Tunnel Syndrome (CTS) is a common and often painful condition
that can interfere with the normal use of your hands. CTS occurs
when the Median Nerve becomes compressed within the wrist
resulting in pain, numbness, and weakness. The Median nerve normally
supplies sensation to the palmar surface of the thumb, index,
middle and half of the ring finger. As this nerve enters into
the palm, it must do so via a small canal known as the Carpal
most common presentation occurs in females from 40 to 50
years of age. It then later reappears in the geriatric population
as a result of degenerative joint disease also described as Osteoarthritis.
The third most common area of presentation is in those individuals
who perform repetitive work or activities with their hands.
In this latter category, typist are the most frequent. In men,
butchers have a very high prevalence. Generally, temporary CTS
is frequently seen in pregnancy, and usually resolves several
weeks following delivery. Individuals who are low in thyroid
can also present with CTS.
Tunnel Syndrome is often easily diagnosed by its more classical
history: Intermittent, but generally worsening numbness
of the first three ½ fingers (see figure above), nighttime
pain which can be relieved by shaking the hand back to "life",
and weakness in ones grip, often followed by atrophy
(muscle wasting) of the thumb.
exam usually confirms the classical pattern of numbness. In addition
there is frequently a shock-like sensation elicited by tapping
the nerve just proximal to the carpal tunnel at the wrist. This
sign is known as a Tinel's Sign. Weakness in opposition
of the thumb and little finger is usually present in more severe
cases. EMG/NCV tests are diagnostic for CTS in over 90% of individuals.
In some early cases, even when pain is significant, the EMG/NCV
test may be normal. It generally takes 4 to 6 weeks before nerve
damage will show up electrically.
pain and/or mild numbness are the only presenting symptoms, conservative
measures will be tried. These include a hand splint to be worn
at night and during painful activity. Anti-inflammatory medications
such as Advil, Alieve (and stronger prescriptions) may also be
of help. It is often noted in the "health-food" literature
that Vitamin B6 can improve CTS. It is worth a try, if nothing
are designed to keep your wrist in a neutral position., Bending
the wrist makes the symptoms worse because it narrows the carpal
tunnel increasing pressure on the nerve.
milder forms, a steroid-type injection may be prescribed. These
are often very effective in stopping the pain, but nerve damage
often continues because the compression remains.
may be advised if symptoms continue after conservative treatment,
or if you are experiencing severe pain. Surgery is designed to
stop further nerve damage, and in over 90% of cases results in
significant improvement in neural function.
surgery is called Carpal Tunnel Release. It takes about 30 minutes
to perform and is usually done as an out-patient service. The
surgery is performed through a cosmetic one inch incision along
the palm's "life-line". As only the ligament over the
nerve is released, hand strength is maintained.
which occur rarely, can include continued pain and numbness in
cases of prolonged and severe nerve compression.
the first two days after surgery, whenever at rest, you should
try to keep your hand elevated. The bandage is removed the day
after surgery. It is recommended that you clean the incision with
alcohol or peroxide, and leave it open to air. Keep your hand
dry. You may shower, but do not soak your hand.
office will call and schedule an appointment for you to be seen
5 to 7 days post-op.
the night of surgery it is recommended to begin gentle exercises.
Move and wiggle each finger, and try to touch your fingertips
to the thumb. Follow this by making a gentle fist.
regenerate at approximately ½ to 1 inch per month. Therefore you
can expect to see sensory improvement in as far out from surgery
as 6 months, and even up to 2 years. If the muscle in the thumb
was atrophied (shrunken) before surgery, most likely it will not
re-grow. You may get stronger however, in the muscles of the hand
which were still functioning prior to surgery.
a third of patients will experience a soreness in the muscle of
the thumb following surgery. It is often described as feeling
like a "stone-bruise". This tenderness can last up to
golf is allowed at 6 weeks after surgery. Tennis may have to wait
3 months, but often can be played safely at 6 weeks with a wrist
support. You can never use the palm of your hand for a Hammer!
Remember the Median nerve is no longer protected by the tough
carpal ligament and will be sensitive to direct blows.