Mar. 30, 2008 Do you feel numbness, burning pain or a tingling sensation in your hand or wrist that seems to increase at night; have difficulty holding objects without dropping them; or find it increasingly difficult to perform repetitive movements such as using your computer mouse or keyboard without pain? If so, then you may be one of the estimated 2 million people in the United States affected by carpal tunnel syndrome, according to the American Association of Neurological Surgeons. About half of all cases are work-related, and in fact, carpal tunnel syndrome accounts for the highest average number of days missed at work, when compared to all other work-related injuries or illnesses.
An estimated 260,000 carpal tunnel surgeries are performed annually in the United States, and of those, more than 35,000 were performed in 2006 by neurosurgeons, according to AANS statistics. A neurosurgeon’s primary role in the treatment of carpal tunnel syndrome is diagnosis, interpretation of test results, and when necessary, surgery. There are frequently other medical professionals involved in the treatment process, such as physical therapists.
Carpal tunnel syndrome most often occurs when the median nerve in the wrist becomes inflamed, caused by a combination of thickened ligaments over the nerve and repetitive movements. “Carpal tunnel syndrome is most prevalent in women ages 40 to 60, and also tends to affect people more frequently who use their hands excessively, such as pianists, concert violinists, hairdressers, computer operators, manual laborers, artists, sculptors, dentists, and even neurosurgeons,” says James R. Bean, MD, AANS president-elect.
Any repetitive motions that cause significant swelling, thickening or irritation of membranes around the tendons in the carpal tunnel can result in pressure on the median nerve, disrupting transmission of sensations from the hand up to the arm and to the central nervous system.
Diseases or conditions that may increase your chances of developing carpal tunnel syndrome include pregnancy, diabetes, menopause, broken or dislocated bones in the wrist, and obesity. Additional causes include repetitive and forceful grasping with the hands, bending of the wrist, and arthritis.
It is important to seek medical advice when you first notice persistent symptoms. Do not wait for your pain to become intolerable. Before your doctor can recommend a course of treatment, he or she will perform a thorough evaluation, including a medical history, physical examination and diagnostic tests. Your doctor will ask about the extent to which your symptoms affect daily living. Sometimes a case turns out to be tendonitis and not carpal tunnel, but only a doctor can make a proper diagnosis.
The main purpose of conservative treatment is to reduce or eliminate repetitive injury to the median nerve. In some cases, carpal tunnel syndrome can be treated by immobilizing the wrist in a splint to minimize or stop pressure on the nerves. If that does not work, patients are sometimes prescribed anti-inflammatory medications or cortisone injections in the wrist to reduce swelling. Your doctor may suggest specific types of hand and wrist exercises, which may be helpful. Treatment for carpal tunnel syndrome may include rest, the use of a wrist splint during sleep, or physical therapy. Conservative treatment methods may continue for up to eight weeks.
If conservative treatment methods do not provide sufficient relief, your doctor may perform diagnostic studies to determine if surgery is an effective option. These diagnostic tests include x-rays and electromyogram and nerve conduction studies. X-rays can help determine if any abnormalities in bones of the wrist may be contributing factors. Electromyogram and nerve conduction studies can reveal significant compression on the median nerve in the carpal tunnel.
If patients suffer from severe pain that cannot be relieved through rest, rehabilitation or nonsurgical treatment, there are several surgical procedures that can be performed to relieve pressure on the median nerve. The most common procedure is called a carpal tunnel release, which can be performed using an open incision or with endoscopic techniques. The open incision procedure or carpal tunnel release, involves the neurosurgeon making an incision in the wrist or palm and then releasing the ligament that is compressing and placing pressure on the median nerve. The endoscopic carpal tunnel release procedure involves making a smaller incision and using a miniaturized camera to assist the neurosurgeon in viewing the carpal tunnel.
Risks of carpal tunnel surgery are minimal. The majority of individuals recover completely. “The results of surgery are usually excellent, with most patients receiving nearly full relief of their symptoms. The earlier you get diagnosis and treatment, generally the better the outcome,” states Dr. Bean.
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