Carpal Tunnel Syndrome
Carpal tunnel syndrome is a painful disorder of the wrist and hand, caused by pressure on the median nerve in the carpal tunnel in your hand. The trusted experience and surgical expertise of the neurosurgeons at The Johns Hopkins Peripheral Nerve Surgery Center make us the best choice for treatment of this condition.
Symptoms
Symptoms of carpal tunnel syndrome may include:
- Numbness
- Pain, sometimes characterized as a burning pain
- Tingling in your thumb, index, and middle fingers, or pain that moves up your arm to your elbow
- Hand weakness
- Dropping objects
- Difficulty manipulating small objects
Causes
Carpal tunnel syndrome is a condition of nerve entrapment. It is caused when the tunnel surrounding the tissues inside the bones of your wrist narrows, inflaming the tissues and your median nerve.
The median nerve gives feeling to your thumb, and index, middle and ring fingers. When tissues in the carpal tunnel, such as ligaments and tendons, get swollen or inflamed, they press against the median nerve. That pressure results in the symptoms of carpal tunnel syndrome.
People engaged in repetitive motions throughout their day may suffer from carpal tunnel syndrome. It is most commonly diagnosed in:
- People who use computers for many hours throughout the day
- Carpenters
- Check-out line technicians
- Assembly-line workers
- Musicians
- Auto mechanics
Hobbies such as gardening, needlework, golfing and boating/rowing can sometimes contribute toward the symptoms of carpal tunnel syndrome. It is critical to have an excellent and experienced physician evaluate you for carpal tunnel syndrome.
Diagnosis
Proper diagnosis of carpal tunnel syndrome requires the expert attention of experienced neurologists and surgical specialists.
Diagnosis will include:
- Complete medical history
- A comprehensive clinical exam. Your doctor will ask you to perform certain tasks with your hands so he or she can determine if carpal tunnel syndrome is a possible diagnosis for your pain.
- Electrodiagnostic studies (EMG) to study nerve conduction within your hands and wrists
Treatment
Depending on the severity of carpal tunnel syndrome, your physician may recommend the following:
- Occupational therapy to strengthen the ligaments and tendons in the hands and wrists
- The daily use of nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and other nonprescription pain relievers to help reduce pain and inflammation
- Wearing splints to help immobilize the wrist
- Resting the hands and wrist for longer periods throughout the day
Your doctor may recommend surgery to treat your carpal tunnel syndrome.
Surgical Intervention
Depending on your symptoms and anatomy, your doctor may choose to perform the surgery in two ways:
- Endoscopically
A small incision is made in the hand or wrist. Your doctor inserts a small camera so the ligaments are visualized and the surgery is performed. The ligament that comes across the palm is then divided.
- Open decompressions
A small incision of about two centimeters is made beginning at the wrist and extending into the palm. Your surgeon will divide the ligament that comes across the palm, opening the carpal tunnel and making it larger. The ligament will be left open and your surgeon will sew up the wound.
Both surgeries are performed on an outpatient basis using local anesthesia with some mild sedation.
Factors in Surgical Intervention
When physical therapy, splinting and other forms of non-surgical treatment fail, surgery is the best option to restore function and alleviate pain.
Recovery
Your bandages will be removed within 24 hours. Stitches if present are taken out in 10 days. Most people return to full activity within six weeks.
