Relief from Carpal Tunnel Syndrome
Say the words “carpal tunnel syndrome,” and most people think of wrist pain resulting from too much time spent at a computer keyboard. Interestingly, studies looking at the connection between excessive computer use and carpal tunnel syndrome have not found enough evidence to support a link.
In fact, although a number of factors have been associated with carpal tunnel syndrome – including anatomy (a smaller carpal tunnel), gender (it’s more common
in women), nerve damaging conditions, inflammation and thyroid disorders – none of these factors has been established as a direct cause of carpal tunnel syndrome.
What Is Carpal Tunnel Syndrome?
The carpal tunnel is a narrow passageway located inside the palm side of the wrist that is surrounded by bones, tendons and a wide band called the transverse carpal ligament. The tunnel protects the median nerve – a main nerve running from the forearm into the palm of the hand that controls sensations to the palm side of the thumb and fingers, except for the little finger. The nerve also controls impulses to some small muscles in the hand that allow the fingers and thumb to move. Carpal tunnel syndrome results when a thickening from irritated tendons or other inflammation narrows the tunnel and causes the median nerve to be compressed.
Symptoms of carpal tunnel syndrome include:
• pain or numbness in the hand, wrist or forearm
• numbness or pain in the fingers that causes waking at night
• loss of thumb function and hand dexterity
• reduced strength and grip in the fingers, thumb and hand
Patients with carpal tunnel syndrome typically complain of numbness or pain at night, which frequently wakes them from sleep. “Many patients come in with bags under their eyes due to months or even years of poor sleep,” says Phelps hand surgeon Jeffrey Jacobson, MD.
There are other conditions that cause symptoms similar to those of carpal tunnel syndrome, including injury to the muscles, ligaments, tendons or bones; nerve problems in the fingers, elbow or neck; and arthritis in the thumb joint or wrist.
To diagnose whether you have carpal tunnel syndrome, your doctor will:
• Review your symptoms, making note of when symptoms occur
• Conduct a physical examination, testing the feeling in your fingers and the muscle strength in your hand
Your doctor may also conduct a nerve conduction study or an electromyogram, which is a test that measures the electrical activity of your muscles and can rule out muscle damage and other conditions. “A recent nerve conduction study is very helpful when discussing how much nerve damage has already taken place. It is not uncommon for patients to already have had nerve tests performed at the direction of their primary care physicians before they arrive in my office for a consultation,” says Dr. Jacobson.
Cross-section of the carpal tunnel
Carpal tunnel release, decompressing the median nerve
Carpal tunnel syndrome should be treated as early as possible after symptoms begin. If the condition is diagnosed early, nonsurgical methods may help improve carpal tunnel syndrome. Methods may include wrist splinting, non-steroidal anti-inflammatory drugs, or corticosteroids. Splinting and other conservative treatments are more likely to help someone with mild to moderate symptoms that have been present for less than six months.
If symptoms are severe or persist for more than six months, despite trying nonsurgical therapy, surgery may be the most appropriate option. Carpal tunnel release is one of the most common surgical procedures performed in the U.S.
In performing standard open surgery, which is done under local anesthesia or with sedation from an anesthesiologist, the surgeon makes a two-inch incision in the palm of the hand above the carpal tunnel and cuts through the ligament. This enlarges the carpal tunnel and frees the nerve. Following surgery, soreness or weakness may persist for
several weeks to a few months. Patients generally return to work in two to six weeks, depending on their occupation.
Endoscopic Carpal Tunnel Release (ECTR)
During the minimally invasive procedure known as an Endoscopic Carpal Tunnel Release or ECTR, the surgeon makes a tiny incision (1/2 inch) in the wrist and inserts an endoscope (a telescope-like device with a tiny camera attached to it) to see inside the carpal tunnel. He then divides the ligament, relieving the pressure. The procedure takes approximately 10-15 minutes and can be comfortably performed under local anesthesia with the patient fully awake or with light sedation from an anesthesiologist. The incision site needs no bandage and patients can shower immediately after surgery.
ECTR is a very specialized procedure and should be performed only by a surgeon who has performed it many times. Dr. Jacobson, who has performed hundreds of these procedures, recently brought the technique to Phelps, one of the few Westchester facilities where it is offered. Surgery brings permanent relief to almost all patients, says Dr. Jacobson. Compared to traditional open carpal tunnel release surgery, patients typically have significantly less pain afterwards and return to work and leisure activities more quickly. Office workers are usually back at work within two to four days, and those who perform physical labor can return to work as soon as they feel up to it, often in less than two weeks. There is some soreness in the palm for a few days, but no bandage is required and there are no restrictions regarding showering.
The change in his patients’ physical appearance after surgery is remarkable, says Dr. Jacobson. “When they no longer have numbness and pain, patients stop waking up at night. This often results in their looking refreshed and healthier, even by their first follow-up visit two weeks later. Often their only complaint is having to come in for the follow-up appointment at all, since they’re feeling so good!”
Jeffrey Jacobson, MD, received his medical degree from SUNY-Stony Brook and completed a residency in plastic surgery at Georgetown University Hospital. Board certified in plastic surgery, Dr. Jacobson is fellowship trained in orthopedic hand and wrist surgery with a specialty in microvascular and peripheral nerve surgery at University of Pittsburgh
Medical Center. In addition to hand surgery, he performs the full breadth of plastic surgery. Dr. Jacobson has offices in Harrison and Katonah (914-421-0123).