Carpal tunnel syndrome affects millions of Americans every year. But what exactly is it? And how is it treated?
Carpal tunnel syndrome is a condition in which the median nerve, located in the wrist, is compressed and causes pain, numbness and tingling. “There is a ligament that sits over the median nerve, and when it becomes thick from overuse it can trap and squeeze the nerve,” says Dr. Levon Nazarian, a radiologist at Thomas Jefferson University Hospital. “This pinching often causes debilitating pain, mostly in the first three fingers, sometimes spreading to the forearm.”
It’s caused by repetitive movements of the affected hand that put stress on the area, like typing on a keyboard. Dr. Nazarian says, “There may be some hereditary components to carpal tunnel syndrome—if you have a close relative with the condition and you perform repetitive movements with your hands, you may be more at risk for developing this condition.”
How is carpal tunnel syndrome diagnosed?
Before you consider surgery or other treatments, you should make sure you’ve been examined by an experienced physician who can diagnose you with carpal tunnel syndrome. If you’re experiencing significant pain, numbness, tingling or weakness in your hand, wrist or forearm that keeps you up at night or makes it difficult to perform everyday tasks, you’ll want to make an appointment with your doctor.
“You may be able to receive a diagnosis just with an ultrasound, but if the nerve is not clearly swollen with that imaging, you’ll need an EMG to determine whether or not you have carpal tunnel syndrome,” says Dr. Nazarian. Electromyography (EMG) is a diagnostic test that measures muscle response or the electrical activity generated by a nerve’s stimulation of a muscle.
Can pain be managed without surgery?
There are many non-surgical treatment options for the wrist and hand pain that accompanies carpal tunnel syndrome. Using a brace can be helpful to keep your wrist in an extended position, where it’s less likely to compress the nerve. This could help if you’re having trouble sleeping at night or functioning during the day.
You can also make an appointment with a physical therapist who specializes in treating carpal tunnel syndrome—they can give you exercises that will help the nerve glide more freely in its tunnel.
For those who don’t want to resort to surgery but need more relief than assistance from a brace, cortisone injections are an option. “Relief from cortisone injections can last from a few months up to a year,” says Dr. Nazarian.
What are the surgical treatment options for carpal tunnel syndrome?
“There are two main reasons we do surgery for carpal tunnel: to relieve symptoms and to keep symptoms from getting worse. If you aren’t treated when your symptoms are severe, you could risk losing muscle in your hand and developing permanent nerve damage,” Dr. Nazarian advises. If your doctor determines that you’re a candidate for surgery, there are a few different options.
Traditionally, carpal tunnel release surgery is performed as open surgery. In recent years, however, a variety of new minimally invasive procedures have been developed.
Ultrasound-guided carpal tunnel release surgery has been recently approved by the FDA and is now available at Thomas Jefferson University Hospital. Dr. Nazarian has performed this procedure more than 100 times with great success. “Using an ultrasound to see the affected area, we insert a small device through an incision in the wrist to cut the transverse carpal ligament that’s pressing on the nerve,” says Dr. Nazarian. “This procedure requires only one incision, as opposed to other procedures that may require a second incision to insert an endoscope.”
The ultrasound-guided procedure is performed in the office with a local anesthetic and doesn’t require any stitches. Patients are usually in and out of the office in about an hour, can take their hand wrapping off within two to three days, and can start using their hand again within four to five days. “Many patients will start to feel relief from pain within two weeks,” says Dr. Nazarian.
If you’ve been diagnosed with carpal tunnel syndrome and you’re interested in learning more about minimally invasive surgery options, talk to your doctor about getting a referral.