Carpal Tunnel

Carpel Tunnel Syndrome

Painful, burning numbness in the palm of the hand is a common symptom of carpal 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 carpal 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.

Diagnosis is made by the findings of three cardinal signs:

  1. Numbness in the distribution of the median nerve in the hand: palm, thumb, index, middle and lateral half of the ring finger.

  2. Tingling sensation radiating into the hand by tapping over the nerve.

  3. Reproduction of symptoms by marked wrist flexion for 30 to 60 seconds.

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.

Factors which can lead to carpal tunnel compression include:

  1. Soft tissue trauma, fracture and repetitive motion.

  2. Rheumatoid arthritis and other connective tissue disorders.

  3. Endocrine disorders: myxedema, acromegaly, diabetes, pregnancy.

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 able to divide the ligament, through a short incision with local anesthesia, in an 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 compression causes numbness in the inner hand, including the small finger. Persistent symptoms can be relieved by incision of 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.