Other Problems

Carpal Tunnel Syndrome ^

Carpal tunnel syndrome is a common and generally well-recognized condition in which a peripheral nerve, the median nerve, is compressed in the palm. The nerves passed through the carpal tunnel, which is formed by the bones of the wrist on the backside and a ligament known as the transverse carpal ligament on the palm side. If the ligament thickens, the nerve is irritated and symptoms of numbness and tingling in the hand result. These symptoms commonly occur at night and are reduced in some cases by shaking the hand. If the compression of the medial nerve is significant enough, weakness in grip can occur (difficulty with jar lids and door knobs) associated with numbness that is often perceived as involving all fingers of the hand, but primarily involves the thumb, index and middle finger.

Predisposing medical conditions include prior injury or fracture of the wrist, low thyroid function and diabetes. Symptoms are more common in women during pregnancy and often resolve after delivery. Repetitive use of the hand is in some cases associated with carpal tunnel syndrome as well.

The diagnosis is often made on the basis of common symptoms and findings of weakness in the major thumb muscle used for gripping and numbness in the appropriate fingers. Confirmation is through a test that measures the speed of electricity moving through the nerve, a nerve conduction velocity study. When the nerve is significantly compressed, the speed of electrical conduction through the compressed segment in the palm is reduced.

Initial treatment is usually to immobilize the hand with a wrist splint and use of a non-steroidal anti-inflammatory drug. If conservative treatment fails, surgical decompression of the nerve is performed with a carpal tunnel release. This involves an operation performed with sedation and local anesthesia and a small incision in the palm. The transverse carpal ligament is divided and the nerve compression alleviated. Although a minor surgical procedure, the palm is a sensitive part of the body and use of the hand is therefore restricted for several weeks following surgery. A return to work is dependent on the physical nature of the job and how much the involved hand has to be used for gripping, pushing and pulling. The risks of the surgery are exceptionally low and the long-term results quite good.

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