Carpal Tunnel Syndrome

We live in the digital age. Whether on our smart-phone, I-pad, or home/work computer, we all spend many hours each week texting or typing on a device.  We are all potentially putting ourselves at risk for carpal tunnel syndrome.

What is carpal tunnel syndrome?

Carpal tunnel syndrome (CTS) is entrapment or compression of the median nerve at the wrist. Around 3-5% of people are affected with CTS. This syndrome causes numbness and pain, and can progress to a decrease in muscle and weakness of the areas innervated by the median nerve. You will most likely notice both hands being affected with CTS, although your dominant hand is usually more severely affected.

What are the symptoms of carpal tunnel syndrome?

Do you ever find yourself awakening in the night with hand numbness or pain? This is an early symptom of carpal tunnel syndrome.  Symptoms during the day are worsened by activities that require repetitive motion.  Shaking your hand repeatedly can improve symptoms.

The pain associated with carpal tunnel syndrome usually includes numbness and tingling in the hand within the distribution of the medial nerve – usually the thumb, index, and middle finger and the radial half of the 4th finger. Some risk factors for developing CTS include diabetes, obesity, female gender, pregnancy, menopause, and especially Workplace factors – repetitive wrist motion, extreme wrist flexion or extension, repetitive vibration exposure.

How can I be tested for carpal tunnel?

-The “gold standard” test of CTS is electrodiagnostic testing. Electromyography (EMG) and nerve conduction studies can confirm the diagnosis and determine the severity of nerve damage

-Ultrasound is more routinely utilized in our office and is a quick and effective way to determine the extent of nerve damage to the median nerve. An ultrasound probe is placed at the carpal tunnel in the wrist, and 12 cm higher up the arm. The median nerve is measured at both locations and a ratio > 1.2 mm at the wrist is considered positive for carpal tunnel syndrome.

What treatment do we offer for carpal tunnel syndrome?

Nonsurgical treatment of carpal tunnel syndrome includes home stretches, physical therapy, wrist splints and injection therapies. The most conservative approach would be Osteopathic Manipulation.  Dr. Chappell is board certified in osteopathic manipulation techniques (OMT) that can provide a substantial amount of relief. OMT techniques that have been shown to reduce median nerve compression within the carpal tunnel.

Injections would be next on the list for conservative treatments.  In our office we perform a procedure called hydrodissection.  With the assistance of ultrasound, we inject small amounts of fluid to “free up” the median nerve and separate the nerve from any adhesions to surrounding ligaments/tissues.  This allows the nerve to move more freely and provides permanent relief of symptoms.

Surgical treatment should be considered as a last resort. Surgical options include open or laparoscopic decompression of the carpal tunnel with release of the transverse carpal tunnel ligament. 

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