Symptoms and Treatment of Carpal Tunnel Syndrome

Newswise — According to a report from the American Association of Neurological Surgeons (AANS), neurosurgeons performed over 25,600 carpal tunnel procedures in 1999 alone. Are you one of the many people who suffer each day from carpal tunnel syndrome? If you're not sure, you may want to ask yourself these questions: Do you feel numbness or a tingling sensation in your hand or hands at night? Do you sometimes experience pain in your wrist and hand, particularly at night? Do you have difficulty holding objects without dropping them? If you answered, "yes" to any of these questions, you may be experiencing symptoms of carpal tunnel syndrome. Carpal tunnel syndrome is a topic of interest during the First Annual Neurosurgery Awareness Week from May 1 to May 6 during the 72nd Annual Meeting of the AANS in Orlando, Florida.

Carpal tunnel syndrome is a common problem that ultimately affects the use of your hand. It most often occurs when the median nerve in the wrist becomes inflamed after aggravation from repetitive movements, such as typing on a keyboard or playing the piano. The condition may cause progressive compression (squeezing) on the median nerve in the carpal tunnel, or "canal" in the wrist through which the median nerve passes. Any repetitive motion that causes significant irritation of the median nerve in the carpal tunnel may alter transmission of sensations from the hand up to the arm and to the central nervous system.

Diseases or conditions that may contribute to the development of carpal tunnel syndrome include pregnancy, diabetes, and broken or dislocated bones in the wrist. Some of the main causes include repetitive and forceful grasping with the hands, bending of the wrist, and arthritis.

Symptoms can include hand and wrist pain, a burning sensation in the middle and index fingers, thumb and finger numbness, or an electric-like shock through the wrist and hand. During the day, symptoms may occur during any activities that involve bending of the wrist. Finger numbness or wrist pain may be most significant at night, when they can actually awaken a patient from sleep.

It is important to seek medical advice when you first notice persistent symptoms. Do not wait for your pain to become intolerable. Before your doctor can recommend a course of treatment, he or she will perform a thorough evaluation, including a medical history, physical examination, and perhaps diagnostic tests. Your doctor will ask about the extent to which your symptoms affect daily living.

The main objective of conservative (non-surgical) treatment is to reduce or eliminate repetitive injury to the median nerve. In some cases, carpal tunnel syndrome can be treated by placing the wrist in a splint to minimize irritation to the nerves. If that does not work, patients are sometimes prescribed anti-inflammatory medications or cortisone injections in the wrist to reduce swelling. Also, hand and wrist exercises may be recommended both during and after work hours. In addition to exercises, treatment for carpal tunnel syndrome may include rest, the use of a wrist splint during sleep, or physical therapy. Conservative treatment methods often continue for up to six or eight weeks.

If conservative treatment such as medication or physical therapy does not provide sufficient relief, your doctor may perform diagnostic studies to determine if surgery is an effective option.

If patients suffer from severe pain that cannot be relieved through rest, rehabilitation or non-surgical treatment, there are several surgical procedures that can be performed to relieve pressure on the median nerve. Neurosurgeons are well qualified to perform these operations because they are trained to treat disorders affecting the entire nervous system.

The most common procedure is called a carpal tunnel release, which can be performed with an open incision or with endoscopic techniques. The open incision procedure or carpal tunnel release involves the neurosurgeon making an incision in the wrist or palm and then releasing the ligament that is compressing and placing pressure on the median nerve. Endoscopic carpal tunnel release procedure involves making a smaller incision and using a miniaturized camera to assist the neurosurgeon in viewing the carpal tunnel. Risks of carpal tunnel surgery are minimal. The majority of individuals recover completely.

A neurosurgeon's primary role in treatment of carpal tunnel syndrome is diagnosis, interpretation of test results, and, when necessary, surgery. However, there may be other medical professionals involved in the treatment process, including physical therapists and other specialists.

Neurosurgeons see a variety of patients who suffer from carpal tunnel syndrome, including pianists, concert violinists, assembly line workers, hair dressers, computer operators, artists, and sculptors, to name a few. The results of surgery are usually exceptional, with most patients receiving nearly full relief of their symptoms. The earlier you get a diagnosis and treatment, the better the outcome. For more information about carpal tunnel syndrome, visit the public Web site of the American Association of Neurological Surgeons at http://www.NeurosurgeryToday.org.

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 6,500 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system including the spinal column, spinal cord, brain and peripheral nerves.