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Carpal tunnel syndrome

Carpal tunnel syndrome occurs when the tissues surrounding the flexor tendons in the wrist swell and put pressure on the median nerve. These tissues are called the synovium. The synovium lubricates the tendons and makes it easier to move the fingers.

This swelling of the synovium narrows the confined space of the carpal tunnel, and over time, crowds the nerve. Carpal tunnel syndrome is a common source of hand numbness and pain.

Symptoms

The most common symptoms of carpal tunnel syndrome include:

Numbness, tingling, and pain in the hand

An electric shock-like feeling mostly in the thumb, index, and long fingers

Strange sensations and pain traveling up the arm toward the shoulder

Symptoms usually begin gradually, without a specific injury. In most people, symptoms are more severe on the thumb side of the hand.

Symptoms may occur at any time. Because many people sleep with their wrists curled, symptoms at night are common and may awaken you from sleep. During the day, symptoms frequently occur when holding something, like a phone, or when reading or driving. Moving or shaking the hands often helps decrease symptoms.

Symptoms initially come and go, but over time they may become constant. A feeling of clumsiness or weakness can make delicate motions, like buttoning your shirt, difficult. These feelings may cause you to drop things. If the condition is very severe, muscles at the base of the thumb may become visibly wasted. Dr. Parikh will recommend various tests to check severity of the nerve function by doing NCV test and x-ray.

Electrophysiological tests. Electrical testing of median nerve function is often done to help confirm the diagnosis and clarify the best treatment option in your case.

X-rays. If you have limited wrist motion, Dr. Parikh and his team may order x-rays of your wrist

Carpal tunnel syndrome will progressively worsen without some form of treatment. It may, however, be modified or stopped in the early stages. For example, if symptoms are clearly related to an activity or occupation, the condition may not progress if the occupation or activity is stopped or modified.

Treatment

Non-Surgical

If diagnosed and treated early, carpal tunnel syndrome can be relieved without surgery. In cases where the diagnosis is uncertain or the condition is mild to moderate, Dr. Parikh and his team will recommend simple treatment measures first.

Bracing or splinting. A brace or splint worn at night keeps the wrist in a neutral position. This prevents the nightly irritation to the median nerve that occurs when wrists are curled during sleep. Splints can also be worn during activities that aggravate symptoms.

Medications. Simple medications can help relieve pain. These medications include anti-inflammatory drugs (NSAIDs), such as ibuprofen.

Activity changes. Changing patterns of hand use to avoid positions and activities that aggravate the symptoms may be helpful. If work requirements cause symptoms, changing or modifying jobs may slow or stop progression of the disease.

Steroid injections. A corticosteroid injection will often provide relief, but symptoms may come back.

Surgical

Dr. Parikh and his team and you may concern surgery if you do not gain relief from nonsurgical treatments. Dr. Parikh and his team will discuss and guide you in helping you make the right decision whether to have surgery is based mostly on the severity of your symptoms.

  • In more severe cases, surgery is considered sooner because other nonsurgical treatment options are unlikely to help.

  • In very severe, long-standing cases with constant numbness and wasting of your thumb muscles, surgery may be recommended to prevent irreversible damage.

The common recommendation for immediate treatment after surgery are

Right after surgery, you will be instructed to frequently elevate your hand above your heart and move your fingers. This reduces swelling and prevents stiffness.

Some pain, swelling, and stiffness can be expected after surgery. You may be required to wear a wrist brace for up to 3 weeks. You may use your hand normally, taking care to avoid significant discomfort.

Minor soreness in the palm is common for several months after surgery. Weakness of pinch and grip may persist for up to 6 months.

Driving, self-care activities, and light lifting and gripping may be permitted soon after surgery. Dr. Parikh and his team will determine when you should return to work and whether there should be any restrictions on your work activities.

Complications. The most common risks from surgery for carpal tunnel syndrome include:

  • Bleeding

  • Infection

  • Nerve injury


Information obtain from www.orthoinfo.aaos.org

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