Dr. Francisco Explains Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

Carpal tunnel syndrome is most often the result of chronic compression of the median nerve at the wrist.  The median nerve enters the hand through the carpal tunnel of the wrist, which is a small box made up of bones on three sides and a thick ligament over the top.  In the box there are nine tendons and the median nerve.

There are different theories about what actually causes compression of the median nerve in the carpal tunnel—repetitive motions at work, thickening of the tendon sheaths in the carpal tunnel, or anatomic predispositions.  Regardless of the exact cause, or the summation of multiple causes, the end result is the same—the median nerve doesn’t have as much room in the carpal tunnel, it gets compressed, and subsequently people develop the characteristic symptoms of carpal tunnel syndrome.

What are the symptoms of carpal tunnel syndrome?

In the hand, the median nerve supplies sensation to your thumb, index, middle, and half of your ring finger.  It also makes the muscles on the thumb side of your hand function.  So, when the median nerve is compressed, it results in pain, numbness, tingling, weakness, and in the end stages permanent loss of muscle.  Patients typically experience worsening of symptoms at night.  They often wake up with their fingers being numb.  Other common times when the symptoms are worse are when people are driving their car, or talking on the phone.  As the symptoms worsen, people start to have weakness—they can’t open jars, or they spontaneously drop things.  Their fingers may also become numb all of the time. ions of the sport.

How is carpal tunnel syndrome treated?

For a classic case of carpal tunnel syndrome, I try to treat people without surgery first.  Often simple things will make a significant difference and reduce the symptoms that patients are experiencing.  One major cause of carpal tunnel syndrome is that people often sleep with their wrists flexed.  This causes an increase in pressure in the carpal tunnel, and subsequently, the median nerve is compressed resulting in the symptoms of worsening pain, numbness, and tingling at night.  Therefore, providing the patient with a splint to wear at night will help.

Many times though, people have already worn splints at night before they see me.  This is where a physical exam and talking to the patient helps significantly in the decision making process.  If the symptoms and complaints seem mild to moderate, and the patient isn’t having significant weakness, then I typically offer the patient a steroid injection into the carpal tunnel.  This serves three purposes.  First, it reduces inflammation around the median nerve and people typically have complete, albeit, temporary relief of their symptoms (usually 3-4 months).  Second, it helps me to confirm the diagnosis of carpal tunnel syndrome if the patient has a good response to the steroid injection.  Third, if the patient has a good response to the injection, surgery, if needed or desired, is more likely to be just as successful.

If the symptoms are severe, constant, and have been present for multiple years and I see loss of muscle when I examine the patient, then I would be more apt to discuss surgery as part of the treatment plan.

In our next blog post, Dr. Francisco will discuss more questions about carpal tunnel surgery.