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This very common syndrome results from compression of a nerve, the Median Nerve, at the wrist.
The nerve, along with a number of tendons, passes through a small tunnel
at the wrist and then travels out to the fingers where it primarily supplies
sensation. Swelling within the tunnel
from many causes such as pregnancy, injury, overuse etc. may cause the nerve to
become compressed resulting in the common symptoms of carpal tunnel syndrome, namely
pain, tingling, and numbness.
Treatment is often directed at making room for the nerve by a
combination of rest, (which helps the swelling to go down), night splinting,
(which holds the tunnel at it’s maximum size), and on occasion a cortisone injection into the carpal canal. Proper
positioning of the hands and wrists at work can be very helpful in reducing
swelling within the carpal tunnel. Anti-inflammatory agents are not generally useful other than for their
analgesic effect.
When the symptoms of carpal tunnel syndrome are persistent and significant despite
appropriate treatment, then surgical release of the carpal tunnel is the best
treatment. The carpal tunnel is a ring made up mostly of bone with a band of
taut fibrous tissue completing the ring. Cutting the band of fibrous tissue changes the tunnel from a tight ring
to an open canal thereby releasing the pressure on the nerve and relieving the symptoms.
Q: Aren't cortisone injections harmful?
A: The cortisone injected into your wrist
by the Hand Surgeon will work almost exclusively at the wrist, it will shrink
down the tissue within the carpal tunnel over a period of several weeks thereby
relieving pressure on the nerve. Unless
the injection is directly into a tendon or the nerve, there should only be the
side effects of swelling and pain which should last less than 48 hours, and
occasional depigmentation, or loss of color of the skin in the area of the
injection.
Q: Don’t you need that band of fibrous
tissue that is cut during the surgery?
A: The band is not necessary for normal
use and function of the hand provided that the contents of the carpal tunnel
are not overly disturbed at the time of surgery.
Q: I have heard that carpal tunnel surgery does not work?
A: When the diagnosis is correct, and
the patient truly has carpal tunnel syndrome, the surgery is almost always
effective in relieving the symptoms from carpal tunnel syndrome, if done
properly. Some patients will have other
problems that prevent a full recovery after surgery. Such problems include diabetes, a pinched nerve in the neck,
advanced age, or cases that have been allowed to progress to permanent numbness
and atrophy of the hand.
Q: Will the problem return if I go back to the same kind of work?
A: Once the tunnel has been released
and the nerve is no longer squeezed, it is possible to resume normal activities
without fear of the nerve being squeezed again, although repetitive activities
are avoided for four weeks.
Q: If I have surgery, how quickly will I be
able to return to work?
A: Most patients are able to drive within
the first few days, and return to light duty within the first week after
surgery. Jobs that require prolonged
typing are possible after four weeks, and if the job is heavy such as
construction work or a mechanic, frequently six weeks is necessary before a
return to full duty is possible.
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