Carpal Tunnel Syndrome Home page (+ links to ergonomic pages):
http://www.netaxs.com/~iris/cts/welcome.html
http://www.repetitive-strain.com/
http://www.miamihand.com/carpal1.html
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"...despite popular opinion, (Carpal tunnel Syndrome) is not caused by
using a keyboard."
Understanding Carpal Tunnel Syndrome
By: Alejandro Badia, M.D.
Hand and Upper Extremity Surgeon
Miami Hand Center
Carpal Tunnel Syndrome is an extremely common as well as a very
misunderstood condition.In recent years, it has received much coverage
in the press but is still not completely understood even by the
scientific community.
The media has branded this condition as an occupational disease because
of workers linking pain in their hands to repetitive activities such as
typing or assembly line work.
Despite popular opinion, this condition is not caused by using a
keyboard. However, if one has a predisposition to this condition,
repetitive activity such as typing can aggravate it.
Carpal Tunnel Syndrome simply means that there is a compression of the
median nerve in the hand. This nerve sits inside a tunnel in the hand
whose floor and walls consist of bones known as carpal bones. The roof
of this tunnel is a structure called the transverse carpal ligament.
Besides the nerve, there are nine tendons which flex the fingers and
thumb and run in the canal.
When lining around these tendons is inflamed, there is less space for
the nerve and it becomes compressed. This compression of the median
nerve leads to the symptoms of Carpal Tunnel Syndrome.
The symptoms most often reported with Carpal Tunnel Syndrome are
numbness and tingling in the hand which often begins at night. Often
there is also pain and weakness in the hand, particularly in the thumb.
If allowed to progress for many years untreated, this could lead to
atrophy of the muscles in the base of the thumb.
Besides the physical symptoms of Carpal Tunnel, the diagnosis is easily
confirmed by a simple nerve conduction study. This measures the velocity
and the latency of the nerve impulse across the median nerve at the
wrist and can tell the physician if the patient has a compression of the
median nerve.
The condition most commonly occurs in middle-aged women, often
perimenopausal. It can be caused by chronic conditions such as diabetes,
gout or thyroid disease. It is also commonly seen in woman in their
third trimester of pregnancy. When any of these other conditions are
ruled out, the condition is labeled idiopathic meaning caused by an
unknown process.
Carpal Tunnel Syndrome often coincides with related conditions such as
tendonitis in the fingers, (trigger finger) of tendonitis in the wrist.
DeQuervain's tendonitis, for example, leads to pain in the wrist at the
base of the thumb.
The treatment for Carpal Tunnel is often directed at decreasing the
inflammation of the tendons. Injections of steroids such as cortisone
can lead to a decrease in the swelling. This will allow the median nerve
more room in the carpal tunnel and relieve the pain. The most common
treatment without the use of drugs or injections is a night splint. The
splint does not allow the patient to flex their wrist at night which
often occurs during dreaming. This relieves some of the pressure within
the canal.
Symptoms are magnified at night because the position of the hand is at
the same level of the heart while laying down leading to pooling of the
fluid in the soft tissues within the canal. There are also hormonal
changes which are quite complicated that can lead to increased fluid
retention at night. As a remedy to this, some researchers believe that
high doses of Vitamin B-6 can act as a diuretic and decrease fluid in
the carpal canal leading to relief of symptoms.
If the compression is severe enough and the patient does not respond to
conservative treatment, the next step would be surgery. Surgery for
Carpal Tunnel Syndrome is also misunderstood by the public as well as
physicians. Rumors abound as to the final outcome after these
procedures. People think they will lose functioning in their hand if
they have surgery. The truth is that surgery is extremely successful.
This surgery actually entails a very simple concept. A division is made
in the ligament which serves as the roof of the carpal tunnel. This
increases the space in the carpal tunnel allowing the median nerve to
function better.
The most recent breakthrough in treatment of Carpal Tunnel, which is
commonly used at the Miami Hand Center, is called endoscopic release. In
this procedure, an incision of less than one centimeter is made in the
crease of the wrist and an endoscope, a tiny camera, is inserted. This
allows the surgeon to literally see the inside of the hand and make the
division of the ligament without a large, open incision.
This is not a laser surgery, but rather surgery using fiber optic
technology, allowing a surgeon to operate "from the inside out." This
means that tender tissue is not violated and there is minimal if any
pain after the procedure. The main advantage of this technique is not
only minimizing the unsightly scar, but also increased recovery time
which allows you to return to work quickly.
The long term results of endoscopic release of Carpal Tunnel Syndrome is
excellent with many more benefits to the patient than traditional means
of treatment. Patients occasionally complain of some soreness in the
palm when resting their hand upon a hard object, but otherwise, there
are minimal complications or pain after the procedure.
The key to understanding Carpal Tunnel Syndrome is to think if this as a
pinched nerve which occurs in the wrist and leads to symptoms such as
numbness or tingling. These are many other painful conditions in the
hand and wrist which need to be evaluated by a surgeon specializing in
such problems. Confirmations by nerve conduction studies is usually done
by either a rehab medicine specialist or a neurologist.
Carpal tunnel Syndrome is an easily diagnosable and treatable condition
when appropriately diagnosed by a trained physician. If you have pain in
your hands, take heart, don't quit your typing job. Call the Miami Hand
Center for an appointment and free yourself from this unnecessary pain.
For more information regarding Carpal Tunnel Syndrome or any upper
extremity concerns, please call
the Miami Hand Center
Dr. J. Orbay, Dr. A. Badia or
Dr. K. Khouri at 661-3000.
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