Carpal Tunnel Syndrome 

Carpal Tunnel Syndrome (CTS) is compression of the median nerve as it crosses the wrist. The median nerve is a large nerve that gives sensation to the fingers in your hand.  The floor of the carpal tunnel is a canal formed by the bones of the wrist. The roof is formed by the transverse carpal ligament.  All of the tendons to your fingers and the median nerve travel through this tunnel. Any swelling of the tendons can squash the median nerve in the tunnel and cause pain and numbness in the hand.

Patients with carpal tunnel syndrome complain of numbness and weakness of their hand, some have pain that wakes them at night.  While others may present with a many different complaints, such as forearm discomfort or shooting pains up the arm, swelling, sensitivity to temperature and pain into the fingers.  Because there are many different symptoms there can be a delay in making a diagnosis.

A careful and through examination will help aid in the diagnosis.

A nerve conduction studies will often aid in the diagnosis of CTS.  X-rays may at times reveal a bony spur is compressing the nerve in the carpal canal.

Some patients have only temporary swelling in their tissues that cause CTS, such as pregnant women. The CTS will usually get better after delivery of the baby.

If not treated, CTS will usually get worse with time. Conservative treatment with splints and Anti-inflammatory medications can sometimes relieve the symptoms.  Some Physicians use injections of steroids into the carpal tunnel to try to decrease the swelling. (These can be painful, but if they relieve the pain they are a good indicator that a carpal tunnel surgery will work)

If conservative treatment fails to relieve the night pain, the hand numbness or weakness, then the patient should consider having the carpal canal released surgically. In most places this is done as an outpatient procedure, usually with local anesthesia.

There are many ways to release the transverse carpal ligament.  Some physicians make large incisions, some make small incisions, and others make small holes and release the ligament with the arthroscope. All are good ways of releasing the ligament.  The most important thing is that the ligament is completely released and no damage is done to the nerve.

Most physicians tell their patients to plan on at least four to six weeks before resuming any aggressive activities with the hand. With the newer techniques you can often return to light duty type work as early a one to two weeks after surgery.