Carpal tunnel syndrome is a very common hand problem that many people have experienced, especially with all our constant use of personal computers.
The carpal tunnel is made up of a carpal bone floor with a thick inflexible roof. Within the carpal tunnel are nine tendons that move the fingers and thumb as well as the softer median nerve. When inflammation occurs in this area, whether it is from trauma such as a wrist fracture or a medical condition, this can compress the median nerve and cause symptoms.
Carpal tunnel syndrome is usually related to performing repetitive motions. Any job that involves pressure onto the carpal tunnel at the wrist, vibration, sustained grasping, or repetitive finger and wrist motions can be associated with carpal tunnel syndrome.
The symptoms of carpal tunnel syndrome include numbness and tingling of the thumb, index finger, middle finger and half of the ring finger. People often report night pain and awakening in the middle of the night or morning with a numb hand. As the condition worsens, the numbness continues during the day with activity and people report weakness in the hand. The symptoms can progress into muscle weakness of the thumb muscles depending on how much and how long the compression is.
For patients I see with carpal tunnel syndrome, I will often start off with a nerve conduction study called an electromyogram. The EMG will show how much compression and/or involvement there is of the median nerve. Patients with mild to moderate compression often respond to physical or hand therapy. If the nerve is seriously damaged, I will suggest surgery.
Depending on the condition, I will either conduct an open carpal tunnel procedure or an endoscopic procedure in which a thin tube—called an endoscope—is guided through a small incision in the wrist. The endoscope allows the surgeon to see structures in the wrist, such as the transverse carpal ligament, without opening the entire area with a large incision.
The cutting tools used in endoscopic surgery are very tiny and are inserted through the small incisions in the wrist or wrist and palm. The procedure includes cutting the transverse carpal ligament which releases the pressure on the median nerve and thus relieves the symptoms of carpal tunnel syndrome.
Whether it’s an open or endoscopic procedure, surgery for carpal tunnel is usually a day procedure that is completed under local anesthesia without an overnight stay in the hospital. After surgery, the hand is wrapped. The stitches are removed one to two weeks after surgery. The pain and numbness may go away right after surgery or may take several months to subside. Try to avoid heavy use of your hand for up to three months.
The timing of your return to work depends on the type of surgery you had including whether the surgery was on your dominant hand (the hand you use most), and your work activities.
If you had open surgery on your dominant hand and you do repeated actions at work, you may be able to return to work in six to eight weeks. If the surgery was on the other hand and you do not do repeated actions at work, you may be able to return to work in seven to 14 days. Patients who have undergone endoscopic carpal tunnel surgery are usually able to return to work sooner than with open surgery.
Remember, carpal tunnel syndrome is a common and hand wrist condition that can be treated with surgery. If left untreated, the condition can develop into permanent nerve and muscle damage so please make an appointment with your primary care physician or here at the Center for Orthopedic and Spine Health.
R. Damani Howell, MD, is a member of the medical staff of the Bristol Hospital Multi-Specialty Group and Bristol Hospital’s Center for Orthopedic and Spine Health. Dr. Howell is a general orthopedic surgeon who specializes in trauma/hand/fracture care. Dr. Howell also sees patients on a weekly basis at the Bristol Hospital Multi-Specialty Group New Britain office which is located at 35 Pearl St. For an appointment with Dr. Howell, please call 1-833-4BHDOCS or visit bristolhospital.org