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BY DR. DWIGHT TYNDALL
Times Correspondent | Thursday, March 06, 2008 | (No comments posted.)
Q: What is carpal tunnel syndrome and who are likely to get it? Also, how is it treated? -- Paul
A: Carpal tunnel syndrome is compression of the median nerve as it enters the wrist and the hand. The median nerve that runs down the middle of the forearm to the hand is responsible for supplying both sensory and motor function to most of the hand.
As the median nerve enters the wrist and hand, it passes beneath what is called the carpal ligament.
Due to several factors such as age, repetitive use of the hand, wrist fractures and certain diseases such as diabetes, the nerve can be compressed, leading to symptoms. Theses symptoms can range from numbness, tingling, weakness and even atrophy/wasting away of the hand muscles -- particularly those around the thumb.
Sometimes, a special study called a nerve conduction velocity study, is used to see how badly the nerve is compressed. Treatment can be guided by how severely compressed the nerve is based on the NCV study.
Treatment is then usually based on the severity of the symptoms and the results of the NCV study. If the cause of the nerve compression is a metabolic disorder, then treatment is geared toward addressing that problem first.
If the symptoms are based on a true compression and repetitive activities, then treatment is geared toward changing those activities. For example, if the person types a lot, then modification of the activity is also addressed. This can be done by limiting time on the computer or changing the way in which the person types.
Initially, treatment usually involves bracing with a wrist splint, combined with activity modifications. This approach is often tried for about six to eight weeks to see if there are any improvements.
If there is no improvement, then an injection of steroid into the carpal tunnel to decrease the swelling of the nerve can be helpful. Often times an injection and other nonsurgical methods are combined to see if there are improvements.
Finally, if the symptoms persist and/or worsen despite treatment, then surgical release of the ligament is indicated. By releasing the ligament, the compression is removed and the nerve can function more or less normally.
However, if there is severe atrophy/wasting of the hand muscles, the surgery might not be successful in reversing the symptoms.
The opinions expressed are solely those of the writer. Dr. Dwight Tyndall is a practicing Spine Surgeon. He can be reached at dstyndall@yahoo.com (use the subject line "bone doctor column"), www.spinecarespecialists.com or at Dr. Dwight Tyndall, 730 45th St., Munster, IN 46321. This column is intended for informational purposes only. Readers should seek specific medical advice from their own physician.
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