| Carpel
Tunnel Syndrome |
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Painful,
burning numbness in the palm of the hand is a common symptom
of carpel tunnel syndrome. The median nerve, which serves
sensation in the palm of the hand, and movement of small muscles
in the hand, is compressed at the wrist. The nerve is pinched
between underlying ligaments and bones of the wrist and an
overlying, tough ligament, the transverse carpel ligament.
Patients complain of tingling in the palm, and sometimes aching
and burning. Characteristically the numbness awakes the patient
at night, or is present with repetitive use of the hand. Pain
may radiate up the arm toward the shoulder.
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Diagnosis
is made by the findings of three cardinal signs:
- Numbness
in the distribution of the median nerve in the hand: palm,
thumb, index, middle and lateral half of the ring finger.
- Tingling
sensation radiating into the hand by tapping over the nerve.
- Reproduction
of symptoms by marked wrist flexion for 30 to 60 seconds.
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| Weakness
in the small muscles of the hand controlled by the median nerve
is found rarely . Sampling the electrical activity in the muscles
and nerves (EMG) can aid in the diagnosis. |
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Factors
which can lead to carpel tunnel compression include:
-
Soft
tissue trauma, fracture and repetitive motion.
-
Rheumatoid
arthritis and other connective tissue disorders.
-
Endocrine
disorders: myxedema, acromegaly, diabetes, pregnancy.
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| In
most cases the cause is not known. Conservative treatment includes
splinting the wrist, oral steroids and anti-inflammatory medications,
and local injection of steroids. When these efforts fail or
when there is weakness operation is indicated. The goal of operation
is simply to divide the ligament, which decompresses the nerve.
Our practice has been to divide the ligament through a short
incision with local anesthesia, in a outpatient surgery center.
The operation only takes a few minutes and patients can return
to normal activities afterwards, limited only by tenderness
in the hand. Complications include a very low rate of infection
and injury to the nerve and the vast majority of sufferers are
relieved of their tingling, burning pain. |
| Compression
of the median nerve at the wrist is only one example of peripheral
nerve compression syndromes which plague us. Another common
problem is compression of the ulnar nerve at the elbow. This
causes numbness in the inner hand, including the small finger.
Persistent symptoms can be relieved by incision the tissues
of the elbow which entrap the nerve. Several other nerves can
be entrapped causing burning numbness in other regions. Obviously
numbness has many other causes, so experienced evaluation is
always the first step in the direction toward cure. |
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