Do you ever find yourself waking up in the middle of the night, shaking your hands to wake them up? Have you ever dropped your favorite coffee cup because you didn’t have feeling in your hands? If you said “yes” to either of the aforementioned questions, you may be affected by carpal tunnel syndrome.
WHAT IS CARPAL TUNNEL SYNDROME?
The carpal tunnel is the most common compressive neuropathy in the upper extremity. It is essentially a pinched nerve in the wrist which can produce numbness and tingling in the hand as well as weakness. Initially symptoms are often intermittent, occurring in the evening and periodically throughout the day, however can become constant with long standing compression.
WHERE IS THE CARPAL TUNNEL AND WHAT ARE THE COMPONENTS OF THE TUNNEL?
The carpal tunnel is a space in the wrist, near the palm of the hand, that resembles a tunnel. The walls of the tunnel are formed by the small bones in the wrist, called carpals, and the roof of the tunnel is formed by a firm, thick ligament. The ligament is called the Transverse Carpal Ligament. The contents of the tunnel include a total of 9 tendons whose purpose is to move the fingers as well as one nerve, called the median nerve.
WHO GETS CARPAL TUNNEL?
Carpal Tunnel is approximately five times more common in women than men, and affects patients of all age groups, however is most common between the ages of 30-60. Individuals with medical comorbidities such as diabetes or thyroid disease have a predisposition to developing carpal tunnel syndrome, however advancing age, genetics, and obesity also predispose individuals to developing carpal tunnel. During pregnancy, women experience fluctuations in hormones associated with fluid shifts which can result in swelling within the carpal tunnel producing symptoms. In addition, traumatic injuries to the wrist can cause swelling, producing carpal tunnel.
HOW IS CARPAL TUNNEL DIAGNOSED?
Carpal tunnel is primarily a clinical diagnosis, however there are also electrodiagnostic tests, such as nerve conduction and electromyography, which can be useful when evaluated in conjunction with a thorough clinical exam.
WHAT ARE TREATMENT OPTIONS FOR CARPAL TUNNEL SYNDROME?
There are a number of nonsurgical and surgical treatment options for carpal tunnel syndrome. Nonsurgical options range from night splints to corticosteroid injections within the carpal tunnel. Surgical options involve release of the transverse carpal ligament and this can be performed via an open incision within the palm of the hand or through a small incision in the wrist utilizing a camera. The decision to proceed with nonsurgical versus surgical treatment is primarily based on the severity of the symptoms at presentation while taking into account the patient’s overall health.
WHAT IS THE BEST APPROACH TO CARPAL TUNNEL?
Dr. Fernandez’ treatment plan is primarily based upon her findings during the clinical exam. Unfortunately, compression of any nerve can potentially lead to permanent nerve injury if it is not treated, so she urges patients with symptoms to come in for an evaluation. If surgery is chosen, the surgeon is pleased to offer her patients’ an endoscopic release for their carpal tunnel. Studies have cited numerous advantages to the endoscopic approach over the open approach to carpal tunnel decompression such as the following: less postoperative pain, faster return to functional activities, and an improved early grip and pinch strength. Fernandez’ clinical results parallel these outcomes, allowing her patients to return to hobbies they love such as golf, tennis, and pickleball.
If you’re looking for an orthopedic surgeon in Naples, call Dr. Fernandez at The Fernandez Upper Extremity Institute at 239-777-9321.