For your convenience we include the information available elsewhere.
The Following information is provided by American Society for Hand Surgery
1) What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is a disorder that causes pain,
weakness and numbness in the hand and wrist.
Patients oftencomplain of symptoms during activities such as driving a car,
holding a telephone, and reading the newspaper. It occurs due
to increased pressure on the median nerve at the wrist. The
associated pain occurs most often about the palm side of the
wrist and hand but may be diffuse. The pain may radiate to the
forearm and shoulder but rarely to the neck. The median nerve
provides sensation to the thumb, index, long and half the ring
fingers and therefore patients with carpal tunnel syndrome will
classically note numbness and tingling in this distribution.
Some patients may note numbness about the entire hand.
These symptoms may occur with activities during the day or
while at rest during the night. In addition to numbness and
pain, patients may complain of weakness of the hand and
dropping objects. With a more severe carpal tunnel syndrome,
atrophy of the muscles at the base of the thumb may be noted.
2) What is the carpal tunnel?
There are eight carpal bones of varying shape and size that
make up the wrist. These carpal bones form a “C” shaped ring
that is covered by a ligament, the transverse carpal ligament.
The ligament and bones form the carpal tunnel through which
pass the median nerve and nine tendons that flex the fingers
and thumb. Any condition that decreases the size of the tunnel
or increases the size of the contents can cause carpal tunnel
3) What causes carpal tunnel syndrome?
There are numerous factors that may cause carpal tunnel
syndrome. It may be related to strenuous repetitive use of the
hands or occur after trauma such as a wrist fracture. The nerve
can be compressed from something extra within the canal.
This includes a mass, an anomalous muscle, or a hematoma
which can occur particularly in patients taking anticoagulation
medication after a fall on the hand. Other disorders associated
with carpal tunnel syndrome include diabetes mellitus,
hypothyroidism, alcoholism, severe infections, and arthritic
diseases such as rheumatoid arthritis, and gout. Carpal tunnel
syndrome is also associated with pregnancy as well as patients
4) How does the doctor make the diagnosis of carpal
The physician can often make the diagnosis after the patient
has explained their symptoms and the extremity has been
examined. During the examination the physician may perform
certain provocative maneuvers to determine if carpal tunnel
syndrome is evident. By tapping over the nerve at the wrist,
termed Tinel’s sign, a patient with carpal tunnel syndrome may
note a tingling sensation in the digits innervated by the median
nerve. Similar findings may be noted while holding the wrist
fully flexed or extended, termed Phalen’s and reverse Phalen’s
signs respectively. The strength of the muscles of the hand
are evaluated as well as the sensation. An EMG / NCV,
electromyography and nerve conduction velocity, is often
performed to confirm the diagnosis and determine severity. Xrays
are not routinely obtained.
5) How is carpal tunnel syndrome treated?
Patients with carpal tunnel syndrome due to a specific medical
condition such as diabetes or a thyroid disorder should have
the associated medical disorder treated appropriately. Wrist
splints are used at night and during the day during activities that
may exacerbate the symptoms. Non-steroidal antiinflammatory
medications may be of benefit but have the risk of
gastritis. Alteration of activities is important. This includes
taking frequent breaks from repetitive activities, and stretching
before and after activities. A therapist may be helpful in
reviewing ergonometric tips or performing a work place
evaluation. A corticosteroid injection of the carpal canal often
provides temporary relief. Approximately 25% of patient treated
with an injection will have long-term relief of their symptoms.
Non-operative treatment modalities are tried for months and if
the symptoms persist or progress surgical treatment is
considered. Those patients with a severe carpal tunnel
syndrome are considered for surgery more promptly since the
non-operative modalities typically are not helpful at this stage.
6) What is involved in the surgery for carpal tunnel
Carpal tunnel release is the most common procedure
performed in the upper extremity. In general surgical
procedures for carpal tunnel syndrome cut the ligament over
the canal to take the pressure off of the median nerve. The
surgery is performed on an outpatient basis under local
anesthesia and often in conjunction with intravenous sedation.
The procedure may be performed using the open technique in
which an incision is made in the palm to cut the ligament. The
nerve and canal is inspected to confirm that there is no other
process compressing the nerve. The skin is sutured and a
sterile dressing and often a splint are applied. The sutures are
removed in 5 to 10 days and an exercise program in started.
An alternative surgical procedure is the endoscopic carpal
tunnel release in which one or two smaller incisions are made
at the palm and or wrist and the ligament is cut while keeping
the skin above the ligament intact. The benefit of the
endoscopic release is less postoperative pain, earlier return of
grip strength, and earlier return to work.
7) What are the results of surgery for carpal tunnel
The majority of patients undergoing carpal tunnel release note
an improvement in their symptoms. Some patients may notice
persistent numbness and tingling. This will occur particularly in
patients that have a more severe carpal tunnel syndrome. At
this stage more permanent changes may have occurred within
the nerve due to longstanding compression. Other patients
may notice persistent or recurrent symptoms due to other
factors for example nerve compression in the neck (cervical
radiculopathy), or a polyneuropathy due to diabetes.
Most patients are capable of performing their activities of daily
living soon after the procedure. Pain about the about the palm
is often noted initially that is treated with scar massage. This
scar pain is one reason full grip strength often does not return
until three months after the procedure.
8) What are the risks of surgery for carpal tunnel syndrome?
There is a small risk of nerve injury since the procedure is
performed adjacent to the nerve. The endoscopic release has
a higher risk of nerve and blood vessel injury as compared to
the open procedure. There is a low risk of infection and
bleeding during the procedure is minimal. Hand and wrist
stiffness is a potential risk but is uncommon if the postoperative
exercises are performed.