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Wrist Pain

Are You a Candidate for Carpal Tunnel Syndrome Surgery?

Have you been ignoring that numbness and tingling sensation in your wrist and hand, thinking it’s just a passing cramp?

How about that sharp and piercing pain that shoots through your wrist and up your arm?

Chances are you have carpal tunnel syndrome—a painful and progressive condition caused by the compression of the median nerve.

Cause

The Median Nerve runs from the forearm into the palm of the hand. When it becomes compressed, carpal tunnel syndrome occurs. The median nerve controls sensations to the palm side of the index, middle and ring fingers and the thumb (excluding the little finger). The carpal tunnel is the rigid and narrow passageway of bones and ligament situated at the base of the hand and houses the tendons and the median nerve.

Sometimes, the thickening of irritated tendons (and other swelling) may narrow down the carpal tunnel and cause the compression of the median nerve. The compression can result to weakness, numbness, and pain in the hand and fingers. In other cases, the pain and numbness may radiate up the arm.

Symptoms

Carpal tunnel symptoms often appear gradually. Frequent tingling, burning, and numbness are felt in the palm of the fingers and the hand. In some cases, carpal tunnel sufferers may feel their fingers are swollen when little or no actual swelling occurs. Many people report the symptoms are more pronounced at night, often waking them up from sleep. Many report the feeling of wanting to “shake out” the tingling and numbness. Some obtain relief by hanging their hand over the bed.

As the symptoms worsen, tingling might already be felt during the day. Other symptoms of carpal tunnel syndrome include difficulty grasping objects, decreased grip and pinch strength, and difficulty performing manual tasks. In untreated and chronic cases, the muscles found at the base of the thumb may waste away (atrophy).

Diagnosis

To avoid permanent damage to the median nerve, early diagnosis and treatment is important. A physical examination of the arms, shoulders, neck, arms, and hands will be carried out to gauge if the condition is related to day-to-day activities or an underlying disorder. Other conditions that mimic carpal tunnel syndrome will also be ruled out.

The wrist will be checked for swelling, warmth, discoloration, and tenderness. Fingers will be tested for sensation. Muscles situated at the base of the hand will also be checked for signs of atrophyCertain tests (i.e. the Tinel and Phalen’s tests) will also be performed to ensure an accurate diagnosis. In most cases, electrodiagnostic tests will be conducted to confirm the diagnosis. The speed of the nerve impulses will be measured by sending small electric shocks through electrodes placed on the wrist and hand on either side of the tunnel. This is called nerve conduction test (NCT). In electromyography (EMG), a fine needle will be inserted into the muscle and electrical activity will be viewed on a screen. The test is done to determine the severity of the median nerve damage.

Treatment

Minor cases of carpal tunnel syndrome are treated using nonsurgical methods. However, surgery is recommended when:

  • Symptoms have not improved after several weeks or months of conservative treatment (this is assuming there are no signs of nerve damage. Otherwise, surgery will be performed immediately).
  • Severe symptoms will make carrying out daily activities possible (i.e. loss of coordination or feeling in the hand or fingers, decreased thumb strength, and when sleep is already disturbed by severe pain).
  • There is a risk of damage or existing damage to the median nerve.

Non-Surgical Treatment

Medications – Nonsteroidal anti-inflammatory drugs like ibuprofen and aspirin may minimize the swelling and alleviate the pain from carpal tunnel syndrome. Nerve medications may also be prescribed.

Lidocaine may also be injected directly into the wrist to relieve pressure on the median nerve and temporary but immediate relief to patients with mild or intermittent symptoms.

Exercise and splinting– Stretching and strengthening exercises can be beneficial for those patients whose symptoms have abated. The exercises may be supervised by an occupational or physical therapist. Plastic wrist immobilisers may be fitted at night to rest the wrist in a neutral posture.

Alternative Therapies – Some patients report benefiting from alternative treatment interventions like chiropractic care, acupuncture, and yoga.

Surgery

Carpal tunnel release is generally recommended for symptoms that have lasted for 6 months. The procedure will reduce the pressure on the median and will involve severing the band of tissue forming the roof of the carpal tunnel. Surgery is performed under local anesthesia thus overnight hospital stay will not be required. The types of carpal tunnel release surgery are:

Open release surgery – this is the traditional procedure performed to correct carpal tunnel syndrome. It involves making an incision in the wrist (at least 2 inches) and cutting the carpal ligament in order to enlarge the carpal tunnel. The procedure is done on an outpatient basis and under local anesthesia.

Endoscopic surgery – this procedure is associated with less postoperative discomfort and faster functional recovery compared to the traditional open release surgery. The surgeon will make two incisions (at least ½ inch each) in the palm and wrist and inserts a camera that is attached to a tube. The tissue will be viewed on a screen when the carpal ligament is cut. The procedure is performed under local anesthesia and is preferred by many as it allows patients to commence doing normal activities in a shorter period of time.

While symptoms are immediately resolved after surgery, full recovery will take months. Occasionally, the wrist will lose strength when the carpal ligament is cut. Occupational or hand therapy is recommended after surgery to help restore wrist strength.

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