Carpal Tunnel Syndrome

Carpal tunnel syndrome is a hand condition that most people have heard of, and it’s common enough that you probably know someone who has it. The most common carpal tunnel symptoms are numbness, tingling, burning pain or weakness and clumsiness of the hand. Fortunately the treatment of this condition is relatively simple. The treatment options for carpal tunnel syndrome include a wrist brace or wrist splint, steroid injections, or a surgery to relieve pressure on the nerve.

What is carpal tunnel syndrome?

The carpal tunnel is a narrow space at the base of the palm through which nine tendons and a nerve pass from the wrist into the hand. The tunnel is surrounded by wrist bones on three sides, and a strong ligament forms its roof. In some patients, the ligament becomes thick and tight, and squeezes the nerve. Alternatively if the contents of the tunnel become swollen, the nerve is squeezed between the wrist bones and the strong ligament. This compression irritates the nerve, leading to a variety of symptoms in the hand. Numbness, tingling, pain, weakness, clumsiness, and waking up at night with discomfort are all commonly experienced. The symptoms often come on slowly, or only with certain activities (like driving, or using a computer mouse). Many patients ignore the symptoms at first, until suddenly – months or even years after they began – you realize that your hand is in constant discomfort. Waiting too long to seek treatment for carpal tunnel syndrome is dangerous, because weakness and numbness of the hand can progress to the point of becoming irreversible.

What causes carpal tunnel syndrome?

We don’t yet fully understand what sets off the process of nerve compression and irritation. For example, when computers were first becoming common, there was widespread concern that using a mouse or a keyboard could cause carpal tunnel syndrome. Given how much we all use computers, this has fortunately not been proven to be true. Research performed by the Department of Plastic Surgery at UT Southwestern has shown that certain factors do seem to increase the risk of carpal tunnel syndrome. It is more common in people over the age of 50, women, diabetics, smokers and patients with a history of migraines.

What are the treatment options?

Although the exact causes that bring on carpal tunnel syndrome are not known, the treatments for it have been thoroughly researched and many good options exist.

  1. Splints: Wearing a wrist splint while sleeping at night can be a very easy, cheap, and simple first step in treating mild carpal tunnel syndrome. Unfortunately, splinting will not cure severe or even moderate symptoms, so this can be a temporary fix.
  2. Injections: Inflammation contributes to swelling and nerve compression. A steroid injection can be helpful to decrease the inflammation around the nerve, and reduce pressure on it. Injections can temporarily or permanently improve milder forms of carpal tunnel syndrome.
  3. Surgery: Many people think of carpal tunnel release as a “simple” surgery because it can be performed so quickly. However, the nerve being treated is critical, and a lot of other important structures are very close by. Experienced surgeons will usually be far more vigilant in performing this surgery than in more complex seeming surgeries. There are two main techniques for carpal tunnel release:
    • Endoscopic: Patients often spend time researching whether carpal tunnel release should be performed endoscopically (i.e. with a small camera introduced into the wrist). This technique requires one or two small incisions in the wrist, and the release is performed from the inside out.
    • Open: This technique requires an incision at the base of the palm, through which the ligament is directly examined and cut, from the outside in.
    • Dr. Nagarkar performs both techniques depending on the situation. In his technique, the open incision is not significantly larger than the endoscopic incision, so there is little difference between the two options.
Dr. Purushottam Nagarkar, University of Texas Southwestern Medical Center, Dallas, Plano and Frisco

Dr. Nagarkar on carpal tunnel syndrome:

Because carpal tunnel syndrome is so common, patients sometimes relate the experience of being diagnosed with it based just on a cursory exam or consultation. While it is certainly true that I can often tell that a patient has carpal tunnel syndrome just by hearing her describe her symptoms, the condition nevertheless deserves a detailed exam. Patients are often amazed by how often carpal tunnel syndrome can be present at the same time as another hand condition (like trigger finger, or cubital tunnel syndrome), or be masquerading as a different condition. A comprehensive hand exam is critical to ensure that any planned surgery or intervention will address all of your symptoms.

What to expect on the day of surgery:

Carpal tunnel surgery is an outpatient procedure that requires around 10 to 15 minutes to perform. Most carpal tunnel surgeries are performed with either local or regional anesthesia. What this means is that your hand or your arm is numb during the surgery and you do not have any pain, but you will generally not require full general anesthesia.

What to expect after surgery:

  • Results: In most cases carpal tunnel syndrome occurs slowly over the course of months or years. As a result, the surgery cannot instantaneously resolve your symptoms. Often if you had burning pain before surgery, this might resolve very quickly after surgery. However, numbness or weakness in the hand may take months to improve.
  • The first few days: After surgery your hand and wrist will be in a soft dressing, but your fingers will be free. Your hand will be numb for several hours after you return home because of the long-acting anesthetic that Dr. Nagarkar will use in surgery. It is critical that you start working on your fingers – closing them into a tight fist, and opening them all the way straight – immediately after surgery. Start these exercises on your way home from surgery. You should do this exercise 10 times per hour, or at every red light and during every commercial break (if you’re watching TV). Don’t squeeze a ball or do any other type of “strengthening” exercise – just close your fingers into a fist and open them up all the way.
  • Pain: Narcotic pain medications are rarely needed after a carpal tunnel surgery – usually anti-inflammatory over the counter medications like Ibuprofen and Tylenol are all you need.
  • Incision care: Your incision will be closed with two or three stitches. You will have a light dressing on your incision after surgery, which you should keep clean and dry – when you are showering, cover your hand with a plastic bag up to the elbow and place a couple of rubber bands around the bag to prevent water from getting onto the dressing. You can remove the dressing four days after surgery, and wash your hand in the shower with regular soap and water. Then pat the incision dry and cover it with a band-aid.
  • Work: You should be able to return to desk work or light work the day after surgery. For work involving any manual labor or lifting over 10 lbs, you should plan on taking at least 2 weeks off.
  • Activities and exercise: You will be able to return to normal every-day activities, like writing, typing, and eating immediately after surgery. You can drive when you are no longer using narcotic pain medications and when you are able to fully and safely control your car. This often takes a few days to a week. Aerobic exercise can be started four days after surgery (when your dressing is removed). More strenuous exercise involving heavy lifting or any impact on the hands (like yoga or push-ups) should be stopped for at least 2 weeks.
  • Hand therapy: Most patients don’t require supervised hand therapy after this surgery. However,
    if you need some help getting full motion back in your hand, Dr. Nagarkar will refer you to a certified hand therapist who can help you improve your hand function.
  • Follow-up visits: You will see Dr. Nagarkar in the office usually 7 – 10 days after surgery to examine the incisions, remove sutures, and ensure that you are healing appropriately. Most patients don’t require further visits, although we encourage you to contact us at any time if you have any questions or concerns.

To meet Dr. Nagarkar in person, schedule your consultation or call us.