Carpal tunnel syndrome is a condition caused by pressure on the median nerve within the carpal tunnel of the wrist. The carpal tunnel is a narrow passageway that runs along the palm side of your wrist where the median nerve and nine tendons pass from the forearm to the hand.
Causes: Carpal tunnel syndrome is associated with multiple conditions including: repetitive motion or overuse, fluid retention during pregnancy, injury to the nerve in the carpal tunnel or rheumatoid arthritis.
Symptoms: Often patients complain of pain, numbness and tingling in the fingers, weakness or aching in the hands.
Diagnosis: Carpal tunnel is diagnosed through physical exam and electromyography, or an EMG. An EMG is an electrodiagnostic study to evalutate and record the electrical activity produced by skeletal muscles. A small needles is inserted through the skin into the muscle. The electrical activity is detected by this needle, which serves as an electrode. The activity is displayed visually on an oscilloscope.
Treatment:
Symptoms can sometimes be relieved without surgery by:
Changing patterns of hand use to reduce pressure on the median nerve.
Keeping the wrist splinted in a straight position to reduce pressure on the median nerve.
Wearing wrist splints at night to relieve symptoms that may prevent sleep.
When symptoms are moderate to severe or do not improve with conservative management, surgery may be needed to release the pressure on the nerve and create more space within the carpal tunnel.
Surgery: A carpal tunnel release is performed through a small incision at the base of the palm. Carefully, the transverse carpal ligament is transected to free up the median nerve. The skin is closed with a layer of dissolvable and removable stitches and you are placed in a plaster splint.
Some stitches are removed at 7 days after surgery and the rest are removed at 14 days after surgery.
The splint is remove 7 days after surgery at the first follow up visit.
You can shower after surgery but the splint must remain dry until follow up.
Numbness and tingling from pressure on the median nerve takes many months to resolve.
Cubital Tunnel Syndrome -
Cubital tunnel syndrome is a condition caused by stretching or pressure on the ulnar nerve (also known as the "funny bone" nerve) near the elbow. The ulnar nerve runs in the groove on the inner side of the elbow.
Causes:
Pressure on the ulnar nerve - this nerve has very little padding over it. Direct pressure such as leaning on arm rest can put pressure on the nerve causing the arm and hand (especially the ring and small fingers) to "fall asleep".
Stretching - Keeping the elbow bent for long periods of time can cause the nerve behind the elbow to stretch. This often happens while sleeping or holding a cell phone
Anatomy - Sometimes the ulnar nerve does not stay in place and snaps back and forth over a bony bump as the elbow moves. Repeated snapping can irritate the nerve.
Symptoms: Patients often complain of numbness and tingling in the ring and small fingers, pain in the forearm and weakness in the hand.
Diagnosis: Carpal tunnel is diagnosed through physical exam and electromyography, or an EMG. An EMG is an electrodiagnostic study to evalutate and record the electrical activity produced by skeletal muscles. A small needles is inserted through the skin into the muscle. The electrical activity is detected by this needle, which serves as an electrode. The activity is displayed visually on an oscilloscope.
Treatment:
Symptoms can sometimes be relieved without surgery by:
Avoiding actions causing pain or numbness/tingling:
Keeping the elbows extended during the day or when sleeping by using nocturnal extension splints.
Avoiding leaning on the "funny bone" or ulnar nerve may help.
When symptoms are moderate to severe or do not improve with conservative management, surgery may be needed to relieve pressure on the ulnar nerve.
Surgery: A cubital tunnel release is performed through an incision along the inside of the elbow. Carefully, osborne's ligament is transected to free up the ulnar nerve. Sometimes, the nerve is moved to the front of the elbow. The skin is closed with several layers or dissolvable stitches and you are placed in a plaster splint.
Usually, there are no stitches to be removed.
The splint is remove 7-10 days after surgery at the first follow up visit.
You can shower after surgery but the splint must remain dry until follow up.
Numbness and tingling from pressure on the median nerve takes many months to resolve.