Carpal tunnel syndrome is associated with a pinched median nerve in the wrist region. It is at the carpal tunnel where the nine tendons and median nerve pass through from the forearm into your hand. Carpal tunnel consists of wrist bone at the bottom and transverse carpal ligament on the top. Tightness or injury to the carpal tunnel may cause tissues within the tunnel to swell. It is the pressure exerted on the median nerve that leads to carpal tunnel syndrome.
Causes of Carpal Tunnel Syndrome
Pressure at the carpal tunnel presents differently including, build-up of fluid during pregnancy, arthritis, fractures, joint dislocations, and tenosynovitis. The above factors may contribute to the narrowing of the carpal tunnel or swelling in the area. In some instances, carpal tunnel syndrome occurs in association with rheumatoid arthritis, diabetes, and thyroid conditions.
Signs and Symptoms of Carpal Tunnel Syndrome
The condition is associated with dropping things, occasional clumsiness, weak grip, tingling, numbness, and pain. The tingling sensation may occur in the ring, middle, index, and thumb fingers. The symptoms are more pronounced in the night but may also occur during the day, especially when driving or holding a book. The development of the symptoms is gradual, and the condition exacerbates with time. The symptoms are severe on the thumb side of your hand.
In diagnosing carpal tunnel syndrome, a hand specialist or a hand surgeon will request a comprehensive medical history. They will be interested in knowing how you often use your hands and any previous injuries on your hand. The physicians may order some laboratory tests when necessary. Note that electro-diagnostic studies are also critical for proper diagnosis and when determining other possible causes of nerve problems.
Treatment of Carpal Tunnel Syndrome
Management may or may not involve surgeries. In most cases, a hand specialist in Birmingham, Alabama, will recommend carpal tunnel release surgery. The surgical procedure alleviates the pain and treats the syndrome. Previously, physicians believed that carpal tunnel syndrome originated from repetitive motions at the wrist or overuse injuries. More studies reveal that the syndrome could be having congenital predisposition, where it runs in families.
There are individuals with narrower carpal tunnels as compared to others. Continued use of vibrating tools, fractures, or sprains are risk factors for carpal tunnel syndrome. In carpal tunnel release surgery, the surgeon will cut through the ligaments exerting pressure on the tunnel.
Why Carpal Tunnel Surgery?
After a proper diagnosis of the syndrome, the physician may recommend non-surgical treatment options, such as OTC pain relievers, before considering surgical procedures. Other non-invasive techniques include physical therapies, steroid shots, wrists splints, and modification of your equipment. The physician will recommend a surgical procedure:
- When symptoms associated with carpal tunnel syndrome have lasted for over six months without relief
- When there is a weakness in the hand muscles and wrist
- After an electro-myography test on the median nerve and confirmation of carpal tunnel syndrome by the physician
- When the non-surgical interventions do not alleviate the pain
Risks Associated with Carpal Tunnel Release Surgery
Just like other surgical procedures, the technique may have some risks. Before the process, the physician will ensure your wrist is numb. The surgeon may sedate you, and local anesthesia may be necessary to minimize any pain sensation. In some instances, the surgeons may prefer general anesthesia to local anesthesia. Note that anesthesia used during surgical procedures is also associated with some risks, although minor.
When planning to undergo carpal tunnel release surgery, remember it can be associated with:
- Sensitive scars
- Injury to the surrounding blood vessels
- Median nerve injury
- Infection
- Bleeding
Complete recovery after the surgical procedure may take time, and it ranges from weeks to months. Compression of the median nerve for an extended period may prolong full recovery. Recovery entails physical therapies and splinting of the wrists to heal and strengthen your hand and wrist. Based on a patient’s medical condition and history, there could be more risks. It would be best if you discussed the concerns with your physician before the surgical procedure.
Preparation for Carpal Tunnel Surgery
It is advisable to inform your specialists of all the current medications you are taking, including supplements, herbs, vitamins, and OTC drugs. It would be best to stop taking medicines that prevent blood clot formation, such as naproxen, aspirin, and ibuprofen. If you are a tobacco smoker, consider terminating its use before the surgery since smoking delays healing.
Electrocardiograms and some blood tests may also be necessary before the procedure. You will be guided appropriately by the hand surgeon. Because the treatment is individualized, the physician may order more tests and preparations based on a particular patient’s needs.
