Carpal tunnel syndrome, or CTS, can interrupt your sleep as the sensation of your hand tingling or going numb wakes you up at night. It can cause pain and interfere with your ability to do your job. It can even lead to atrophy and loss of function in your hand. But CTS can be treated in a variety of ways, depending on how far it has progressed. Here, Thomas Wolff, MD, orthopedic surgeon with Kleinert Kutz, offers important information about this very common, and often debilitating condition.
What is CTS?
“To understand CTS,” said Dr. Wolff, “it is helpful to understand something about the anatomy of the wrist. The symptoms of CTS are caused by compression of the median nerve that runs from the neck all the way down the arm into the hand. In the wrist, the nerve goes through the carpal tunnel, where the nerve must share space with nine tendons that also go into the hand. Anything that decreases the size of the tunnel or causes swelling can create compression of the nerve, which supplies sensation to the thumb, index and long finger plus half of the ring finger. The most common causes are repetitive motion and overuse.” As Dr. Wolff explained, “The first symptoms are usually tingling and numbness that wake you up at night. As the condition progresses, symptoms may start to appear during the day, maybe when you’re holding a pen or gripping the steering wheel. Eventually, it can progress to the point where muscles start to atrophy or people get sores on their fingers because they have no feeling in them.” How can CTS be treated? According to Dr. Wolff, “Appropriate treatment depends on what level your condition has reached in the spectrum of symptoms. If you’re only having symptoms at night,” he said, “a brace that keeps your wrist straight may be all you need. We have also found that Vitamin B6 is helpful for some people. A dose of 50 milligrams a day seems to help nerve function.” Therapy, with emphasis on stretching and strengthening can be another option. In addition, non-steroidal, anti-inflammatory drugs (NSAIDS) may also reduce swelling and help to alleviate symptoms. “If symptoms are interfering with your activities during the day,” said Dr. Wolff, “injections that decrease swelling and reduce compression of the nerve are often helpful. We may use a combination of a local anesthetic and hydrocortisone. We use this injection diagnostically as well as therapeutically. There are other things that can cause compression of the nerve. If the shot helps, even temporarily, it is likely to be CTS. Other diagnostic measures include a nerve conduction study called electromyography that measures the speed in which impulses are conducted along the nerve.”
Outpatient surgery can prevent permanent damage in severe cases
When symptoms persist or are very severe, surgery to decompress the nerve may be the best option. “In severe cases, permanent loss of function can result without surgical intervention,” explained Dr. Wolff. “The surgery can be performed on an outpatient basis at Kleinert Kutz Surgery Center in New Albany. It may be endoscopic or open, which allows the surgeon to better visualize the structures. In the procedure, we may enlarge the carpal tunnel, remove excessive tissue compressing the nerve, or both.” The surgery is performed with local anesthesia. “Recovery time varies with what people have to do with their hands,” said Dr. Wolff. “Post-operatively, most people wear a splint that allows the fingers to move. They can work in the splint while the stitches heal. Patients can usually have the surgery on Friday and return to work on Monday. Of course, if they have to use power tools on the job or do something else very active with their hands, they may not be able to return to work that soon. We usually take the stitches out in about two weeks.”