By Becky Wiese
Tingling. Burning. Waking up at night with hand numbness and wrist pain. Weakness in the hand. These are just a few of the more common symptoms of carpal tunnel syndrome (CTS). Every year, more than half a million people in the US alone undergo surgery to alleviate the pain of carpal tunnel syndrome, making it one of the most common hand surgeries performed.
Carpal tunnel syndrome occurs when the ligaments in the wrist thicken and compress the median nerve that lies underneath in the carpal tunnel, according to Dr. Emilio Nardone, a neurosurgeon at Central Illinois Neuro Health Sciences. The median nerve supplies sensation to the middle and index fingers, half of the ring finger, and the tip of the thumb.
“Carpal tunnel typically presents with numbness, which often worsens at night, and causes the patient to attempt finding relief by shaking the hand. Sometimes the pain also occurs in the wrist and forearm up to the elbow,” Dr. Nardone explains. “It’s a common problem, affecting about three to six percent of the population. Many times, both wrists are involved, although the dominant hand typically has more pain.”
The causes vary. Repetitive motion is a common culprit, and, because many jobs and activities involve doing the same motion over and over, the professions of people who often suffer from CTS differ even though their symptoms are similar. Computer users and typists often complain of carpal tunnel symptoms, but heavy-labor jobs that involve repetitive motion, especially combined with cold temperatures or vibrating machinery, have an even higher incidence.
Workers in the meat and fish industries and airplane assemblers, for example, have some of the highest incidences of CTS, although jackhammer operators, painters, seamstresses, even musicians — any activity which requires the wrist and arm to be at specific angles over a long period of time — can be susceptible.
Other factors can also play a part. Women seem to be more likely to experience carpal tunnel syndrome — up to three times more likely than men — perhaps because their wrists, and therefore their carpal tunnels, are smaller. Hormones also seem to have an effect. Overweight people, the elderly, and those with diseases such as diabetes, high blood pressure, and thyroid problems are prone to developing the problem.
Mild symptoms can be treated by stopping the activity, resting, icing the wrists, and using an anti-inflammatory medication. Wearing a wrist splint at night can help significantly, as it will take pressure off the median nerve.
However, if the pain is severe and non-surgical options, including steroid shots and other medical interventions, have not mitigated the problem, surgery may be indicated. Tests would be conducted first to verify that carpal tunnel surgery is warranted. These tests involve simple nerve exams, x-rays, and nerve conduction tests to verify the diagnosis.
Carpal tunnel surgery is quite common and is typically done by cutting a vertical opening into the wrist and hand (at the bottom of the palm) over the carpal tunnel ligament. The ligament itself is then cut to release the ligament and eliminate the pressure. This surgery uses a vertical cut into the wrist and base of the palm. “The surgery is very common and is well tolerated,” says Dr. Nardone. “It usually requires a few weeks of recovery.”
Dr. Nardone recently started offering patients another surgical option — one that requires a smaller incision and even less recovery time. “The endoscopic carpal tunnel release procedure is a minimally invasive surgery that utilizes a very small incision, about one centimeter, horizontally in one of the wrist creases. The incision allows for the endoscope to pass under the ligament, then, with the blade that is attached to the endoscope, the ligament is released (cut) as the endoscope is withdrawn from below the ligament.”
Both surgeries accomplish the goal — relieving pressure on the median nerve — but the endoscopic surgery, because it uses such a small incision and does not require the palm and wrist to be open as in the traditional surgery, does not disrupt the soft tissue.
“The benefits to this are numerous,” says Dr. Nardone. “Recovery is faster, with less pain. There is a faster return to function; the incision looks better cosmetically. There is also decreased chance of infection and fewer wound-care problems because there are fewer sutures. Overall, there is less scarring over the nerve, providing less chance of recurrence.”
For patients who suffer from CTS, the endoscopic carpal tunnel release surgery is an option to consider to make numb and tingling hands a thing of the past.
Central Illinois Neuro Health Sciences is located at 1015 S. Mercer Ave. in Bloomington. For more information or to schedule a consultation, you may contact them at 309-662-7500 or through their website, cinhs.com
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