CARPAL TUNNEL SYNDROME

What causes Carpal Tunnel Syndrome?

Pressure may be put on nerves in the wrist due to inflammation resulting from repetitive motion, normal wear and tear due to aging, arthritis, fluid retention, or previous fracture of the wrist which narrows the carpal tunnel.

What are symptoms of Carpal Tunnel Syndrome?

Usual symptoms of Carpal Tunnel Syndrome include pain, numbness, and tingling in either or both hands and in all or a few fingers. At the onset, symptoms may be experienced mostly at night. If diagnosis and treatment are delayed, symptoms tend to get worse: pain increases, grip strength weakens, and you may drop things. Early treatment may prevent permanent nerve damage and potential disability.

How is Carpal Tunnel diagnosed?

Your physician will take your history and do a physical examination. Some questions might include:

• Does your hand primarily bother you at night?
  
• Do symptoms occur anytime you hold your hand in a static position, such as working at a computer or driving?
  
• How do you describe your discomfort in the nature of sensations and the frequency?
  

Electro-diagnostic tests may be ordered to determine whether a nerve is being pinched. These tests may include: nerve conduction studies, electromyography, and somatosensory evoked potentials. X-rays may be ordered.

What can I do about carpal tunnel syndrome?

Your doctor may order a brace and/or anti-inflammatory medications. If treatment does not help, surgery may be recommended. Early treatment has the best potential for a good outcome. Some things you can do to reduce your risk of carpal tunnel syndrome:

• Make changes in the way you position your hands to maintain a "neutral" position while working, driving, writing, and so on.
  
• Minimize repetition-particularly while grasping an object in the same position. Try to vary even small repetitive movements.
  
• If you perform repetitive movements with force, make the movements more slowly in order to allow recovery at the wrist before the next forceful movement. Use power tools whenever possible.
  
• Rest or alternate activities. Give your hands and wrists a break occasionally.
  
• Strengthen hand and arm muscles.

If surgery is needed, how is a Carpal Tunnel Release done?

There are two common ways the Carpal Tunnel Release is done.

• In the open Carpal Tunnel Release, an incision is made down the middle of your palm.
  
• In the endoscopic carpal tunnel release, a small incision is made at the wrist in the crease, and perhaps a small incision at the palm. The transverse ligament is divided (or released) to open the carpal tunnel and remove the pressure on the nerve. The procedure takes about 45 minutes.

What will I need to do before surgery?

• Your doctor may want you to have lab tests before surgery. The person who schedules your surgery will discuss these with you and schedule any tests needed before surgery.
• Seven days before surgery, you should not use aspirin containing products or non-steroidal anti-inflammatory medication (NSAID). NSAIDs include aspirin, ibuprofen, Advil, Motrin, Daypro, and Naprosyn. These medications have been associated with an increased incidence of blood clots after surgery. There is a new class of NSAIDS, including Vioxx and Celebrex, that may be taken until 2 days before surgery. (Stop two days before your surgery day.) This will be discussed with the doctor who prescribes those medications.
• If you take herbs or alternative prescriptions, please advise your doctor. Some of these can cause odd interactions with common drugs.
• If your surgery will be in the morning, you will be asked not to eat or drink anything after midnight the night before surgery. You should not eat or drink anything 8 hours before surgery. This includes food, water, coffee, chewing gum, etc. If you take a medication regularly, you may take it with a small sip of water.
• Wash hands thoroughly several times the day before surgery with antibacterial soap.

What are the risks of carpal tunnel release?

In addition to the usual risks of any surgery, the potential risks for carpal tunnel release include:

• Numbness
  
• Impaired muscle function
  
• Recurrence or persistence of the condition requiring the operation
  
• Continued, increased, or different pain.
  

1. Your symptoms or pain may be completely improved.
   
2. Your symptoms or pain may be partially improved.
   
3. Your symptoms or pain may be the same as before surgery.
   
4. Your symptoms or pain may be worse than before surgery.

Your doctor will discuss with you any concerns you may have about the surgery and recovery.

What can I expect after surgery?

• Naturally, your incision area will be sore; however, if you have any drainage, pain, redness, swelling, fever, white or pale blue hand or nails, increasing pain not relieved by medications, or loss of sensation in fingers, please call the office immediately.
• Do not become alarmed if you experience the same type of pain that you had before your surgery, or even some new weakness or numbness. This is common and usually lasts only a short time. The healing process takes time.
• Any time the skin is punctured, infection is a risk. If treated early, infection is easier to control. Infection is rare, but it can happen. By being aware of the signs of infection, you can take action quickly if it should happen to you. If in doubt, call your doctor's nurse. Mention to the switchboard operator that you have recently had surgery and your call will be handled immediately.

Be alert for the signs of infection:

• Fever - even one degree
  
• Heat at the incision
  
• Increased pain at the incision site
  
• Drainage that is pus-like in nature
  
• Redness and swelling at the incision
  
• Unpleasant odor at the incision
  

Use your pain medication carefully. Many patients have been on a lot of narcotics prior to and after surgery. Using them wisely in your post-operative period will avoid future problems and you will get better pain relief if you do not have an increased tolerance to them.

Let your pain determine your activity level. If something causes increased pain, avoid that activity. To keep your hand flexible as it heals, it is best to begin moving your fingers right after surgery. Certain exercises may be recommended to help maintain circulation in your hand, improve flexibility, and increase your strength.

To protect your healing skin and ligament, avoid bending your wrist very far forward (flexion) or backward (extension).

It is okay to loosen the dressing if it is too tight. The dressing may be removed on the 4th day after surgery.

Within a day or two after surgery, you can begin to use your hand for light activities. Your hand will probably be weak at first, but it will get stronger as you use it. Avoid bumping or hitting the area around the incision(s). In many cases, you will be able to resume driving when you stop taking prescription pain medications, usually in about a week.

You may take a shower, but cover the hand and wrist with plastic or some sort of covering and keep it elevated above the water. It is best not to get the incision wet until after the sutures are removed and you are told by the doctor that you can wash it. DO NOT TAKE A BATH as the incision should not be soaked in water. DO NOT PUT OILS OR OINTMENTS ON THE INCISION SITE. Keep your dressing clean and dry.

For the first several days after your surgery, keep your hand elevated above the level of your heart to reduce swelling and pain. You may notice that the palm and the back of your hand are black and blue for a few days-this is normal and nothing to worry about. If you have discomfort in your wrist or palm, take your pain medications as directed. An ice pack may also help relieve discomfort.

Follow-up office visits:

Sutures will usually be removed within about 10 days. At that time, an appointment will be made for a 6-week follow-up office visit. You and your doctor can discuss the results of your surgery.

If your carpal tunnel injury was caused by repetitive strain, you may need to make some changes in how you use your hands to avoid future problems. With care, you may regain full use of your hand and remain free from painful symptoms.