Carpal Tunnel Syndrome
Dr. John Buckley has specialized training in surgery of the hand and upper extremity. He received his medical training at the University of Cincinnati and completed a residency at the Mayo Clinic. In 1974, he founded the University Orthopaedic Clinic with Dr. H. Chester Boston. He is particularly interested in microvascular surgery and surgery of the hand and completed a fellowship with the Mayo Graduate School of Medicine in those areas.
Q: Please explain what Carpal Tunnel Syndrome is.
A: Carpal Tunnel Syndrome or CTS is a condition that occurs when the median nerve is compressed as it passes through the carpal canal or tunnel. Located at the wrist, the carpal tunnel is a bone and ligament structure that contains tendons and the median nerve. CTS occurs when the contents of the carpal tunnel expand putting pressure on the median nerve. Several things can decrease space in the carpal tunnel: the synovium or covering of the tendons in the carpal tunnel may become thickened, a previous dislocation or wrist fracture may narrow the canal, and sometimes fluid retention causes swelling that can compress the nerve. Rarely a small cyst can occupy space in the canal compressing the nerve.
Q: Is it true that symptoms are often first noticed a night?
A: Yes. Many patients first experience CTS symptoms when they are awakened by pain, numbness or tingling. Exercising the hand may make the symptoms go away at first but if ignored, the pain may worsen, the grip may weaken and patients may begin dropping things. Untreated CTS can sometimes cause permanent damage if symptoms are more than occasionally present.
Q: What is the difference in endoscopic carpal tunnel release and an open procedure?
A: There are two techniques for releasing pressure on the median nerve at the wrist. One involves dividing the constraining ligament through an incision placed over the ligament. The other technique involves dividing the ligament from inside using an endoscope which is placed through a small incision on the palm and another at the wrist. There are, of course, many variations on these two basic approaches. During the first few weeks following the operation, the endoscopic technique may result in less discomfort. Several months post operatively there is little difference between the two techniques. The potential for complication is somewhat higher using the endoscopic technique.
Q: Is surgical decompression the only treatment for CTS?
A: No. An operation is needed when the patient has severe pain or is in danger of developing permanent nerve damage. Usually CTS is treated first by splinting the wrist and/or giving medication. These treatments are more successful when CTS is diagnosed early. Splints are designed to keep the wrist in a “neutral” position to relieve pressure. Medications such as anti-inflammatory drugs are used to reduce swelling and inflammation.
Q: Is CTS a work-related condition? What kinds of tasks may contribute to CTS?
A: Certain repetitive hand activities may be associated with an increased incidence of CTS, such as the movements common to garment workers, packing house workers, certain assembly workers, musicians and computer operators. The relationship between work place activities and carpal tunnel syndrome is not well defined since the majority of workers in any given occupation do not have trouble with carpal tunnel. Some studies have demonstrated that factors such as age, gender and body size may play a role in increasing an individual’s susceptibility to carpal tunnel. Other factors can contribute to the development of the condition and should not be overlooked. These include diabetes, thyroid disorders, inflammatory arthritis and pregnancy.
Q: What can I do to lessen my chances of developing CTS?
A: First, be sure to follow your company’s hand and wrist safety policies and procedures. Then avoid using your wrist in a flexed, extended or twisted position for long periods of time. Avoid repetitive movements taking brief breaks to rest your wrist. Alternate easy and hard tasks, switch hands or rotate work activities. Use power tools whenever possible, but avoid continuous exposure to vibration and slow down when making forceful, repetitive movements.