Carpal Tunnel Syndrome
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What is carpal tunnel syndrome?
The carpal tunnel is a space in the wrist that contains the median nerve, one of the major nerves for the hand, and the nine tendons running to the thumb and fingers. The median nerve is responsible for feeling or “sensation” in part of the hand and movement of part of the hand, particularly the thumb. When the median nerve is trapped in this space, this is known as “median nerve compression”. If the median nerve is compressed within the tight space of the carpal tunnel, then this pressure can affect the function of the median nerve and cause a “compressive neuropathy”. Early detection and treatment is important for increasing the chance of a full recovery. Delayed treatment may result in worsening symptoms, including permanent loss of thumb function.
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How is carpal tunnel syndrome evaluated?
Symptoms of carpal tunnel syndrome typically include hand numbness or hand tingling (“paresthesias”) that occur in a characteristic pattern involving the thumb, index finger, middle finger, and half of the ring finger. More severe carpal tunnel syndrome may result in clumsiness, dropping objects, and weakness with pinch. When seeing your hand surgeon, there are specific physical examination maneuvers that are used to test for carpal tunnel syndrome. Often, electrodiagnostic testing with nerve conduction studies (NCS) and electromyography (EMG) is performed. This is a special test typically performed by a neurologist or physical medicine and rehabilitation specialist (PM&R or physiatrist). These tests assess the function of the nerves and can assess for other nerve problems, including a pinched nerve in the neck.
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What are the treatment options for carpal tunnel syndrome?
Treatment options depend on the severity of carpal tunnel syndrome and median nerve compression. Non-surgical treatment options include wearing a splint (typically at night but sometimes during the day) and steroid injections (“cortisone shot”). In milder cases of carpal tunnel syndrome, this may be all that is necessary.
Surgical treatment is often necessary in cases that do not respond to non-surgical treatments or in severe cases. Surgery involves releasing or cutting the tight ligament that forms the roof of the carpal tunnel and contributes to compression of the median nerve. This may be performed through an “open” approach with a small incision in the palm or “endoscopically” with a small camera inserted through the wrist (“endoscopic carpal tunnel release”). Our hand surgeons offer both of these approaches.
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What is the expected recovery from carpal tunnel syndrome?
Surgery decreases pressure on the median nerve and may result in rapid improvement of the numbness and tingling symptoms, particularly in more mild cases that are treated earlier before the nerve compression becomes more severe. The surgical scar can be tender for the first several weeks but in many cases requires only acetaminophen (Tylenol) and/or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin) or naproxen (Aleve). Depending on job demands on the hands and recovery from surgery, individuals often can return to work anywhere from within several days to several weeks.
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How to find a surgeon?
Be sure to see an experienced surgeon to treat this condition. Our fellowship-trained specialists at The Buncke Clinic in San Francisco treat patients with carpal tunnel syndrome from across the Bay Area and Northern California. Contact us to schedule a consultation.
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Additional Information
Below are links for third party resources
Frequently Asked Questions (FAQ)
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Carpal tunnel syndrome occurs when the median nerve, which controls sensation and movement in part of the hand, becomes compressed within the carpal tunnel in the wrist, leading to symptoms such as numbness, tingling, and weakness in the affected hand.
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Common symptoms include numbness, tingling, or pain in the thumb, index finger, middle finger, and half of the ring finger, which often happens at night. More severe carpal tunnel syndrome may include weakness and clumsiness when gripping objects.
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A surgeon or specialist will perform a physical examination and may use tests such as nerve conduction studies (NCS) and electromyography (EMG) to confirm the diagnosis and rule out other nerve problems.
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In mild cases, non-surgical treatments such as wrist splints and cortisone injections may be sufficient to alleviate symptoms.
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Surgery may be necessary when non-surgical treatments fail to provide relief or when symptoms are severe. This can help to reduce the risk of worsening symptoms or permanent symptoms, including thumb and muscle weakness.
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There are two main surgical options: open carpal tunnel release, which involves a small incision in the palm, and endoscopic carpal tunnel release, which uses a small camera inserted through the wrist.
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Recovery times vary, but many patients can return to work within several days to several weeks, depending on job demands and individual recovery progress.
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Yes, there will be a small surgical scar, which may be tender for several weeks but typically fades over time.
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If treated early, most people can experience significant relief from symptoms, but delayed or inadequate treatment may lead to permanent damage.
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As with any surgery, there are risks such as infection, bleeding, and anesthesia complications. Specific risks related to carpal tunnel surgery include nerve damage and incomplete relief of symptoms. Generally, this is a very safe procedure with excellent results.
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Yes, most patients can return to their usual activities, including sports and playing musical instruments, after they have fully recovered from surgery.
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Only very rarely do patients require physical or hand therapy after carpal tunnel surgery.
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Yes, hormonal changes and fluid retention during pregnancy may result in carpal tunnel syndrome. Sometimes this resolves on its own but often benefits from evaluation by a specialist.
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No, our hand surgeons work with each patient to customize their treatment in accordance with their goals and the severity of their carpal tunnel syndrome. Often this can be treated initially with non-operative measures if appropriate.
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