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Anatomical Considerations Leading to Carpal Tunnel (CTS) syndrome

We see many patients from Cary, Raleigh, Apex, Chapel Hill, Garner and the Triangle with symptoms of CTS syndrome. The median nerve courses from the cervical spine (neck) down the arm and into the hand. As it travels through the wrist it passes through a tunnel formed by the carpal bones of the wrist and a binding or stabilizing tissue called the Flexor Retinaculum. The median nerve transmits sensation and motor functions to a specific portion of the hand. CTS syndrome is a disorder of the hand created by impingement of the Median nerve between the carpal bones and the Flexor retinaculum as it passes through this tunnel at the wrist. The Flexor retinaculum keeps the tendons and nerves that pass under it in place and provides protection for the nerve. Overuse of the hand and wrist, or excess pressure directly on the carpal tunnel can create inflammation and pressure and produce the symptoms of CTS syndrome, such as hand numbness and hand pain.

What Are Specific Causes of Carpal Tunnel (CTS) syndrome?

There is no one specific cause that may create CTS syndrome but usually there are many factors involved. Often times the condition is caused by an accumulation of many predisposing factors that finally culminate in the production of symptoms. As the human body is a very dynamic structure, as factors accumulate and associate with normal aging, this in and of itself can create the trigger that produces the symptoms.

CTS syndrome is most often seen in the age range from 30- 60 years much more often in women than men. It is often associated with heredity or genetics with possible predisposition to body make up, with speculation that the size of the carpal tunnel itself can be genetic. CTS syndrome symptoms are often seen temporarily in pregnancy and also post-menopausal. Other factors considered are obesity which has been found to be the best predictor of CTS syndrome, inflammatory arthritis, and diabetes. There are many other medical conditions that can play a contributory role in developing CTS syndrome. Mechanically the median nerve can become impinged with improper ergonomic set up at work, repetitive overuse activities or continual pressure to the wrist and hand (road or mountain biking). One may also have neck impingement from a bone spur/arthritis or a disc herniation that can create isolated or contributory problems with the median nerve at the hand.

What Are the Symptoms of Carpal Tunnel (CTS) syndrome?

Symptoms normally associated with CTS syndrome include hand numbness and hand pain and tingling in the hand and fingers. Usually there are no associated sensation changes with the little finger.

One may complain of shooting hand pain that feels as if it travels up the arm from the wrist. There may be a feeling of swelling or fullness in the fingers. The most common complaint is loss of sensation at when asleep that may awaken you. Fine motor control may be diminished, and result in dropping objects or a feeling of weakness and loss of hand coordination may occur. The symptoms are often relieved by a change in position, or pressure relief.

How Is Carpal Tunnel (CTS) Syndrome Diagnosed?

The history and physical exam usually allow for a straightforward clinical diagnosis of CTS syndrome. There are specific tests that can be conducted clinically to reproduce the symptoms and sometimes your physician may elect to perform electro-neuro diagnostic tests such as nerve conduction velocity.

In the event of difficulty localizing the area of nerve impingement (neck, elbow or wrist) it may be diagnostic as well as therapeutic to perform a local steroid injection into the carpal tunnel to establish this differential diagnosis.

Other CTS syndrome treatment modalities that may provide both therapeutic and diagnostic benefits would include wrist splints for both day and nighttime use, and ergonomic changes (keyboard, mouse etc).

Specifics Of Conservative Treatment

Once the diagnosis of CTS has been made there are multiple conservative options to consider. Your physician should strive to identify any medical causes for the condition such as obesity, poor circulation, fluid retention, pregnancy or any other inflammatory medical condition. Measures should be taken to address these medical conditions first. In conjunction with any identifiable medical condition, external causes should be examined. Once these causes are identified, measure should be taken to correct such as ergonomic changes, splinting for rest and pressure relief, activity modification, antiinflammatory medications or steroid injections in indicated cases. Stretching of the wrist forearm musculature may also be helpful and can be directed by your physician or physical therapist.
 

Are There Risks To Having This Condition Unresolved?

While this condition is not life threatening or medically serious it can present with progressive loss of feeling and function in the hands. If allowed to persist, this damage can become permanent. In the event of circulatory compromise in the Carpal Tunnel you may experience tissue damage as well.
 

Surgery:

Surgery for this condition may be performed either open by making an incision or endoscopic by using specific instrumentation that does not require an incision but rather a puncture approach. It has been found that both procedures over time are equally effective. The surgery can be conducted under local or general anaesthesia.
 

Post Operative Considerations

Although this surgery is considered to be successful in 95% of all cases, the recovery periods can vary.

The lesser the preoperative symptoms the quicker the post operative recovery period. In the event of significant pre surgical numbness that has been constant and long lasting, it may take a full year to recover, and some patients report some sensory loss that does not dissipate.

The same results may occur with weakness and muscle wasting around the thumb.

One common and persistent complaint post-operatively is that of aching and weakness in the base of the hand near the surgical site. This complaint eventually settles down after a few months.

For those patients that work in heavy lifting and manual labor, the residual effects from surgery on a progressed CTS could result in having to change to another line of work less manually intensive.

As with surgery of any type, complications exist but in this instance are rare. One must be aware of the possibility of infection or extensive bleeding, residual nerve, artery or tendon damage, stiffness, unresolved pain,color or sensory abnormalities and stiffness. At any point this causes concern you should feel free to discuss with your surgeon either pre or post-operatively.

For more information on how the carpel tunnel prevention specialists at Cary Orthopaedics can help you, contact us today at 919-467-4992 for an appointment!

Cary Orthopaedics serves patients from Raleigh, Garner, Cary, Apex, Holly Springs, Fuquay-Varina, Clayton, Chapel Hill, and Pittsboro, NC