Carpal Tunnel

Carpal Tunnel Syndrome

  • Carpal tunnel syndrome (CTS) is the result of swelling in the lubricating membrane (synovium) of the wrist; reducing the space, or tunnel, where the nerve travels from the forearm into the hand. When this tunnel swells, the resulting pressure can cause irritation and pain in the nerves of the wrist.
  • The condition can range from mild to severe with possible symptoms including numbness, weakness, pain, or loss of control of the fingers.
  • Carpal tunnel syndrome is often a repetitive strain injury resulting from performing the same motion(s) over and over in anything from computer to factory work. It can also be the result of conditions ranging from hormonal changes to sugar diabetes to arthritis.
  • Preventative measures such as good posture, frequent breaks from repetitive motion, massaging and stretching your hands and arms to improve circulation reduce the risk of injury.
  • Non-surgical treatmentin mild cases include rest, wrist splints, heat to relieve pain and/or cold to reduce inflammation.
  • Anti-inflammatory medication (NSAID’s) or corticosteroid injections into the tunnel may also be prescribed.
  • Persistent symptoms and advanced cases may require surgery. Cutting the ligament on the top of the carpal tunnel reduces pressure on the nerve.
  • Numbness or tingling–that may extend to the thumb, the first three fingers, or the palm, it is especially common at night and after using the hands repetitively.
  • Decreased sensation in the thumb and first two fingers.
  • Weakness or reduced control in the grip or a tendency to drop things.
  • Persistent pain in the wrist or forearm.
  • The patient has the signs and symptoms of carpal tunnel syndrome.
  • After treatment, the patient experiences persistent pain, weakness, numbness or tingling.
  • The patient experiences unexplained symptoms, other types of pain, or unexpected side effects from medication.
  • Repetitive motion including tight grasping and bending of the wrist.
  • Injury to the wrist, such as broken bones, which cause swelling.
  • Arthritis.
  • Sugar diabetes.
  • Hormonal changes such as pregnancy and menopause.
  • Hyper or Hypo thyroidism

Few advances in surgical techniques have been as beneficial as the development of arthroscopic surgery. An arthroscopic procedure greatly reduces the “invasiveness” of surgery; it allows a surgeon to make only a few small incisions instead of one large incision – as is common with open procedures. A reduction in surgical invasiveness is helpful for many reasons, one of which is the improvement in recovery time after surgery.

A primary tool of this surgery is the arthroscope, a small fiber-optic viewing instrument, which projects images onto a monitor, allowing the surgeon to look deep inside the joint. The arthroscope can be placed and positioned within the joint to give detailed views of internal structures, providing physicians with an excellent tool to examine, diagnosis and treat patients. Arthroscopic surgical procedures use specially designed instruments that are inserted through other accessory incisions; the arthroscope allows the physician to closely monitor the procedure as they treat the patient.

During an arthroscopic procedure, the surgeon inserts the arthroscope through a tiny incision (about 1/4 of an inch) into the joint. Usually the joint is made to slightly distend, or expand through the introduction of fluid that also clears away any blood. If the procedure calls for treatment, other incisions, called portals, are then made to allow the surgical tools to enter the joint. These incisions result in very small scars, which in many cases are unnoticeable after time.

The arthroscope was first used as a diagnostic tool; the name literally translates “to look into a joint,” but has since greatly developed in use. With advances in instrumentation and surgical techniques, the arthroscope has become a standard surgical tool as well, used to treat all major joints in the body. The instrument is a small size, only 3 or 4 mm in diameter, yet it incorporates a fiber-optic camera, a light source, a lens and a flexible mounting system.

  • The length of recovery before resuming normal activities varies from several weeks to several months depending on the age of the patient and the severity of the injury.
  • Following surgery, numbness may persist for a period of time in more severe cases, and some lingering tenderness at the incision site is common.
  • Participation in a hand therapy program to improve strength, flexibility, and circulation following surgery.

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