Carpal Tunnel Syndrome occurs when the median nerve in the forearm becomes compressed or irritated, as it crosses the wrist. The median nerve is one of the three main nerves in the arm, and travels from the neck down into the hand, and can be constricted in several places along the way. The most common location is in the wrist, where the nerve passes through a “trough” of wrist bones on the front of the wrist, as it enters the hand. This area in known as the “carpal tunnel”, and at this location the nerve is constrained by a thick sheet of fibrous soft tissue called the transverse carpal ligament, which spans the “trough” and additionally limits the space available in the area. Several tendons also pass through this tight environment and limit the amount of space. In activities or occupations that require an increased amount of dexterity or hand and finger motion, inflammation and swelling can build up in the carpal tunnel and cause increased pressure and irritation of the median nerve. This can cause damage to nerves cells, which is perceived as numbness, tingling, pain and weakness in the parts of the hand supplied by the median nerve. Symptoms are often worse in the morning or at night when the individual spends some hours sleeping with their hand bent under their pillow, or tucked in next to the body, a position which closes off the carpal tunnel and adds to the pressure in the local environment. In addition, activities and occupations that require repetitive wrist motion, like mechanics, painters and office workers, can predispose to the development or worsening of the condition.

Symptoms

Typically patients report pain, numbness and tingling in the hand, most pronounced in the thumb, index and long fingers. A sensation of weakness and the hand “falling asleep” is common as well. These symptoms are generally worse first thing in the morning, or after work that involves repetitive hand and wrist motion.

Diagnosis

The diagnosis is typically made by a combination of the patient’s history, and the findings on physical examination. An xray can be helpful in identifying bony abnormalities in the area. A nerve conduction study is commonly used to confirm the diagnosis, and also to rule out nerve entrapment at other sites along the course of the median nerve, or involvement of other nerves, that could contribute to symptoms.

Treatment

The approach to treatment of carpal tunnel syndrome depends on the severity and duration of symptoms and associated debility, as well on the degree of damage to the nerve based on the nerve conduction study. Generally, a trial of conservative treatment is attempted initially, and can help improve symptoms. Those include activity modification, bracing designed to keep the wrist straight and oral anti-inflammatory medication. If these approaches do not lead to resolution of symptoms, operative treatment can be considered. Surgery involves a carpal tunnel release or decompression, which means freeing up the median nerve by splitting open the transverse carpal ligament and removing any tissues that contribute to the pressure on the nerve.

At Oceana Sports Medicine and Orthopaedic Center, Dr. Aboka brings added expertise in minimally invasive treatment of Carpal Tunnel Syndrome, facilitating your return to pain-free function. This procedure is an outpatient/same-day surgery, and is done through a ½ inch incision, leading to less pain and scarring and quicker recovery and return to normal function.