From the AAOS…
Study assesses prevention, symptoms, treatment options and prognosis of Carpal Tunnel Syndrome
A study appearing in the September 2007 issue of the Journal of the American Academy of Orthopaedic Surgeons reports approximately 500,000 surgical procedures on Carpal Tunnel Syndrome or CTS are performed each year in the United States. The economic impact due to CTS is estimated to exceed $2 billion annually.
The study is from Northwestern University Feinberg School of Medicine in Chicago, looking at CTS evaluation and management.
Most patients with CTS present to their orthopaedic surgeon with numbness, tingling and weakness in their hands and fingers. Occasionally, pain can occur and go up the arm or into the shoulder. Theses symptoms are caused by median nerve compression.
Most cases of CTS do not have an identifiable cause. Women are more commonly afflicted than men and incidence increases with age. Other conditions associated with carpal tunnel syndrome may include:
- Wrist Trauma
- Obesity
- Hypothyroidism
Additionally, rheumatoid arthritis and renal (kidney) failure may lead to an increase in pressure within the carpal tunnel; drug toxicity, diabetes and alcoholism may have direct injurious effects on the median nerve. CTS also occurs in 20-45 percent of all pregnancies, however it typically disappears after childbirth.
Some people believe that work activities that involve overuse of the wrist and hand, repetitive impact on the palm and tools that vibrate can cause CTS. Extremes of wrist flexion and extension have been shown (experimentally) to elevate pressure within the carpal tunnel. However, the relationship between repetitive work activity and CTS has never been objectively demonstrated.
Medical history and physical examination are key in the diagnosis of CTS. An orthopaedic surgeon will evaluate for other conditions that can mimic CTS including neck problems, thoracic outlet syndrome, and other nerve compression syndromes. The examination includes:
- Assessment of cervical spine and upper extremities motion
- Skin and muscle assessment
- Strength testing with grip and pinch measurements
- Sensory testing
- Other provocative tests for CTS.
X-rays, nerve tests, or blood tests may also be ordered.
Conservative, non-surgical treatment for CTS patients includes:
- Splinting
- Corticosteroid injection.
If conservative treatments fail, carpal tunnel release surgery may be necessary. Open carpal tunnel release is the most common method of surgical treatment.
Complications of surgery are infrequent but can occur. Recurrent carpal tunnel syndrome develops in 7 to 20 percent of surgical cases and revision surgery is less successful than primary carpal tunnel release surgery.
Although our understanding of CTS has come a long way, additional basic science and clinical outcome studies are needed to solve the many uncertainties and controversies that still exist.
I (JTM) have personally performed many hundreds of carpal tunnel releases in my career. The success rate is very high with almost immediate relief of the symptoms of tingling, aching and nighttime pain. If there is advanced nerve damage as indicated by permanent damage to the nerve on the preoperative nerve conduction testing, then numbness may persist after the surgery. If the nerve has the potential to recover, it will do so gradually over the months after surgery.
I prefer the mini-open carpal tunnel release since I believe it is the most reliable and associated with very few complications. Recovery is quick. Patients wear a padded dressing dressing for 48 hours after the surgery. The dressing is removed at home and the would is covered with a bandaid. I encourage patients to use the hand as tolerated until the sutures are removed at 10 after surgery. Return to work can be as soon as 1-2 days post op with restrictions. Return to unrestricted work is at 3 weeks post op.
Check out my online presentation on the numb hand at www.OrthoOnTheWeb.com.
Thanks.
JTM, MD