Contributor: Brad Pierce, MD
We’ve all known someone who has suffered from carpel tunnel syndrome (CTS). With the many demands we place on our hands throughout our lives, it is a fairly common condition that affects the hand and wrist.
The carpal tunnel is a narrow canal comprised of a number of carpal bones in the wrist and a tight ligament spanning the bones. Within the tunnel are nine tendons that flex the fingers and thumb, and the median nerve.
When the median nerve is compressed or pinched it causes typical symptoms of CTS, including:
In Orthopaedics, CTS occurs at a rate of one to three cases per 1,000 patients each year. The risk of developing CTS is associated in part, with a number of factors, including:
- medical issues
- social issues
- vocational work
No specific cause has been identified, but symptoms are usually intermittent and associated with certain activities, including:
- repetitive activities at work or at home
- reading the newspaper
People with CTS often experience nighttime symptoms that awaken them. The pain can be relieved by shaking the hand/wrist or hanging the hand over the bed. Initial management typically consists of nighttime splinting of the wrist(s) in an attempt to calm any increased pressures in the carpal tunnel when the wrist is flexed or extended during sleep.
Treatments for CTS include stretching exercises, occupational therapy and anti-inflammatory medications. Further non-surgical management may consist of steroid injection into the carpal tunnel which has been shown to be therapeutic. Injections may also be beneficial prior to surgical management that needs to be delayed.
The American Academy of Orthopaedic Surgeons, as recently as 2010, released a recommendation that nerve testing be conducted if surgical intervention is considered. Patients who have severe findings on their nerve tests, or who have failed conservative management are also recommended by the Academy to undergo operative decompression of the nerve at the wrist.
Surgical intervention has provided high initial success rates–greater than 90 percent in fact– with low rates of complications. And surgical intervention has been found to halt any permanent sensory or functional loss.
If you are suffering from CTS, see an orthopaedist and discuss your treatment options. Over time, surgery may be the best route to permanent relief.
To schedule an appointment with Dr. Pierce or any of hand specialists, please call 440.312.6242.