Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is common among loggers, fishermen, and industrial workers. In addition, women are genetically predisposed to this debilitating condition.

The surgeons at Longview Orthopedic Associates are experts in diagnosing and treating Carpal Tunnel Syndrome.

If the symptoms below described are similar to what you have been dealing with, call 360.501.3400 to schedule an appointment.

Carpal Tunnel Release Surgery

The carpal tunnel is a narrow passageway on the palm side of your wrist. Small wrist bones known as carpals form the bottom and sides of your carpal tunnel and a strong band of connecting tissue, known as the transverse carpal ligament, covers the top of the carpal tunnel.

Carpal Tunnel Syndrome

The carpal tunnel houses the flexor tendons that allow you to bend your fingers and the median nerve that provides sensation to most of your fingers and hand.

Special tissues known as synovium surround and lubricate the flexor tendons in your wrist, allowing smooth movement of the fingers. Carpal Tunnel Syndrome occurs when the synovium swells, narrowing the limited space within the tunnel and pinches the median nerve over time. The transverse carpal ligament can also become tight, narrowing the carpal tunnel space and putting pressure on the median nerve.

Carpal Tunnel Syndrome

Signs & Symptoms

Common symptoms associated with Carpal Tunnel Syndrome include:

Carpal Tunnel Syndrome

  • Numbness and tingling in the thumb, index, and middle fingers
  • Pain and burning in the hand and wrist that may radiate up the arm to the elbow
  • Decreased sensation and weakness in the hand with diminished grip-strength
  • Worsening of symptoms at night

Causes

The following factors have been known to increase a person’s risk of developing Carpal Tunnel Syndrome:

Carpal Tunnel Syndrome

  • Repetitive Motion: performing heavy, repetitive hand and wrist movements with prolonged gripping at work or play
  • Congenital: Some people are born with narrower carpal tunnel canals
  • Trauma: Injury to the wrist such as fractures or sprains
  • Hormonal Changes: Pregnancy, menopause, birth control pills or hormone pills are risk factors as they alter the levels of hormone in the body
  • Medical Conditions: Conditions such as hypothyroidism, rheumatoid arthritis, diabetes, obesity, gout, overactive pituitary gland, or the presence of a cyst or tumor extending to the carpal tunnel

Diagnosis

Your doctor diagnoses Carpal Tunnel Syndrome by performing a detailed medical history and physical examination. Further tests may be ordered, including an x-ray to view your wrist bones; blood tests to rule out underlying medical conditions such as diabetes, arthritis and thyroid problems; and electrodiagnostic testing to assess the speed and degree of electrical activity in your nerves and muscles.

Treatment

Carpal Tunnel Syndrome can be treated with conservative measures or surgical intervention. Conservative treatment options may include treating any underlying medical conditions, such as diabetes and arthritis. Your hand and wrist may be immobilized with a splint or wrist brace for 4 to 6 weeks. Ice packs may be recommended to reduce swelling. You may be advised to avoid activities that tend to bring on the symptoms. Medication and steroid injections may be used to treat pain and swelling. You may be referred to therapy to be taught strengthening and stretching exercises.

When conservative treatment options are not effective, surgery may be recommended.

Surgical Procedure – Endoscopic Technique

Carpal Tunnel Syndrome

You will be given a local anesthetic to numb your hand and wrist. During endoscopic surgery a thin, flexible tube with a camera (endoscope) attached is to its end is employed. A small incision is made in the wrist. The endoscope is inserted through the small incision and helps the doctor visualize the internal structures at the wrist, such as the transverse carpal ligament, thus avoiding the need for a large incision.

When the ligament is located, a tiny cutting tool is employed to release the ligament. In the single-portal technique, a single small tube contains both the camera and the cutting tool, whereas in two-portal technique the camera and cutting tool are inserted through different incisions. After insertion of the cutting tools through the respective incisions, the transverse carpal ligament is cut. This releases the pressure on the median nerve and alleviates the symptoms of Carpal Tunnel Syndrome.

The small incision is closed with stitches. The ligament will heal with the development of scar tissue around the cut ends.

Post-operative

Patients having carpal tunnel release surgery can be discharged the same day.

Your surgeon will suggest certain post-operative procedures for a better recovery and to avoid complications.

  • Elevate the hand above heart-level to reduce swelling
  • A splint may be recommended
  • Apply ice packs to the surgical area to reduce swelling
  • Keep the surgical incision clean and dry; cover the area with plastic wrap when bathing or showering
  • Physical therapy may be ordered to restore wrist strength
  • A healthy diet will promote healing, as will avoiding tobacco products

Call Longview Orthopedic Associates at 360.501.3400 for more information or to schedule an appointment.