Daniel G. Branham, M.D, a highly experienced hand surgeon at Tennessee Orthopaedic Alliance, explains what carpel tunnel syndrome is.
Carpal Tunnel Syndrome
What is Carpal Tunnel Syndrome?
Carpal tunnel is a condition where the median nerve which goes to the thumb, index, and long finger gets trapped in the wrist and it’s a pressure situation where there’s too much pressure on the nerve for it to have its normal blood supply and function
What are the symptoms?
Pain, discomfort in the wrist, tightness, numbness in the fingers. And this is often seen when the patient’s trying to sleep, or go to sleep, or stay asleep, or do repetitive tasks like working or driving.
Who can get it?
Anybody can get carpal tunnel, 20s to 80s, men, women, activity, no activity. It’s a very common condition. Roughly 1% of the population will be struggling with carpal tunnel at any given time.
What causes it?
The cause is multifactorial. Lots of things can kind of contribute. Some people just have an anatomic disposition to getting carpal tunnel. Sometimes people will have medical conditions like diabetes or thyroid conditions that make them more susceptible to developing carpal tunnel. And then sometimes it’s activity related. The more you do, the more it is aggravating, and the more symptoms flare up.
What can I expect at my first visit?
So what we try to do when we see somebody for carpal tunnel is first establish the diagnosis, to make sure that what they think is carpal tunnel truly is, and that there’s not another concomitant condition that could be masking or contributing to the diagnosis. We try non-operative techniques like night splinting, and if that’s not successful then we do have an operative correction for the condition.
What are the surgical options?
There is what we call an endoscopic technique where we do two little incisions and do the same work underneath the skin and that’s good for people that are trying to go back to those heavy lifting kind of higher activity events as quickly as possible. So it has that advantage, the downside is with that particular technique in my hands, you need to go to sleep. So people that are looking to avoid a general anesthetic typically perform the procedure with just a local. Surgery generally involves an incision between here to here, so about a two to three centimeter incision. Stitches come out at two weeks, no splint, no cast, no therapy, just a simple wound care for two weeks. And then patients gradually get back to doing what they want to do.
Which procedure has the best outcomes?
Same results at six months. And that’s my experience, and that’s also what’s been born out in the literature. People that go back and study how do people do at six months, it seems to be not really relevant which way you had the technique, but just that you had the procedure performed.
When will I see results?
The nocturnal symptoms, the shake it out, wake you up in the middle of the night nuisance that’s gone within a day or two. Depending on how severe it is, sometimes people get sensation back to the fingertips within days to weeks. Sometimes if it’s really severe and it’s been there for years, that may take longer. But the very reliable thing is the nocturnal, the night pain, the shake it out pain, people say that’s better within a day or two.
