Carpal tunnel syndrome is due to a compressed median nerve at the wrist. The pinched nerve causes pain on the inner part of the forearm up to the elbow, but usually not past the elbow. There is decreased feeling with pins and needles in the thumb, index, and long fingers. A classic association of carpal tunnel syndrome is waking up at night and shaking your hand to make it feel better.
Conditions associated with carpal tunnel syndrome include diabetes, renal failure, trauma to the wrist including broken wrists, obesity, arthritis in the neck, and pregnancy.
Carpal tunnel is typically graded as mild, moderate, or severe by your surgeon. In moderate carpal tunnel syndrome, there is weakness of the muscles of the thumb, and in severe cases, there is atrophy or thinning of the muscles of the thumb. Mild carpal tunnel syndrome usually responds well to behavior changes and resting the area. Sometimes carpal tunnel symptoms can be caused by conditions that are temporary (such as pregnancy or recovering from broken bones or surgery) and will get better as time passes. Moderate and severe carpal tunnel are not usually improved with therapy or temporary measures such as steroid injections.
Patients with mild carpal tunnel syndrome frequently wear night splints to lower the pressure on the nerve. The splints prevent bending of the wrist at night, so the median nerve is not in a bent and compressed position. Patients with symptoms not responsive to splinting or with thumb weakness are generally considered candidates for surgery.
As part of Dr. Barbour’s practice, both traditional open approach and minimally invasive (using a smaller incision) carpal tunnel releases are performed. Some patients interested in office-based procedures may be candidates for “wide awake” surgery and carpal tunnel release with local numbing medicine alone.
