Understanding Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is an extremely common as well as a very misunderstood condition.   In recent years, it has received much coverage in the press but is still not completely understood even by the scientific community. The media has branded this condition as an occupational disease because of workers linking pain in their hands to repetitive activities such as typing or assembly line work.   Despite popular opinion, this condition is not caused by using a keyboard.   However, if one has a predisposition to this condition, repetitive activity such as typing can aggravate it.

Carpal Tunnel Syndrome simply means that there is a compression of the median nerve in the hand.   This nerve sits inside a tunnel in the hand whose floor and walls consist of bones known as carpal bones. The roof of this tunnel is a structure called the transverse carpal ligament.

Besides the nerve, there are nine tendons which flex the fingers and thumb and run in the canal.   When lining around these tendons is inflamed, there is less space for the nerve and it becomes compressed.   This compression of the median nerve leads to the symptoms of Carpal Tunnel Syndrome.

The symptoms most often reported with Carpal Tunnel Syndrome are numbness and tingling in the hand which often begins at night.   Often there is also pain and weakness in the hand, particularly in the thumb.   If allowed to progress for many years untreated, this could lead to atrophy of the muscles in the base of the thumb.

Besides the physical symptoms of Carpal Tunnel, the diagnosis is easily confirmed by a simple nerve conduction study.   This measures the velocity and the latency of the nerve impulse across the median nerve at the wrist and can tell the physician if the patient has a compression of the median nerve.  

The condition most commonly occurs in the middle aged women, often perimenopausal.   It can be caused by chronic conditions such as Diabetes, gout or thyroid disease.   It is also commonly seen in women in their third trimester of pregnancy.   When any of these other conditions are ruled out, the condition is labeled idiopathic meaning caused by an unknown process.

Carpal Tunnel Syndrome often coincides with related conditions such as tendonitis in the fingers, (trigger finger) of tendonitis in the wrist.   DeQuervain's tendonitis, for example, leads to pain in the wrist at the base of the thumb.

The treatment for Carpal Tunnel Syndrome is often directed at decreasing the inflammation of the tendons.   Injections of steroids such as cortisone can lead to a decrease in the swelling.   This will allow the median nerve more room in the carpal tunnel and relieve the pain.

The most common treatment without the use of drugs or injections is a night splint.   The splint does not allow the patient to flex their wrist at night which often occurs during dreaming.   This relieves some of the pressure within the canal.   Symptoms are magnified at night because the position of the hand is at the same level of the heart while lying down leading to pooling of the fluid in the soft tissues within the canal.

There are also hormonal changes which are quite complicated that can lead to increased fluid retention at night.   As a remedy to this, some researchers believe that high doses of Vitamin B-6 can act as a diuretic and decrease the fluid in the carpal canal leading to relief of symptoms.

If the compression is severe enough and the patient does not respond to conservative treatment, the next step would be surgery.   Surgery for Carpal Tunnel Syndrome is also misunderstood by the public as well as physicians.   Rumors abound as to the final outcome after these procedures.   People think they will loose functioning in their hand if they have surgery.   The truth is that surgery is extremely successful.

This surgery actually entails a very simple concept.   A division is made in the ligament which serves as the roof of the carpal tunnel. This increases the space in the carpal tunnel allowing the median nerve to function better.

The most recent breakthrough in treatment of Carpal Tunnel Syndrome, which is commonly used at the Miami Hand Center, is called endoscopic release.   In this procedure, an incision of less than one centimeter is made in the crease of the wrist and an endoscopic, a tiny camera, is inserted.   This allows the surgeon to literally see the inside of the hand and make the division of the ligament without a large, open incision.

"...despite popular opinion, (Carpal Tunnel Syndrome) is not caused by using a keyboard."

This is not a laser surgery, but rather surgery using fiber optic technology, allowing a surgeon to operate "from inside out".   This means that tender tissue is not violated and there is minimal, if any pain, after the procedure.   The main advantage of this technique is not only minimizing the unsightly scar, but also increased recovery time which allows to return to work quickly.

The long term results of endoscopic release of Carpal Tunnel Syndrome is excellent with many more benefits to the patient than traditional means of treatment.   Patients occasionally complain of some soreness in the palm when resting their hand upon a hard object, but otherwise, there are minimal complications or pain after the procedure.

The key to understanding Carpal Tunnel Syndrome is to think of this as a pinched nerve which occurs in the wrist and leads to symptoms such as numbness or tingling.   These are many painful conditions in the hand and wrist which need to be evaluated by a surgeon specializing in such problems.   Confirmations by nerve conduction studies is usually done by either a rehab medicine specialist or a neurologist.

Carpal Tunnel Syndrome is an easily diagnosable and treatable condition when appropriately diagnosed by a trained physician.   If you have pain in your hands, take heart, don't quit your typing job.   Call the Miami Hand Center for an appointment and free yourself from this unnecessary pain.

For more information regarding Carpal Tunnel Syndrome or any upper extremity concerns, please call the Miami Hand Center, Dr. Alejandro Badia (305) 661-3000.

Alejandro Badia, M.D, F.A.C.S.