CARPAL TUNNEL SYNDROME
Carpal tunnel syndrome results from the pinching or entrapping of the median nerve in the underside of the wrist. The actual pathology in most cases is due to either a decrease in the volume of the carpal tunnel and/or a swelling or thickening of the flexor tendons that pass through the carpal tunnel along with the median nerve.
Some patients experience a decrease in the size of the carpal tunnel. This is most often associated with fractures or dislocations of the distal radius and/or wrist. It is occasionally seen when large bone spurs or “osteophytes”, form due to degenerative joint disease or arthritis.
Swelling or thickening of the tendon lining is by far the most common cause of carpal tunnel syndrome, yet in the majority of cases the exact etiology is unknown. It will occasionally involve acute inflammation such as infections, rheumatoid arthritis, partial tendon ruptures or potential masses within the carpal tunnel. In the idiopathic cases (or when the cause is unknown) the thickening of the tendon most often stems from an increase in the tendon lining and/or water retention within the tendon. This decreases the amount of space in the carpal tunnel for the median nerve.
The masses that can occur within the carpal tunnel are very infrequent, most commonly caused by an anomalous muscle and/or benign ganglion from the wrist joint.
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Carpal Tunnel Anatomy
Carpal tunnel symptoms occur when the median nerve is pinched beneath the transverse carpal ligament at the level of the wrist. The carpal tunnel is a space bounded by the transverse carpal ligaments and several or the wrist bones. On the transverse view, what you see is a box formed by the carpal bones and the transverse carpal ligament. Passing through the boxy carpal tunnel are the median nerve and nine flexor tendon that move the fingers and thumb. Of these, the median nerve is the most superficial making it prone to being pinched underneath the transverse carpal ligament if the carpal tunnel decreases in size or the tendons thicken.
Carpal Tunnel Exercises
Intermittent stretching exercises, if done frequently throughout the day, help promote improved blood flow to the carpal tunnel region and emphasize tendon gliding as a way to regain functional range of motion. Exercising with a soft piece of foam or squeeze ball can be helpful. Try to avoid prolonged power exercises as these may aggravate, rather than alleviate, symptoms.
Carpal Tunnel Evaluation
- Nerve conduction studies and Electromyogram:
These are “nerve tests” which are used to evaluate for carpal tunnel syndrome and additional nerve disorders. These are very safe tests that allow us to document the entrapment or compression of the median nerve at the wrist. Although not currently done in our office, we will coordinate the necessary tests with you to document the presence and severity of carpal tunnel syndrome.
Radiographs are done infrequently for carpal tunnel unless there is an associated condition needing evaluation. Many patients may have an associated concern for arthritis and an X-Ray is often obtained to assess this. However, an X-Ray is unnecessary to diagnose carpal tunnel syndrome.
This is a relatively new tool that we are using for screening. If definitive changes are demonstrated, a nerve conduction study may not be necessary.
Carpal Tunnel Treatment via Non-Surgcial Techniques
Bracing is the gold standard treatment for carpal tunnel syndrome. It can be successful with multiple types of braces. The purpose of the brace is to hold your hand in a neutral position. It does not need to be a rigid construct but rather simple braces that keep your wrist from moving in extension or flexion will achieve similar results. These should not be strapped tightly. Braces are worn primarily at night, when most symptoms occur, but can be worn during the day for repetitive activities such as prolonged driving or those that require heavy or strenuous movement. To our knowledge there is not a specific brace that has been shown to have a significant benefit over another; one that is comfortable for you is preferable.
There are several medicines which have been utilized for carpal tunnel.
- Non-steroidal anti-inflammatory drugs - The most common of which is over-the-counter Ibuprofen or Naproxen. These medications reduce pain and have been shown to help some patients with carpal tunnel syndrome.
- Steroids - A short steroid course may be considered with carpal tunnel syndrome patients if circumstances include inflammation and/or substantial swelling.
- Several other medications have been tried and are infrequently used at MD West ONE. These include diuretics (water pills), Vitamin B6, etc.
- Carpal tunnel injections - Occasionally, for diagnostic as well as therapeutic reasons, a steroid injection can be administered in a sterile fashion for carpal tunnel syndrome. This often improves patient symptoms for two to three months and may allow adequate symptom relief until a more favorable time for potential intervention such as surgery can be identified.
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