OakLeaf Medical Network Healthy Viewpoints, Winter 2003
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Dr. William DeCesare, MD

Tendons and the median nerve pass underneath a tight ligament at the wrist

Carpal Tunnel Syndrome

William DeCesare, MD
Orthopedic Surgery
DeCesare Orthopedic Clinic, Eau Claire

Carpal tunnel syndrome is one of the most common causes of hand pain that prompts doctor visits. Carpal tunnel syndrome is caused by pressure on the median nerve at the base of the wrist. The tendons and the median nerve pass underneath a tight ligament, shown on the graphic as the transverse carpal ligament, and anything that compromises this space tends to precipitate these symptoms. The tendons are very resilient, but the nerve is very sensitive to pressure and stops working, causing tingling and numbness in the thumb, index, long and usually part of the ring finger. This numbness is also associated with a painful and burning sensation. Anything that causes pressure in this area can cause these symptoms. Swelling of the tendons caused by overuse of the hand, fluid retention (such as during sleep or pregnancy), arthritis in the wrist joint, or injury to the area all can be major factors. Medical conditions such as rheumatoid arthritis, hypo-thyroidism and diabetes are frequently associated with a higher incidence of this problem.

One of the first symptoms is awakening from sleep. This is assumed to be due to fluid retention, flexing or bending of the wrist during sleep. As the swelling worsens, these symptoms occur during daily activities, such as driving a car, talking on the phone and other activities that hold the wrist in a flexed position.

By the time the patient sees a physician, their description of the symptoms may make the diagnosis obvious. Examination can confirm this with a positive Tinelís test (pain shooting to the fingers when tapping on the nerve at the wrist), and Phalenís test (numbness occurring when holding the wrist in a flexed position for 20 to 30 seconds). If by history and exam, the diagnosis is not certain, electromyelography (EMG) can frequently confirm this diagnosis.

Non-surgical treatment usually consists of anti-inflammatory medicines to decrease swelling and/or use of a splint at night to keep the wrist from falling into a flexed position. If treatment fails and the patient continues to have pain, numbness and difficulty sleeping, surgery is often indicated.

The surgical procedure involves a two to three inch incision at the base of the hand to release the transverse carpal ligament. This is an outpatient procedure usually taking only 10 to 15 minutes and can be done without a general anesthesia. This is a very predictable procedure with a 95 - 97% success rate. Reoccurrence is very rare at perhaps one to two percent.

The timing of surgery is also important. Treatment should be sought when symptoms are still intermittent. At the point where there is constant numbness and tingling in the hand, the nerve may be permanently damaged to the extent that surgery would relieve the pain, but the numbness and weakness may persist.

In summary, carpal tunnel syndrome is an extremely common disorder that can often be treated conservatively. If surgery is in fact necessary, it has an excellent prognosis. Ignoring the symptoms can lead to permanent numbness and weakness in the hand.

For more information, or to schedule an appointment with Dr. William DeCesare » 715.839.8399, DeCesare Orthopedic Clinic