The carpal tunnel is a narrow passageway located on the palm side of the wrist that protects the main nerve to the hand and the nine tendons that bend the fingers. When the tendons or ligaments become stressed from repetitive movement, they become swollen and inflamed – causing them to press against the median nerve. This compression results in the improper functioning of the nerve and pain or a numbing feeling – referred to as Carpal Tunnel Syndrome (CTS).
Women are three times more likely to develop CTS than men as a result of the musculoskeletal and physiological differences. Hormonal changes and repetitive movement such as that required in lengthy computer use predispose a person to CTS. Older people are at higher risk than younger adults. It is very rare in children. There are many other causes for this including: repetitive hand movements, an injury to the wrist, heredity, medical conditions such as diabetes and hormonal changes related to pregnancy and menopause. Obesity is also highly linked to this condition.
Employees at highest risk for CTS are those working in professions that require repetitive hand movements, such as data entry, carpenters, assembly-line workers and musicians. Carpal Tunnel Syndrome accounts for the highest average number of days missed at work, when compared to all other work-related injuries and illnesses.
The symptoms usually begin gradually and worsen without treatment. The most common symptom is numbness, tingling and pain in the hand and fingers. The dominant hand is usually affected first and produces the most severe pain.
Treatment is usually non-invasive if approached early. A splint can be used to immobilize the wrist to minimize or stop pressure on the nerves. Anti-inflammatory medication such as Ibuprofen or Advil may also be prescribed to reduce swelling.
If conservative treatment is not effective, a qualified orthopedic surgeon may perform diagnostic studies to determine if surgery is necessary. The surgery, an Endoscopic Carpal Tunnel Release, involves cutting the ligament at the top of the carpal tunnel making more room in the tunnel and relieving pressure on the nerve. The wound is closed with three or four absorbable sutures and dressing is applied.
The dressing is removed the next day and patients are started on exercises and activities as they feel comfortable. Patients usually regain the normal use of their wrist and hand within a few weeks to a few months following surgery, depending on age and activity level.
To avoid future recurrence, it is important to take good care of the wrists and hands – recognizing early signs of stress leading to this condition. Patients should focus on keeping their wrist in a neutral position. When holding an object it is important to use the whole hand not just the fingers. Lastly, if possible, it is best to switch hands often when repeating movements.
The Sanders Clinic for Orthopaedic Surgery and Sports Medicine is experienced in correcting most problems affecting the hand and wrist. To learn more about CTS log onto www.sandersclinic.net to learn more about ACL injuries and treatment, or call 1.888.8 DR MARK (24/7).