The median nerve passes through an opening that is called the carpal tunnel. Carpal tunnel syndrome is a condition in which the median nerve is compressed in the area of the wrist from the narrowing of the carpal tunnel. Approximately 5% of Americans suffer from carpal tunnel syndrome sometime in their lives with women over the age of 55 two times more likely than men to experience it.
Persons most likely to suffer from carpal tunnel syndrome are those who work using a computer keyboard (in the past it was a typewriter), or musicians who play stringed instruments like piano, guitar, violin, etc; and wind instruments like clarinet, saxophone, trumpet. It is the repeated use of the fingers and hands that cause the condition.
Other causes of the condition include the use of oral contraceptives, being overweight or obese, prediabetes, (a condition of impaired glucose tolerance), diabetes, hypothyroidism, arthritis, and trauma from injuries such as a fall when the hands take the fore of the impact.
What are the symptoms associated with carpal tunnel syndrome?
People who suffer from carpal tunnel syndrome often experience tingling and numb sensations in the thumb, index, and middle fingers, and also the ring fingers will sometimes have these symptoms. They may also complain of burning sensations in these areas. Some more general symptoms displayed often include the loss of grip strength and pain, tingling and numbness in the hands and wrists.
How is carpal tunnel syndrome diagnosed?
Diagnosis of carpal tunnel syndrome is conducted by a series of specific tests. These include:
- Ø Phalen’s maneuver: This test is performed by having the patient flex their wrist as much as they are able and holding it in the flexed position. If after one minute this results in numbness of the median nerve distribution then it is considered a positive test.
- Ø Tinel’s sign: Although less sensitive, this test detects irritated nerves. This test is performed by tapping the flexor retinaculum in order to elicit the “pins and needles” sensation.
- Ø Durkan test, AKA, carpal compression test: In this test firm pressure is applied to the palm of the hand for thirty seconds in order to elicit symptoms.
- Ø Hand elevation test: The hand elevation test is more sensitive and specific than the three previously mentioned tests.
What treatments are available for carpal tunnel syndrome?
The wearing of rigid wrist braces while sleeping and while performing the activity that causes symptoms to increase often help to ease the symptoms associated with carpal tunnel syndrome, but it is not a cure. For some persons physical therapy can help but it is also not a cure. For persons with debilitating carpal tunnel syndrome, surgery may be the only way to restore use of the hand and wrist.
For persons that are still functional but need relief from pain, often corticosteroid injections are found to be very effective. These injections are performed on an outpatient basis and generally take only about ten minutes to perform, followed by an observation period of thirty minutes to watch for negative reactions to the injections.
How is the procedure performed?
The patient is placed on an exam table with the hand positioned for the best access. The area to be injected is first cleaned with antiseptic solution and then numbed with a topical anesthetic. A thin needle is gently inserted and contrast dye is injected. This dye ensures the medications will bathe the nerve.
The medication is then slowly injected; often the patient will experience immediate but temporary relief from the local anesthetic but this usually wears off in a day. The steroid medication may take a couple days to take effect but then provide relief for an extended period, often for several weeks to months.
Risks and side effects from these injections are very minimal and include slight swelling, bruising, and bleeding at the injection site. For the benefit to be gained from the injections the risks are quite low. Discuss with your pain management physician in Colorado to determine if you are a candidate for these injections to treat your symptoms.