John Berschback, MD
Chippewa Valley Orthopedics & Sports Medicine
What is carpal tunnel syndrome?
Carpal tunnel syndrome (CTS) is the most common nerve compression syndrome of the upper extremity. We don’t always know what causes this condition, and a number of factors are often implicated. The carpal tunnel is a relatively small space in the wrist area that contains nine tendons and one nerve (the median nerve).
What are the symptoms?
Typically, patients with carpal tunnel syndrome will have numbness or tingling in the thumb, index, middle, or ring fingers. Any or all of these digits can be involved. The pinky finger usually is not affected in CTS. Patients with CTS also frequently report that their hands will fall asleep while holding onto the steering wheel in the car, or that they have to shake their hands out in the middle of the night because the symptoms have woken them from sleep. The pain and numbness can travel up the arm to the shoulder region, and wrist pain can also be a presenting symptom. As CTS becomes more severe, patients will report dropping objects, more pain, and an inability to button their clothing (due to sensation loss).
How is CTS diagnosed?
History and physical exam are the most important tools I use to diagnose CTS. After carefully listening to a patient’s symptoms, I will examine them by looking for any muscle wasting, tapping on the median nerve at the wrist, and pressing on the nerve at the wrist. I also check how good their sensation is and check strength. It is important to remember that neck problems (like disk herniations) can mimic the symptoms of CTS, and the nerve that travels through the carpal tunnel can rarely be compressed in other areas of the forearm and elbow region. After my history and physical exam, I will sometimes order a nerve test to help me make the diagnosis. The nerve test can be slightly uncomfortable, but can help show the severity of the compression and rule out other areas where the nerve may be compressed.
Are certain medical conditions associated with CTS?
Yes. Carpal tunnel syndrome is often associated with diabetes, rheumatoid arthritis, low thyroid function, obesity, and alcoholism. If you have a previous wrist fracture, you are more likely to develop CTS over time, especially if the fracture did not heal in a good position. While not a medical condition, people who work jobs with frequent vibration of the hand or wrist (such as operating a jackhammer) are more likely to develop CTS.
What is the treatment?
There are various treatment options, depending on how severe the symptoms are and how long they have been present. For patients initially presenting to my office, I frequently will prescribe a wrist brace to be worn at nighttime. The brace helps to relieve some of the pressure on the nerve while you sleep, and can improve the nighttime numbness and tingling. For mild cases, and for cases where I am unsure of the diagnosis, I will sometimes give the patient a steroid injection into the carpal tunnel. If the symptoms improve after the injection, I can be confident of a diagnosis of CTS. Therapy and other treatments such as ultrasound have not shown to be reliably effective in the treatment of CTS. If the non-operative treatment options have failed, or if the patient presents with advanced CTS, surgery is an option. The surgery consists of cutting a thick ligament that is the “roof” of the carpal tunnel. It typically takes 5–10 minutes to perform the surgery. I am able to perform the surgery in my office under local anesthesia or it can be performed in the operating room on an outpatient basis.
While there are risks with the surgery, it has an overall high success rate in terms of resolution of symptoms, but in severe cases the symptoms may never go away and the hand may never be the same again. Sometimes surgery is performed just so things don’t continue to worsen, with the expectation that the symptoms may not ever get better. Nerves do take up to 12 months to recover, so you have to sometimes be patient after having your surgery to see what your final result will be.
Carpal tunnel syndrome is a very common condition. Early recognition and treatment can lead to more favorable results,
and surgery may be necessary if non-operative measures fail. Talk to your doctor if you are having symptoms similar to those described in this article.
Dr. Berschback – Chippewa Valley Orthopedics & Sports Medicine
For information or to schedule an appointment:
715-832-1400 | 800-322-1747 | cvosm.com
Dr. Berschback sees patients in Altoona, Chippewa Falls and Rice Lake.