Carpal Tunnel Syndrome

What is the carpal tunnel?

The carpal tunnel is a narrow canal in the wrist. The bottom and sides of the tunnel are formed by a semi-circle of bones called carpal bones. A strong tissue, called a ligament, forms the top of the tunnel. The median nerve and tendons pass through this narrow space. (The tendons are “rope-like” structures that connect muscles in the forearm to bones in the hand.) Tendons allow the fingers and thumb to bend and straighten. Conditions that further narrow the carpal tunnel or cause the tendons that pass through this tunnel to swell cause carpal tunnel syndrome by compressing the median nerve.

What is carpal tunnel syndrome?

The wrist comprises of several small bones collectively known as the carpal bones. The carpal bones are interconnected via strong ligaments and connective tissue known as the flexor retinaculum. Collectively, this arrangement forms a space known as the carpal tunnel .The carpal tunnel contains numerous flexor tendons from the muscles of the forearm allowing them to attach to the wrist and fingers via the carpal tunnel. In addition, a nerve known as the median nerve lies within the carpal tunnel . The median nerve is responsible for supplying some sensation and motor control to the hand.

Occasionally, the carpal tunnel may narrow resulting in compression of the median nerve. When this occurs, the condition is known as carpal tunnel syndrome. Carpal tunnel syndrome normally occurs following damage to the flexor tendons within the carpal tunnel. This results in swelling and inflammation of the tendons, thereby reducing the dimensions of the carpal tunnel, compressing the median nerve.

Damage to the flexor tendons usually occurs due to overuse of the forearm flexors. During contraction of the forearm flexors, tension is placed through the flexor tendons within the carpal tunnel. When this tension is excessive due to too much repetition or high force, damage to the tendons may occur. This is usually due to gradual wear and tear associated with overuse, however, it may also occur traumatically due to a specific incident. Although carpal tunnel syndrome can occur at any age, it is commonly seen in patients greater than 50. Carpal tunnel syndrome is also more common in women and usually affects the dominant hand. Occasionally, it may affect both hands.

Ankle replacement surgery is done if the ankle joint is severely damaged. Your symptoms may be pain and loss of movement of the ankle. Some causes of damage are:

• Heredity is the most important factor - carpal tunnels are smaller in some people, and this trait can run in families.

• Hand use over time can play a role. Especially in computer operators and musicians who keep their wrists in extended position for a long time.

• Hormonal changes related to pregnancy can play a role.

• Osteoarthritis

• Age — the disease occurs more frequently in older people.

Symptons :-

The Most Common Symptons of Carpal Tunnel Syndrome Include :-

• Numbness, tingling, and pain in the hand

• An electric shock-like feeling mostly in the thumb, index, and long fingers

• Strange sensations and pain traveling up the arm toward the shoulder

Symptoms usually begin gradually, without a specific injury. In most people, symptoms are more severe on the thumb side of the hand.

When these initial efforts fail to control symptoms, an operation called a carpal tunnel release is advised by your surgeon. During the procedure, the surgeon carefully cuts the wrist ligament, releasing the pressure inside the carpal tunnel, usually providing almost instantaneous relief from arm and hand pain and tingling. As the wound heals, new tissue will bridge the severed ligament in about six weeks, making the ligament long enough to create additional space inside the tunnel and prevent recurrence of symptoms in most cases.

The most common surgery for relieving carpal tunnel symptoms involves cutting the transverse carpal ligament to relieve pressure on the median nerve in the wrist. Two approaches for this surgery are :

• Open carpal tunnel release surgery, which allows the doctor to see more of the inner tissues, including the full width of the transverse carpal ligament where it is to be cut. Open surgery requires an incision in the palm and wrist, which disturbs more of the tissues in the hand, and requires a longer recovery period. It leaves a larger scar than does endoscopic surgery. But there may be less chance of other complications. See a picture of open carpal tunnel surgery.

• Endoscopic carpal tunnel release surgery, which requires only a small incision at the wrist (single-portal technique) or at the wrist and palm (two-portal technique), and which disturbs less tissue in the hand. Recovery is quicker than with open surgery. And the scars heal more quickly, are smaller, and tend to be less painful at 3 months after surgery. There may be a slightly higher rate of reoperation after endoscopic carpal tunnel surgery. See a picture of endoscopic carpal tunnel surgery.

What are the Aims and Benefits of Carpal Tunnel Release Surgery?

• Relief from Neural Compression

• Pain Reduction

• Prevention of Further Deterioration

The chance of obtaining a significant benefit from surgery depends upon a wide variety of factors. Your neurosurgeon will give you an indication of the likelihood of success in your specific case.

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