What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome is a condition that can occur from increased pressure on the median nerve in the wrist. This nerve runs through the carpal tunnel passageway on the palmar side of the wrist, which is made up of bones and ligaments. The median nerve is what sends signals between the brain and the hand; it provides sensation to the thumb, index and middle fingers, as well as half of the ring finger.
However, when the carpal tunnel is too narrow, for whatever reason, it can create pressure on the median nerve. This can cause pain, numbness, and weakness in the hand and wrist. If left untreated, this may cause pain to radiate up the arm and even to the shoulder.
What Causes Carpal Tunnel Syndrome?
Some of the factors that contribute to the development of carpal tunnel syndrome include:
- Smaller carpal tunnel, often found in women
- Wrist injuries
- Hormone imbalance in the thyroid gland
- Medical conditions, such as diabetes
- Repetitive hand/wrist movements
Patients with mild carpal tunnel syndrome may be able to wear a brace or a splint to keep the wrist in a neutral position to prevent further advancements of the condition. Additionally, patients can take non-steroidal anti-inflammatory drugs to reduce any pain or discomfort that is associated with the condition. In more advanced cases, a patient may require a surgical procedure to correct the carpal tunnel syndrome. This procedure is known as the carpal tunnel release and it can be performed in one of two ways, endoscopic or open technique. Upon evaluation, Dr. Murphy can better determine which technique will be best.
Common Carpal Tunnel Syndrome Symptoms
Carpal tunnel syndrome symptoms include:
Tingling and numbness are often the first indications of early stages of carpal tunnel syndrome. However, any of the aforementioned symptoms can arise when there is pressure being placed on the median nerve, which can occur from repetitive hand and wrist movements. As the progression of the condition continues, the symptoms may persist throughout the day and into the night. Sleeping on the wrist can also cause the onset of these symptoms when a patient awakes in the morning. If left untreated, there may be progressive atrophy of the muscles in the thumb.
How Do I Know if I Have It?
If you experience any of the above symptoms, it is advised that you come in for a consultation with Dr. Murphy. In order for Dr. Murphy to accurately diagnose the carpal tunnel condition, he may perform one or more of the following tests. The importance of these tests is to determine the underlying cause of the pain, whether or not the patient has carpal tunnel syndrome or cubital tunnel syndrome. It is possible for both to occur at the same time.
Tinel’s test: Dr. Murphy will tap the median nerve at the wrist mildly to see whether or not the patient has a sensation of numbness or tingling in one or more fingers.
Phalen’s test: The patient will press the backs of their hands against each other, leaving the wrists at a bent angle. If they experience tingling or numbness within a minute or less, this may be an indication that there is damage to the median nerve.
Nerve conduction study: This is the most commonly performed test. Electrodes are placed on the hand and wrist and mild electric shocks are administered. This test will measure the rate at which the nerves transmit the shock impulses to the muscles within the surrounding area.
Electromyography: A fine needle is inserted into the muscle, allowing the electrical activity to be portrayed on a screen. This can reveal whether or not there is any damage to the median nerve and how severe it is.
Blood tests: Blood tests can help detect many underlying conditions. Dr. Murphy may use a blood test to see if the conditions are related to carpal tunnel syndrome.
Imaging scans: X-rays can help to determine if there is a fracture or some other disorder in the wrist and hand, such as rheumatoid arthritis. Dr. Murphy may also use ultrasound scans because they can help evaluate the structure of the median nerve.
Majority of patients experience symptoms in both wrists, but that is not always the case.
Good candidates for a carpal tunnel release procedure have transient symptoms; this can include tingling in the fingers, pain that wakes the patient up at night, or any of the other aforementioned symptoms. After performing a series of tests during the consultation the doctor will be able to determine if you require treatment.
Those with permanent numbness may not be considered good candidates because this may indicate that the nerve has died. In this case, treatment will not completely resolve the symptoms; it can help though. The only way to truly determine if you have carpal tunnel syndrome is to come in for a consultation where an evaluation will take place.
In some cases, splints or steroid injections can alleviate carpal tunnel syndrome symptoms. However, these are usually temporary reliefs and will require routine injections or an extended period of time wearing the splint. During the consultation, Dr. Murphy will review all of your options so you can make an informed decision.
Both release techniques take about 20-30 minutes to perform. Most studies reveal similar results for endoscopic and open release after 2 weeks. The main differences are pain level and when you are able to return to work. The only preparation required prior to the procedure is to stop narcotics and smoking 3 weeks prior.
Endoscopic Carpal Tunnel Release
Endoscopic carpal tunnel release is performed with a camera inserted through a tiny incision. Either general anesthesia or a regional block (only block nerve movement in the region) can be used. The goal is to make sure the patient does not move, and both of the aforementioned will accomplish this. Some patient would just rather be completely asleep for the procedure. This technique is more comfortable than the open technique and has a quicker recovery.
Dr. Murphy prefers the endoscopic technique for those with a tiny wrist, tighten tunnel, and muscular individuals. If necessary, the doctor can switch from endoscopic technique to open technique during the same session. This is only necessary in about 5% of cases, but all patients are warned of this during the consult. One reason for this scenario is excessive synovium lubricant around the tendon where the doctor cannot get a good view of ligament.
Open Carpal Tunnel Release
Open carpal tunnel release involves a long incision along the wrist. General anesthesia or a regional block are both options. There is more pain, longer recovery, and a larger scar associated with an open release. With that said, it is sometimes necessary when an endoscopic release is not a suitable option. Just cases include those who have tiny wrists, rheumatoid arthritis, underactive thyroid, are overweight, or have a tumor. Open release technique can be performed on both wrists only if the patient has a support system to assist them with daily tasks.
Why Choose Dr. Murphy?
Aside from his in-depth knowledge of the hand/wrist anatomy and his decades of experience, Dr. Murphy is one of the only surgeons who can perform endoscopic carpal and cubital tunnel release. Most other surgeons only perform the open technique which is not always necessary. The open technique results in a larger scar and more pain. Additionally, Dr. Murphy is honest. He will let you know if you only need splints or steroid injections to alleviate your symptoms.
Recovery is fairly easy and minial after carpal tunnel release.
Light daily activities can be resumed after treatment and patients can go back to a desk job the very next day. Heavy lifting and strenuous activities are discouraged for about 5 days.
Patients should elevate their hand for at least 5-7 days; this helps reduce swelling.
The cost of a carpal tunnel release procedure will vary from case to case depending on the extent of treatment that is required. Some insurances may cover the cost of the procedure, which is why we advise patients to speak with their providers before scheduling a consultation. To determine if this surgery is the right treatment for you, please contact our office and schedule a consultation with Dr. Murphy.
Carpal Tunnel Syndrome consultations are held in Pearland, Texas with Dr. Kevin Murphy. During the consultation, the patient will explain the sensation or pain they are experiencing and how frequently it arises. The doctor will conduct a series of tests to properly determine if a carpal tunnel release surgery will be the right treatment for the patient. If they are considered a good candidate, he will then review the procedure options and construct a custom treatment based on the patient’s needs. It is important to Dr. Murphy that his patients are comfortable and confident in their decision to undergo this procedure. If you have any questions, please feel free to contact our office. We look forward to speaking with you!