Everybody has heard of carpal tunnel syndrome, but a common misconception is that all wrist and hand pain are carpal tunnel syndrome. The truth is carpal tunnel has a very specific presentation.
Carpal tunnel is a narrow passage situated on the palm side of the wrist that connects forearm to hand. Nerves and a tendon cross through this passageway. The compression of the median nerve in this area is carpal tunnel syndrome. The compression can be caused by multiple factors including underlying health problems like diabetes, thyroid dysfunction, fluid retention like in pregnancy, autoimmune disorders like rheumatoid arthritis, fractures or trauma to the wrist, or patterns of hand use.
Common presentation is numbness, tingling and pain in the thumb and first three fingers of the hand. The symptoms are more often intense at night time or with activities of gripping and grasping like reading a book or driving a car. Over a period of time, weakness of the hand can happen as the median nerve also supplies some of the muscles in hand.
Diagnosis is made by a detailed physical exam but nerve conduction studies and electromyography are confirmatory. They are performed in-office, putting electrodes and very thin needles in the tested muscle area.
Treatment depends on the severity of symptoms. Non-surgical treatment includes using wrist splints, medication to reduce inflammation, physical therapy, and treatment of underlying condition like uncontrolled diabetes. Steroid injection can be done as well to reduce pain and symptoms. In severe cases, surgery is recommended if there is severe damage to the median nerve. The surgery involves making a small incision on the palm side of the wrist and releasing the tight band of tissue that is causing compression of the nerve. The outcome after surgery is usually good but depends on the age of the patient, severity, and duration of symptoms and other associated health issues. Physical therapy is recommended after the surgery.
Dr. Leon Popovitz and Dr. Michael Mizhiritsky, along with their team of best-in-class orthopedic physicians, are known for their exemplary orthopedic surgical skill and best-rated physical medicine and rehabilitation program. This, along with their top in-office physical therapy and long-term sports rehabilitation processes, leads to athletes of all levels returning to their top physical potential. Contact us today to schedule a consult!
