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Carpal Tunnel Syndrome
Carpal tunnel syndrome is a common condition affecting the hand. The carpal tunnel is an area within the wrist that is bounded by bones and has a ligament running along the top. There are 9 tendons and 1 nerve that run through the carpal tunnel. Any one of those can swell or be pressed, leading to the nerve being compressed and causing the hand to feel numb or tingly. About 1 in 25 people are affected by carpal tunnel syndrome.
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Carpal tunnel syndrome symptoms and risks
Numbness and tingling are usually the first symptoms of carpal tunnel syndrome. This most often affects the thumb, index and middle finger. The sensations may be intermittent at first but as the condition gets worse, the numbness and tingling become more constant. Your fingers may also feel swollen. Weakness and pain in the hand and wrist may occur. You can have difficulty pinching or gripping objects and may drop things more frequently.
People with carpal tunnel syndrome also report waking up at night with pain or numbness in their hand.
Carpal tunnel syndrome can have many different causes. They include:
- Repetitive motions like typing
- Using vibratory equipment like jackhammers
- Nerve compression for long periods of time
- Conditions that lead to inflammation, such as rheumatoid arthritis or autoimmune diseases
- Metabolic diseases or diabetes, which can make nerves more susceptible to compression
- Increased fluid retention, such as during pregnancy or menopause
- Injury to the wrist that causes swelling
Carpal tunnel diagnosis and screening
If you’re concerned about carpal tunnel syndrome, discuss your symptoms with your doctor. Make sure to notice details about which side or which fingers feel different and if it happens with certain activities or times of day.
Physicians will conduct a physical exam to identify all the areas experiencing numbness or tingling. Electromyography (EMG) may be used in some cases for diagnosis.
Hear from the doctors
Orthopedic and plastic surgeons discuss the symptoms and treatment of carpal tunnel syndrome.
Carpal tunnel syndrome treatment
Nonsurgical options
Nonsurgical treatments include over-the-counter anti-inflammatory medications like aspirin, ibuprofen and naproxen. If there are activities triggering the carpal tunnel symptoms, there may be modifications such as how frequently you do them or how you position your wrist.
Splints are also commonly used to keep the wrist in a neutral position. These can be particularly helpful at night.
Additionally, steroid shots may be an option.
Surgery
Carpal tunnel release is an outpatient hand surgery used to treat and, in some cases, heal carpal tunnel syndrome. There’s an open procedure where the surgeon will make an incision to open the wrist and enlarge the carpal tunnel area. The surgery may also be done endoscopically, using a thin, flexible tube and camera that are inserted through a tiny incision in the wrist. The camera guides the surgeon to complete the procedure without opening the wrist. The most recent option is ultrasound-guided surgery, which doesn’t even require a stitch to close the incision at the end.
Jessica Lovell:
You recently started using a new surgical technique, and we watched you do it on another patient. Jamie Shurtz says that her carpal tunnel pain got so bad that she couldn't stay asleep. The pain would literally wake her up every few hours. Lauren, you mentioned that that got so bad for you that it would wake you up in the middle of the night too, but in this case she kept putting off surgery because she was simply busy with work and kids, that often happens, but then she heard about this new surgical technique.
Jamie Shurtz:
I know people that have had the traditional surgery. I was expecting, you know, one arm have it completely wrapped up can't use it for x amount of time then do the other hand. When I came in and Dr Jehle told me, “Hey, there's this other option, and you can do them both at the same time. You'll be down and out, you know, for 48 hours or so,” and really way less limitations way less time off work I was like, “Wow, yeah, I'm kind of glad I waited in that aspect.” Because I have a baby, it's hard to be down and out, you know, for that long.
Jessica:
No doubt. Dr Jehle, then tell us the difference between the technique the new one you did on Jamie and what you did on Lauren.
Charles Christopher Jehle, MD:
This is kind of a logical progression in what we'd said before. The most critical element of the surgery is to take that transverse carpal ligament and transect it. This is similar to what had been done previously with a camera, but now instead of using a very small camera and a bulky expensive setup with, you know, all these different cameras in one's office, you can just use an ultrasound and release that ligament from the inside.
Jessica:
We've got this video here. Quick warning to viewers, it does include little cut and pokes and things like that. Just kind of walk us through the video here what you're doing.
Dr. Jehle:
So, this this device has on it some balloons that move the nerve itself out of the way, and then this is all being watched on the ultrasound itself. Then at the tip is a small blade that cuts that ligament. You're watching that blade as well as the nerve at all times, making sure that you're not injuring the things you don't want to, and that you're getting a cut through the ligament that you want. It has a very small kind of introducer, so there's not even a stitch at the end of this procedure.
Jessica:
What makes for a good candidate for this newer technique?
Dr. Jehle:
I do evaluate the patient in preop or in the first visit to make sure anatomically they're a candidate. Most people are, but every once in a while someone's nerve or artery might be in an anatomic position that would preclude them from having this particular surgery, the surgery done in this way. Then folks that have had this so severe that they're starting to get weakness, or their symptoms are profound, typically we would do it in an open fashion like Mr. Miller.
Frequently asked questions about carpal tunnel syndrome
Charles Christopher Jehle, MD:
It is something that doing it earlier rather than later is important. If symptoms truly are episodic and they go away completely with more conservative measures like splinting, then it's not necessarily important that they do right away but once it does start interfering with the activities of daily living and it's waking you up from your sleep it's making a difference in your life, then doing a surgery is is probably a great time to do that.
Why choose us for carpal tunnel syndrome
The University of Kansas Health System has the multidisciplinary team to diagnose and treat carpal tunnel syndrome all in one place. Our team offers a wide range of experience in both routine and complex nerve compression conditions. We also have an expert neurology team, who helps evaluate and treat complex cases.
If you do need surgery, our Kansas City plastic surgeons and orthopedic surgeons have completed the highest levels of specialty training and have experience second to none. Our advanced specialists are board-certified and have completed fellowships – the most advanced medical training – earning certificates of added qualifications (CAQ) for hand surgery.