Carpal Tunnel Syndrome
The carpal tunnel is a narrow, tunnel-like structure in the wrist. The bottom and sides of this tunnel are formed by carpal (wrist) bones, while the top of the tunnel is covered by a strong band of connective tissue called the transverse carpal ligament. Carpal tunnel syndrome happens when pressure builds up from swelling in this tunnel and puts pressure on the median nerve. This nerve travels from the forearm into the hand through the carpal tunnel and controls feeling in the palm side of the thumb, index finger, and long fingers. It also controls the muscles around the base of the thumb.
Repetitive hand use is NOT the culprit in carpal tunnel syndrome. Heredity is actually one the most important factors – carpal tunnels are smaller in some people and this trait can run in families. Other causes include: hand use over time, hormonal changes related to pregnancy, age (the disease occurs more frequently in older people), and medical conditions such as diabetes, rheumatoid arthritis, and thyroid gland imbalance.
The most common symptoms of carpal tunnel syndrome include numbness, tingling, and pain in the hand. There is also an electric shock-like feeling, mostly in the thumb, index, and long fingers, as well as strange sensations and pain traveling up the arm toward the shoulder. Symptoms usually begin gradually, without a specific injury, and may occur at any time. In most people, symptoms are more severe on the thumb side of the hand.
While initial symptoms usually come and go, they may become constant over time. A feeling of clumsiness or weakness can make delicate motions, like buttoning your shirt, difficult. In addition, these feelings may cause you to drop things. If the condition is very severe, muscles at the base of your thumb may become visibly wasted.
Dr. Pianka can check for signs indicating carpal tunnel syndrome with in-office clinical exams/tests and electrophysiological tests, electrical testing of nerve function.
NONSURGICAL TREATMENT
For most people, 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 aggravated by an activity or occupation, the condition may not progress if the occupation or activity is stopped or modified.
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. Pianka will always try simple treatment measures first, including bracing or splinting to keep the wrist in a neutral position, anti-inflammatory medications to help relieve pain, and steroid injections. He might also recommend changing patterns of hand use to avoid positions and activities that aggravate the symptoms.
Surgical Treatment
Surgery may be considered if you do not gain relief from nonsurgical treatments. The 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 additional irreversible damage.
Traditional approaches to carpal tunnel syndrome surgery require an open surgery, which also includes a three-inch incision from wrist to palm. However, in many cases, Dr. Pianka is able to offer a “mini-open” technique using a one-inch incision to divide the transverse carpal ligament, without opening the entire area with a large incision. This procedure is performed on an outpatient basis under local anesthesia, and results in a speedier recovery, reduced pain, and diminished scarring.
During the surgery, the transverse carpal ligament, or roof of the carpal tunnel, is divided. This increases the size of the tunnel and decreases pressure on the nerve. Once the skin is closed, the ligament begins to heal and grow across the division. The new growth heals the ligament, and allows more space for the nerve and flexor tendons.
Patients can use their hand right away, and the bandage is removed in 10 days. Strength returns gradually over several weeks. Relief of symptoms depends on the ability of the nerve to heal itself; therefore earlier treatment yields better results.
Dr. George Pianka Discusses Carpal Tunnel Syndrome on Chanel 7 News
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