By Alexander Germanis
When watering the lawn or washing the car, the second the water ceases to flow, the culprit is usually the same: a kink in the hose. The only way to restore proper water flow is, of course, to relieve the pressure in the hose by straightening it out again.
A kinked hose is usually an easily fixed annoyance, but when something similar happens in the carpal tunnel of the wrist, merely straightening the wrist out again may not be enough to alleviate the pressure.
The carpal tunnel is a narrow passageway in the wrist formed by the transverse carpal ligament and the carpal bones. “The carpal tunnel contains the nine flexor tendons and the median nerve in the wrist,” explains orthopaedic surgeon Dr. Ericka Lawler of Orthopaedic Specialists in the Quad Cities. “Carpal tunnel syndrome develops when there is increased pressure within the carpal tunnel which leads to pressure on the median nerve.”
The number of cases of carpal tunnel syndrome have, in Dr. Lawler’s experience, been on the rise. Although this may be due to an increased awareness of the symptoms and subsequent diagnoses, certain factors may still play a significant role in the apparent increase.
Environmental factors could certainly be to blame, says Dr. Lawler. An increased use of keyboards, repetitive workloads, and poor wrist and/or forearm position are major contributors to median nerve impingement. Typically, those who experience carpal tunnel pain are people in industrial or administrative occupations but are often younger than the most common population of syndrome sufferers.
“As patients get older, the carpal tunnel space narrows – either due to inflammation or arthritis,” Dr. Lawler says. “This population tends to be more female than male in patients over the age of 55. Additionally, many causes of carpal tunnel syndrome have been identified, including patients with inflammatory arthritis, diabetes, obesity, and thyroid disorders.”
Should carpal tunnel release surgery need to be performed, the transverse carpal ligament is divided, which increases the space in the carpal tunnel and, consequently, relieves the pressure applied to the median nerve. Carpal tunnel release is an outpatient procedure usually performed in an ambulatory surgery center.
Two methods can be applied: open and endoscopic. The open method – typically done under local anesthesia – is done through an incision on the palm. “This incision is carried down to the transverse carpal ligament which can then be divided surgically, and pressure is then relieved from the nerve,” Dr. Lawler outlines. “A few skin sutures are then placed along with a soft bandage.”
The endoscopic approach involves an incision in the forearm through which a camera is inserted into the carpal tunnel. The ligament can then be visualized from within and divided. This approach has increased in popularity as the forearm incision tends to be less painful and usually allows for a more rapid return to work.
Advances in the use of ultrasound have improved surgeons’ diagnostic capabilities. “In ultrasound you can actually get measurements of the size of the nerve and visualize the anatomy of the nerve and its relation to the flexor tendons,” says Dr. Lawler. “Additionally, it tends to be less uncomfortable for patients as it only involves a transducer being placed on the skin.”
As with most physical ailments, awareness of the signs and symptoms of carpal tunnel syndrome are important. Dr. Lawler states: “If patients can identify factors in their lives that aggravate symptoms – especially occupational hazards or personal issues such as wrist positioning during keyboarding, repetitive gripping, or nighttime symptoms – then they can maintain nerve health with exercises, ergonomic modifications, or splinting, which may allow them to prevent symptoms from increasing to the point of requiring surgical intervention.”
Orthopaedic Specialists have locations at 3385 Dexter Court, Suite 300, in Davenport, Iowa, and at 2635 Lincoln Way, #D, in Clinton, Iowa. If you would like to request an appointment, please call us at (563) 344-9292. And visit us on the web at
www.osquadcities.com.
