Carpul Tunnel Syndrome:
Diagnosis and Treatment
By Nicholas J. Avallone, M.D.
Have you ever been awoken by pain or numbness in your hands? Are you often finding yourself shaking your hand to get it to “wake-up” while you are doing certain activities? If the answer to either of these questions is yes, then you may be suffering from carpal tunnel syndrome. This disorder affects millions of Americans and, if not diagnosed promptly and treated appropriately, can have significant long-term consequences.
Carpal tunnel syndrome is a compression of the median nerve at the wrist. It can be caused by a variety of things such as trauma, diabetes and pregnancy. However, in most instances one cause is not readily identifiable. Most patients complain of numbness in their thumb, index, middle and half of their ring fingers. Pain and numbness often awaken people from sleep. Many feel weakness in their hand, particularly their thumb.
When seeing a physician for this disorder, a good history accompanied by specific physical exam findings can lead one to suspect carpal tunnel syndrome. However, possible neck issues must be investigated and ruled-out as well. A relatively simple, first-line treatment for suspected carpal tunnel syndrome is the use of off-the-shelf braces to keep the wrist relatively straight at night and during aggravating activities. This will allow more room for the nerve in the carpal tunnel and often will alleviate symptoms.
If conservative measures fail, the patient may be referred to an orthopedic surgeon who may recommend an injection or surgery after certain symptom and physical exam criteria are met. If there is doubt as to the cause of the numbness and pain, a test called an EMG is often ordered to study the median nerve.
Generally, an injection of steroid into the carpal tunnel initially provides good relief for most patients. However, this often wanes over the first 18 months and many patients will require surgery. If surgery is warranted, a relatively simple procedure is performed in an outpatient setting. Modern techniques enable surgeons to use a small incision or endoscopy to release the pressure off of the median nerve. This speeds recovery with faster return to work and activities of daily living.
The extent of the nerve’s recovery depends largely on the severity and duration of the disease prior to surgical release. Most studies show that symptoms lasting greater than one year have a worse prognosis postoperatively than those addressed sooner. Thus, prompt diagnosis and appropriate treatment are essential to curing carpal tunnel syndrome.
For further information about carpal tunnel syndrome and other orthopedic conditions please contact Orthopedic Associates of the Greater Lehigh Valley at 908-859-5585 or visit them at www.bonedrs.com.
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