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Carpal Tunnel

Carpal tunnel syndrome is a common source of hand numbness and pain. Although it is often associated with repetitive hand movements—such as typing—many things can cause carpal tunnel. For most people, carpal tunnel syndrome will progressively worsen without some form of treatment. Carpal tunnel syndrome is also known to be more common in women than men.

Carpal Tunnel Syndrome and the Median Nerve
The median nerve travels from the forearm into the hand through this tunnel in the wrist. The median nerve controls feeling in the palm side of the thumb, index finger and long fingers. The nerve also controls the muscles around the base of the thumb. The tendons that bend the fingers and thumb also travel through the carpal tunnel. These tendons are called flexor tendons.

Carpal tunnel syndrome occurs when the tissues surrounding the flexor tendons in the wrist swell and put pressure on the median nerve. These tissues are called the synovium. The synovium lubricates the tendons and makes it easier to move the fingers.

Carpal Tunnel Symptoms
The most common symptoms of carpal tunnel syndrome include numbness, tingling and pain in the hand as well as strange sensations and pain traveling up the arm toward the shoulder. It has also been known to produce an electric shock-like feeling mostly in the thumb, index and long fingers.

Symptoms usually begin gradually, without a specific injury, and at any time. In most people, symptoms are more severe on the thumb side of the hand. Because many people sleep with their wrists curled, symptoms at night are common and may awaken you from sleep. During the day, symptoms frequently occur when holding something, like a phone, or when reading or driving. Moving or shaking the hands often helps decrease symptoms.

Carpal Tunnel and Loss of Function
Symptoms initially come and go, but over time they may become constant. A feeling of clumsiness or weakness can make delicate motions, like buttoning your shirt, difficult. These feelings may cause you to drop things. If the condition is very severe, muscles at the base of the thumb may become visibly wasted.

Carpal Tunnel Diagnosis
To determine whether you have carpal tunnel syndrome, your doctor will discuss your symptoms and medical history. He or she will also examine your hand and perform physical tests checking for weakness in the muscles around the base of your thumb, bending and holding your wrists in positions to test for numbness or tingling in your hands, and looking for any other signs of numbness or tingling.

Non-surgical Treatment of Carpal Tunnel
If diagnosed and treated early, carpal tunnel syndrome can be calmed without surgery. In cases where the diagnosis is uncertain or the condition is mild to moderate, your doctor will always try simple treatment measures first. Treatments such as bracing or splinting, medications, activity modification and steroid injections are common.

Surgical Treatment of Carpal Tunnel
Surgery may be considered if you do not gain relief from non-surgical treatments. The decision whether to have surgery is based mostly on the severity of your symptoms. At Gwinnett Medical Center–Duluth, carpal tunnel surgery is done on an outpatient basis under local anesthesia.

During surgery, a cut is made in your palm. The roof (transverse carpal ligament) of the carpal tunnel is divided. This increases the size of the tunnel and decreases pressure on the nerve. Once the skin is closed, the ligament begins to heal and grow across the division. The new growth heals the ligament and allows more space for the nerve and flexor tendons.

Some surgeons make a small incision with the aid of a small camera or endoscope, to cut the ligament from the inside of the carpal tunnel. In some instances this can speed up recovery. However the end result of traditional and endoscopic procedures is the same. Your doctor will discuss the surgical procedure that best meets your needs.

Recovery from Carpal Tunnel Surgery
Complete recovery may take up to a year. If significant pain and weakness continue for more than two months, your physician may instruct you to work with a hand therapist. Carpal tunnel syndrome can occasionally recur and may require additional surgery.

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