient surgery.  The endoscopic release it the method I prefer, because it reduces post-operative pain, lessens recovery time and allows for a quicker return to normal activities, even in the worker’s compensation population.  The operation relieves the symptoms of carpal tunnel syndrome immediately.  The patient has only mild residual pain at the surgical site and mild grip strength weakness, both of which resolve with time postoperatively.  Patients may return to work with no restrictions as soon as they are comfortable.  Most patients recover completely and it is rare for a recurrence of CTS to be reported after surgery.

Can CTS be prevented?

In the workplace, it is important to address existing ergonomic concerns, take breaks, stretch and pay attention to your posture and wrist position.  However, there is no conclusive proof that making modifications to your work routine and station will prevent CTS.  Being aware of your body and understanding the reasons that CTS occurs will help you to look out for symptoms and to take action should you notice a problem.  An OSC orthopaedic specialist can best assess and determine a treatment for CTS, ensuring the most satisfactory outcome for you.

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