The Surgical Procedure
Carpal tunnel release surgery is an outpatient treatment implying that the specialists expect you to return home after the procedure, assuming the process is successful. There are two forms of the release surgery, including open and endoscopic carpal tunnel release.
Endoscopic Carpal Tunnel Release
Your physician will make an incision in the endoscopic method and force a thin and flexible tube containing a camera into it. The camera will guide the physician during the surgical procedure without making large incisions. Physicians use lighter cutting tools in the endoscopic technique, and cutting the carpal ligament relieves pressure on your median nerve.
Open Carpal Tunnel Surgery.
It may be necessary when:
- There is a tumor
- There is a severe destruction of the median nerve, followed by the hand losing its function
- There is continuous loss of coordination or feeling on the hands or fingers
- Symptoms persist after an extended period of non-invasive treatments
In open release surgery, hand specialists in Birmingham, Alabama, will make an incision at your palm base. The cut enables them to view the transverse ligament. After the incision, the skin will be closed using stitches. The region where the specialists cut the ligament will eventually fill up with scar tissues. It is a minor procedure that does not require a prolonged stayed at the hospital.
After Carpal Tunnel Surgery
The physicians will heavily bandage the wrist or splint for about a fortnight. Our doctors at Birmingham, Alabama, will schedule an appointment to get rid of the bandage. It is at this moment that the specialist will advise you to prevent stiffness by moving your fingers. It is common to experience some pain after the surgery. The pain is relieved by the oral over-the-counter painkillers.
The hand surgeon may recommend that you elevate your hand when sleeping to minimize the chances of swelling. After the splint removal, you will be in a position to join the physical therapy programs. Our physical therapists at Birmingham, Alabama, are ready to guide you through the motion exercises to improve motion at the wrist or hand. The activities will strengthen the carpal tunnel and catalyze healing.
In some instances, the braces or splints may still be vital for some months after the surgical procedure. Healing ranges from days to several months. You may find it wise to take off from your work or adjust the duties until complete recovery. During the recovery phase, be on the look-out for the following symptoms and inform your physician promptly:
- Intense pain at the incision site
- Drainage from the cut site, bleeding, swelling, or redness
- Fever
Prevention of Carpal Tunnel Syndrome
In your daily operations at home and hobbies, remember to change activities that entail repeated use of fingers, wrist, or hand. It would be best to train yourself to use other techniques or positions that do not impact a lot of stress on your wrist. Ensure you have good health generally. A healthy lifestyle involves regular exercises, termination of smoking, if any, and monitoring of your weight.
Ensure your finger, wrist, and hand muscles are flexible and more robust. Your hands should be in neutral positions, meaning that your wrist should only be slightly bent or straight. Keep off activities that may twist or bend the wrist for an extended period. The wrists and hand movements should evenly spread the motion and pressure throughout the wrist and hand.
In your daily operations, remember to take breaks to allow your hands to rest. Always change positions and switch hands when handling repetitive tasks. Avoid processes that are associated with numbness at the wrist or finger. You may consider wearing wrist splints to ensure the wrists are in neutral positions. It minimizes the stress on the wrists, hands, and fingers. Wrist splints are vital, especially when an individual cannot control the wrist motions, such as when sleeping.
If your job description involves extensive use of the fingers, wrists, and hands, there could be some pain or numbness. Inquire about different ways of handling the same task to minimize the injury. Besides, there could be a need to evaluate the ergonomics of the procedures and workspace.
Failure to manage carpal tunnel syndrome early enough may lead to permanent disability and impairment. Individuals are also likely to develop chronic hand or wrist pain, with or without sympathetic reflex sympathetic dystrophy.
If you observe any symptoms associated with carpal tunnel syndrome, promptly reach out to Dr. Sauer in Birmingham, Alabama. The hand plastic surgeon is ready to assist you in restoring motion and regular operation of your hand.
Carpel Tunnel
Carpel Tunnel
REFERENCES.
https://www.bcm.edu/healthcare/specialties/aesthetics/hand-surgery
https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/carpal-tunnel-release
https://www.uofmhealth.org/health-library/hw212359
https://www.assh.org/handcare/condition/carpal-tunnel-syndrome