Carpal Tunnel Syndrome

Eric H. Williams MD
Specializing in reconstructive surgery and pain relief in the Greater Baltimore area.

When we discuss nerve-related conditions in the upper limbs, carpal tunnel syndrome is one that tends to be the most common—to the point we’d wager there isn’t a person in the U.S. who doesn’t know someone who either has this condition or had it at some point.

This condition is also interesting because it’s treated by a variety of medical specialists, including peripheral nerve surgeons like Dr. Williams. If you are suffering from tingling, numbness, and other neuropathic symptoms in your arm and/or hand because of this condition, you may want to contact our office and request a consultation.

Medial Nerve Compression

Given the commonality of this medical condition, you probably are already aware that it affects the hand, wrist, and sometimes even the forearm. From a general perspective, this particular upper extremity condition occurs when a specific nerve—the medial nerve—is compressed or pinched within the carpal tunnel.

The actual carpal tunnel is a narrow anatomical passageway formed by ligaments and bones, and is located basically in the middle of your wrist (closer to your hand), on the palm side. If you look at your hand, the carpal tunnel is in the meaty part of the palm.

There are many causes of this condition, however, the basic underlying issue (that leads to symptoms) is that there isn’t enough room for the nerve in the tunnel. This chokes out the nerve by restricting blood flow, thereby decreasing nerve function.

The condition frequently, but not always, occurs because of repetitive motions like typing, writing, and activities that are used in various occupations. It can cause symptoms such as frequent tingling and burning sensations, decreased grip strength, numbness, and (in severe cases) muscle atrophy at the base of the thumb. When the condition progresses in severity, these symptoms can lead to disrupted sleep – waking you up at night with intense pain.

Is the common thought that carpal tunnel syndrome is always caused by repetitive stress accurate? Well, not exactly. There are numerous cases where the injury is certainly the result of repetitive stress, but other cases have different root causes – including obstructed blood flow to the nerve or underlying medical conditions that cause swelling in the wrist, swelling of tendons around the nerve, swelling of the nerve itself, and (rarely) ganglion cysts or tumors taking up space in the tunnel.

With regard to diagnosis, this condition can often be recognized based on physical examination, symptoms, and medical history alone. With that said, an EMG (electromyograph) may provide additional neurophysiological evidence that the median nerve is pinched (which causes the problem). Imaging studies and MRI can provide further visual evidence of compression.

It is critical to treat carpal tunnel syndrome before the condition worsens. If the symptoms are ignored, they may result in long-term damage.

Carpal Tunnel Syndrome Treatment

There are nonsurgical treatment options for carpal tunnel syndrome, such as rest, wrist splinting, medication, physical therapy, and corticosteroid injections. However, surgery can sometimes be the best option to alleviate painful symptoms and restore proper function – especially when conservative treatments aren’t effective.

Depending on your situation, you may want to consider having a peripheral nerve surgeon, like Dr. Williams, perform the procedure for you. The reason for this comes down to the fact peripheral nerve surgeons are trained and experienced in performing procedures to relieve neuropathic pain for our patients.

Carpal tunnel syndrome can be treated with surgery to decompress the median nerve by cutting or dividing the transverse carpal ligament in the wrist and hand to release pressure off the nerve. The carpal tunnel is right above the wrist on the palm side of the hand.

Factors such as the severity of your carpal tunnel syndrome, presenting symptoms, your overall health, and even the anatomy of your hand will be used to decide which of the following paths we recommend:

  1. Open surgery (surgery using a standard surgical incision)
  2. Surgery using an endoscope and a smaller incision
  3. Ultrasound-guided surgical procedures

Either way, this is an outpatient procedure and you go home the same day. Your hand and wrist may be bandaged for up to a week. Typically, the bandage stays in place until the stiches are removed.

You may or may not experience immediate relief of symptoms in fingers and hand (depending on severity and length of time the condition has been present), particularly given that the area will likely be sore following your surgery.

During the recovery period, you should expect to rest and elevate your hand and wrist as much as possible over the next several days. On top of that, you will have to take measures to limit hand and wrist use.

Depending on what your work responsibilities entail, you may need to take some time off. This isn’t because the surgery is necessarily a huge deal in and of itself, but the odds are good that you use your hands a lot at work. Accordingly, your abilities might be somewhat compromised or limited.

As an encouraging note, minimally-invasive procedures available today have led to shrinking recovery periods. This has resulted in a positive situation wherein those procedures mean you only have to take a minimal amount of time off of work.

One of the aforementioned techniques that is particularly exciting—and one that has promise for speeding recovery times—is the ultrasound-guided technology. In addition to faster recovery, it can also be an especially safe, effective option.

For more information about carpal tunnel treatment—or if you want to find relief from neuropathic pain caused by injured peripheral nerves—contact our Baltimore office by calling (410) 709-3868 or connecting with us online today.