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Carpel Tunnel

A modern debilitation

One of the greatest causes of hand, wrist and forearm pain is due to the entrapment neuropathy commonly known as carpal tunnel syndrome. It happens when the median nerve (which extends from the hand, through the wrist, and into the arm) gets compressed inside the wrist joint, between the bones that make up a passage called the carpal tunnel.

Symptoms of carpal tunnel syndrome like pain, numbness, and tingling don’t usually start quickly. Rather, they usually take months or years to become apparent. The condition can occur with excessive hand use, disease or even pregnancy. Symptoms progress to more severe hand or finger pain, wrist pain, numbness or tingling, they feel itching or coldness in the fingers or palm of the hand. Onset symptoms are especially prominent in the thumb, index and middle fingers. Sometimes the fingers feel swollen even though they are not. These sensations can occur in one or both hands. Eventually, the person feels a decrease in dexterity and grip strength. Severe or chronic cases that are left untreated for many years can result in muscle wasting at the base of the thumb, and some people lose the ability to sense temperature in their fingers and hand.

Symptoms like pain, tingling and numbness occur because the median nerve reacts to being compressed. Why does the median nerve get compressed in the first place? ​It has to do with inflammation of the flexor tendons (those which help close the fingers). These tendons lie right next to the median nerve inside the carpal tunnel. Under certain conditions, the tendons become inflamed or swollen. It’s like a kind of tendonitis but deep in the carpal tunnel. These swollen tendons have only so much space in which to swell and expand. But since the median nerve is right next to the tendons, as they swell they push on the median nerve, squeezing it against the wall of the carpal tunnel. Therefore, it gets compressed or entrapped in that small, confined space.

A modern medical approach

In the early stages of carpal tunnel syndrome, a simple brace will sometimes decrease the symptoms, especially the numbness and pain occurring at night.  These braces simply keep the wrist in a neutral position (not bent back too far nor bent down too far). When the wrist is in this position, the carpal tunnel is as big as it can be - so the nerve has as much room as possible. The brace needs to be worn at night while you sleep to prevent the numbness and pain occurring at night. If you have symptoms during the day as well, the brace may help reduce those symptoms as well.

The downside of a brace is that without movement, circulation to the affected area decreases making this ineffective.

Anti-inflammatory medications may also help control the swelling of the tenosynovium and reduce the symptoms of carpal tunnel syndrome. These medications include the common over the counter medications such as ibuprofen and aspirin. In some studies, high doses of Vitamin B-6 have also shown some efficacy in decreasing the symptoms of carpal tunnel syndrome.

If these simple measures fail to control your symptoms an injection of cortisone into the carpal tunnel may be suggested. This medication will decrease the swelling of the tenosynovium and may give temporary relief of symptoms. It is used not only to treat the problem, but serves to aid in diagnosis. If you don't get even temporary relief from the injection, it may be a sign that other problems exist that are causing the carpal tunnel symptoms. There is also a newer way to get cortisone medications down into the carpal tunnel. Iontophresis is a technique where an electrical current is used to move the molecules of the medication through the skin down into the carpal tunnel. It is less painful than an injection, but is probably not as effective.

Surgical Treatment

If all of the previous treatments fail to control the symptoms of carpal tunnel syndrome, surgery may be required to reduce the pressure on the median nerve. There are several different surgical procedures designed to relieve pressure on the median nerve. The most common are the traditional open incision technique described below, and the newer Endoscopic Carpal Tunnel Release using a smaller incision and a fiberoptic TV camera to help see inside the carpal tunnel.

But surgery is only a temporary fix because it relieves the compression, but the problem of inflammation continues - unaddressed. That is the main reason why there is over 50% failure rate of such surgeries.​

Basic Steps in Open Carpal Tunnel Release

  1. A small incision, usually less than 2 inches, is made in the palm of the hand. In some severe cases, the incision needs to be extended into the forearm another 1/2 inch or so.
  2. After the incision is made through the skin, a structure called the palmar fascia is visible. An incision is made through this material as well, so that the constricting element, the transverse carpal ligament, can be seen.
  3. Once the transverse carpal ligament is visible, it is cut with either a scalpel or scissors, while making sure that the median nerve is out of the way and protected.
  4. Once the transverse carpal ligament is cut, the pressure is relieved on the median nerve.
  5. Finally, the skin incision is sutured. At the end of the procedure, only the skin incision is repaired. The transverse carpal ligament remains open and the gap is slowly filled by scar tissue.

A bulky dressing is applied to the hand following surgery. You should leave this in place until your first office visit after the surgery. Your sutures will be removed 10 - 14 days after surgery. You should avoid any heavy use of the hand for 4 weeks after your surgery. You should not get the stitches wet. Expect the pain and numbness to begin to improve after surgery, but you may have tenderness in the area of the incision for several months.

This also means that your occupation that caused this injury is over.  Resuming work will eventually cause the  same problem in the ligaments and tendons that have taken over the role of those removed.

Natural Treatments 

The only real, effective, and permanent way to treat carpal tunnel syndrome is to attack the problem of inflammation and swelling. One of the very best ways to do this is with deep tissue massage of the wrist and forearm. That drains fluid from around tendons and breaks the adhesions that cause inflammation and swelling. Daily deep tissue massage done professionally and a balanced exercise and rest regime is the only effective and lasting remedy for this debilitating condition.

  • Massage is one of  the most effective treatments as it aides circulation bringing nutrition to  the affected tissues, and removal of toxins from the  affected area.
  • Yoga exercise is effective when done regularly as it improves the flow of energy into the area and balances the musculature.  It may also help your posture and reduce the strain on those tissues.
  • Improved diet and lifestyle may help.
  • The products used to support arthritis may also help

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This material does not constitute medical advice. It is intended for informational purposes only. Please consult a physician for specific treatment recommendations.

References:
Carpal tunnel Costs

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