Dr. M.J. Bazos, MD Patient Handout

CARPAL TUNNEL SYNDROME


About Your Diagnosis
Carpal tunnel syndrome (CTS) may cause pain or “tingling/numbness” in the hand, the wrist, and sometimes the arm. It is seen four times more often in women than in men, and it occurs most often in middle-aged patients. More than 50% of patients with CTS have it in both hands. Several nerves travel from the spine, down the arm and into the hand, and help make fine movements of the fingers and hand possible (i.e., handwriting, buttoning, and fine coordination). The nerve affected in CTS is the “median nerve.” It travels under the transverse carpal ligament along with the flexor tendons of the wrist and hand through the carpal tunnel, a very small space in the wrist.

Living With Your Diagnosis
Carpal tunnel syndrome may be caused by repetitive motion of the hand or fingers, resulting in inflammation or mild injury of the median nerve. Other medical conditions (obesity, diabetes, hypothyroidism, pregnancy, or tuberculosis) may cause or contribute to CTS. The most common symptoms of CTS are numbness or burning/aching pain (some have no pain) of the hand and/or fingers, which may awaken an individual from sleep or occur while bending the wrist (e.g., when driving or holding a telephone receiver). Also, some patients may have a weak grip and/or wasting of the palm muscles.

Treatment
Several treatment options are available for CTS. Nonsurgical treatments are usually tried first, depending on the stage of the syndrome. Your physician may suggest wearing a wrist splint to keep your wrist in a neutral position to reduce further irritation of the nerve. Fifty percent of patients improve when in early stages of CTS, although relapse is common. A wrist splint may be especially helpful if worn when sleeping. Steroid medication injections into the carpal tunnel may help to reduce the inflammation. Oral anti-inflammatory medications such as aspirin or ibuprofen may be prescribed to help reduce inflammation and relieve symptoms. Surgery may be considered if conservative treatments have failed to provide adequate long-term symptom relief. A minor surgical procedure may be done through a traditional, small incision in the palm and wrist to release the compression of the median nerve. In some cases, a special endoscope may be used to release the nerve. In either case, it is usually done in outpatient surgery. The patient usually goes home the same day, with the wound bandaged and wearing a sling and/or wrist splint.

The DOs
• If your work requires repetitive wrist or hand action, make sure your wrists and arms have adequate support. Try using a wrist support at the keyboard if you type often. If you begin having symptoms of CTS, rest or divide your work possible to minimize repetitive wrist or hand action.
• If you are diabetic, try to keep your blood sugar under adequate control.
• Follow your physician’s activity and medication instructions.

The DON’Ts
• Avoid striking things with the butt of your palm. This may injure your median nerve and cause CTS.
• Don’t allow your weight to exceed or remain above the normal limits for your age and height. This may worsen the symptoms of CTS.
• Don’t delay in getting treatment. Once muscle wasting has occurred, the chances of full recovery are significantly reduced.
• Avoid using vibrating hand tools.
• Avoid awkward positions of the hand or wrist.
• Avoid repetitive movements of the hand or wrist, especially forceful grasping or pinching.
• Avoid direct pressure over the palm and wrist.

When to Call Your Doctor
• If the conservative measures prescribed by your doctor have not provided any relief of your symptoms.
• If the pain, numbness, or tingling worsens significantly.
• If your grip becomes weaker.
• If you have any problems associated with your medications.

Websites:
http://www.neuropathy.org