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REGIONAL ORTHOPAEDIC AND SPORTS MEDICINE CENTER

Carpal Tunnel Syndrome and Treatment

December 21, 2017

There are a whole host of conditions that affect the general population that can have special consequences in the active population.  One emerging occupational condition that also affects the athletic population is carpal tunnel syndrome. 

 

Ten to 15 years ago, few people knew what carpal tunnel syndrome was.  Today, it is a household term.  This occurred not because the condition did not previously exist; rather, new diagnostic and treatment options have been developed to find and treat this syndrome.  Carpal tunnel syndrome is actually a nerve entrapment problem.  The median nerve provides sensation and motor functions to various areas of the hand.  In people with CTS, the nerve does not function properly from the wrist and beyond and causes a variety of symptoms.  The wrist bones are called carpals.  On the palm side of the wrist, there is a canal formed on three sides by the carpal bones and on one side by a semi-rigid fibrous structure.  A number of tendons run through the carpal tunnel with the median nerve.  With repetitive motion of the tendons that course through the carpal tunnel, a small amount of inflammatory debris can accumulate.  Due to the close quarters within the tunnel, the median nerve becomes compressed.  It is the entrapment of the median nerve through the carpal tunnel that causes all of the symptoms of CTS.

 

CTS are common among people who perform repetitive motion with their hands.  Occupations at risk include computer operators, machinists, dental hygienist, surgeons, etc.  As you can imagine, repetitive sports motions such as those in golf or tennis may also lead to the development of CTS.  Even if you develop the condition occupationally, it can severely hamper your leisure and sporting activities.

 

Tingling and numbness in the thumb, index and long fingers of the hand are the most common symptoms of CTS.  Weakness may also develop.  Also, in advanced cases there may be palmar muscle wasting.  Diagnosis of CTS is based on the symptoms described above and a variety of manual tests performed in the office.  In questionable cases, electrophysiological studies of the nerve can help eliminate any confusion.

 

Treatment depends on a variety of factors.  In the early stages of CTS, it is worth a try to attempt to eliminate the motions that aggravate the condition.  For example, keyboard operators can use ergonomic devices to keep their wrists in the proper condition.  A cock-up wrist splint helps maintain the optimal wrist position.  This can be especially helpful at night because many people sleep with their wrist flexed.  Flexion of the wrist minimizes the space within the carpal tunnel and can aggravate CTS.

 

Occasionally, an orthopaedist may elect to inject cortisone into the inflamed area.  This can help to calm the irritation and relieve some of the symptoms.  Results from a steroid injection range from no effect, to temporary relief, to a complete cure.

 

In advanced cases of CTS or after the failure of other more conservative treatments, surgical intervention is warranted.  CTS are dealt with by releasing the fibrous roof of the carpal tunnel.  Without the harsh restraint of ligamentous covering, structures within the carpal tunnel have significantly more room.  This effectively serves to eliminate the compression on the median nerve.

 

In years past, carpal tunnel release was quite a large procedure, which took much time to recover from.  However, in recent years carpal tunnel release has been improved and is now minimally invasive and much easier to get over.

 

The procedure has an extremely high rate of success and is done on an outpatient basis.  Keep in mind that other, more rare conditions can cause some of the same symptoms as CTS.  For this reason it is advisable to seek the advice of a physician if you believe that you may have CTS.  Additionally, early diagnosis may reduce the need for surgical intervention in some cases.

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