Staying on the theme of hands for now, let’s take a look at carpal tunnel syndrome.
You probably know people who have had it – or perhaps suspect you have it – so what’s it all about?
The carpal tunnel is just that – a type of tunnel deep in the heel of your hand running beneath muscle fibres, ligaments, and tendons that come from your wrist and help you make a fist. If you were to cut straight across your wrist, you would see the carpal tunnel right in the centre, surrounded by these very rigid tissues which protect it.
The median nerve and tendons that make your fingers and thumb work are located inside this carpal tunnel but because the surrounding tissues are held very firmly, when there is pressure within the carpal tunnel the space can’t expand, so you get a build-up of pressure in the carpal tunnel. And when the median nerve inside the tunnel gets squashed, you feel strange sensations in your fingers or thumb and some pain, usually on the thumb-side of your hand.
That pressure on the median nerve is called carpal tunnel syndrome and it can be caused by anything that aggravates or inflames the tendons in that area – arthritis of the little bones in your wrist, repetitive movements of your hand, a forceful trauma, diabetes, obesity, and pregnancy.
That pain and numbness can be worse at night because when you’re sleeping, your hands are bent up in different ways so there is more compression. But during the day, you may notice discomfort when you’re driving or talking on the phone … anything where your wrist is flexed. If it goes on, you may find your hand becomes weak.
To help your surgeon be more certain of what the problem might be, nerve conduction studies are ordered. These are done by a neurologist and involve stimulating the nerves in the hand and wrist to identify where exactly and how much the nerve is being compressed. It’s very unlikely you will need an x-ray unless you’ve had a trauma or there may be an underlying medical condition in your wrist.
As for treatment, our first option is to try and manage it without surgery. Conservative options include resting the area and avoiding activities that will aggravate it. Some hand therapy and massage and other treatments involving heat, ultrasound, and occasionally acupuncture, can all help relax the area and give the nerve more space and a chance to recover.
Sometimes a steroid injection will be tried, but only once and usually just in unusual cases and anti-inflammatories can be useful, but only in the short-term. If symptoms are persisting, we should do something more permanent and that means two surgical options: an open carpal tunnel release or an endoscopic (keyhole) carpal tunnel procedure.
The open carpal tunnel involves a larger cut across the heel of the hand while the endoscopic involves just one or two small cuts with the surgery done with a telescope from the inside out. Basically, the goal of surgery is to release the flexor retinaculum, the strong fibrous band that covers the carpal bones near the wrist, on the palm-side of your hand. This gives the median nerve more space, releases the pressure in the carpal tunnel, and enables the nerve fibres to work properly and therefore, resolve your symptoms.