Carpal Tunnel Syndrome
Carpal
tunnel syndrome (CTS) is one of the most common conditions affecting
the hand and wrist. It causes numbness, pain, and loss of
hand function.
CTS occurs when the major nerve that serves the
hand becomes compressed in a tunnel formed between a ligament and the
bones of the wrist. This nerve is responsible for most of the
feeling in the hand, and its ability to grip and pinch.
CTS
frequently is associated with repetitive hand movements, such as
keyboard or computer mouse activity. It also can occur as a
result of fluid retention during pregnancy, or as a result of some
other medical conditions such as diabetes, hypothyroidism, and
rheumatoid arthritis. Most often, however, the cause is not known.
Classic symptoms of CTS include:
• Numbness and/or pain in the palm of the hand and fingers
• Worsening of symptoms at night
• Weakened grip
A Nerve Conduction Study is sometimes used to help diagnose CTS and to rule out other possible causes.
Treatment
of CTS depends on severity as well as other factors. Conservative
management (splinting, medication, and activity modification) is
generally tried first, particularly in mild cases.
When symptoms
persist despite conservative treatment, surgical treatment is often
appropriate. Surgery for CTS is done as an outpatient under local
anesthesia, with sedation. A short incision is made in the palm,
and the tightness in the tunnel is released by dividing the
ligament. Relief of pain and numbness is usually immediate,
unless the nerve has been damaged by longstanding compression.
A
wrist splint is worn after surgery, full time for 10 days and part time
for another 10 days, with light activity allowed almost
immediately. Most patients are able to resume their usual
activities after three weeks.