Carpal Tunnel syndrome
Carpal tunnel syndrome is a common condition where one of the major nerves to the hand (the “median nerve”) gets compressed as it passes through a tunnel leading from the forearm to the palm. Common causes include trauma, overuse, or pregnancy.
Symptoms typically include numbness and tingling in the thumb, index, and middle finger. This "buzzing" sensation, that the hand has "fallen asleep", can awaken people at night, causing them to shake the hand, hold it up in the air, or off the side of the bed to alleviate the symptoms. The "pins and needles" sensation can also be felt while driving, using a computer, doing one's hair, or holding a book/tablet. Some individuals may also note pain in these fingers, weakness in the hand, or loss of dexterity (e.g. difficulty with buttons or picking up small objects).
Carpal tunnel syndrome can oftentimes be diagnosed by talking with your doctor and having them examine your hand and arm. Occasionally a nerve test (EMG or nerve conduction study) can be used to assess the function of the nerve and determine if its being compressed.
Modify activities - improving the posture or position of the hand and wrist with activities such as computers, driving, reading, etc can minimize symptoms.
Wear a wrist splint at night - sleeping with the wrist in a bent position will decrease the diameter of the carpal tunnel, resulting in the nerve being pinched. A wrist splint keeps the wrist in a straight/neutral position. This can improve the quality of your sleep.
Steroid injection - a cortisone injection into the carpal tunnel bathes the medial nerve in a strong anti-inflammatory fluid, this can shrink down a swollen and inflamed nerve, which decreases the pain and tingling.
Median nerve gliding exercises (see below) - these stretches should be performed several times per day. They can increase the health of the nerve by helping normal gliding, decreasing adhesions, and opening up the carpal tunnel.
Traditional “open” carpal tunnel release - performed through an incision overlying the carpal tunnel along the palm of the hand. Typically the incision is less than 1 inch. Underneath the skin, the "roof" of the tunnel is released with a scissors and/or knife. This increases the diameter of the tunnel and eliminates the compression.
Endoscopic carpal tunnel release - performed through an incision in the forearm. A camera is inserted into the carpal tunnel. A knife blade is attached to the camera, which is used to release of roof of the carpal tunnel from the inside. Unfortunately, in some cases, inserting a camera into the already tight carpal tunnel can irritate the nerve.
I typically perform an “open” carpal tunnel release, as I find this to have less risk to injuring/irritating the median nerve, and find the invasiveness of the two procedures and recovery to be very similar. I place absorbable sutures underneath the skin, and use Dermabond (medical grade "Super Glue") to seal the incision. A bandage is applied which remains in place for 3 days.
The hand can be used for normal light activities immediately, and you can get the incision wet once the bandage is removed. More demanding activities (e.g. lifting weights, gardening, manual labor) should be avoided until the skin heals (~10 days).
Dr. Schreiber is a board certified orthopedic surgeon specializing in hand, wrist, and elbow conditions. Dr. Schreiber practices at the Raleigh Orthopaedic Clinic in Raleigh, North Carolina.