Carpal Tunnel Syndrome
What is Carpal Tunnel Syndrome?
The “carpal tunnel” is formed by eight carpal bones of the wrist (the bottom and sides of the tunnel) and the transverse carpal ligament (the top of the tunnel). The carpal tunnel surrounds multiple flexor tendons that allow the fingers to flex (bend). Also within this tunnel is the median nerve, a softer structure containing the nerve fibers that are primarily responsible for sensation to the thumb, index, long and half of the ring fingers. Carpal tunnel syndrome occurs when pressure within the tunnel increases, thereby compressing the median nerve and restricting blood supply to those fingers. Many factors may contribute to increased pressure within the carpal tunnel, including inflammation of the flexor tendons, fluid retention, wrist injuries, rheumatoid or degenerative arthritis, diabetes, hypothyroidism and pregnancy.
Signs and Symptoms:
Numbness and a tingling sensation in the thumb, index, long, and thumb side of the ring fingers are symptoms of carpal tunnel syndrome. A patient may notice decreased dexterity, such as dropping, or inability to pick up, small items. Symptoms may worsen at night, or while grasping or flexing the wrist. Discomfort may be relieved by shaking or massaging the wrist, or wearing a wrist splint.
Conservative options include resting the hand, wrist and forearm and avoiding activities that may provoke symptoms. A splint may be worn, and a cortisone injection may be offered to help reduce pain and swelling.
If conservative treatment is not effective, surgery may be recommended. An incision is made in the palm to expose the transverse carpal ligament that forms the roof of the carpal tunnel. The ligament is cut (released) in order to relieve pressure on the median nerve.
Post Operative Rehabilitation:
- Expect a surgical bulky splint to be kept in place for 10-14 days.
- Gentle finger full range of motion encouraged several times a day.
- Elevate and ice for at least 3 days.
- Continue to elevate as often as possible until your next clinic visit. (Elevate above your heart.)
- Shower with a plastic bag covering the splint and seal with tape.
- Your pain may be worst in the first 24-48 hours and then will lessen.
- Fingers may feel numb for 12-16 hours from anesthetic agent.
- Take your pain medicine as needed and as prescribed. Call if any problems or questions arise.
10-14 Days Post Op (at therapy):
- Splint and sutures will be removed.
- Expect a prefabricated or custom splint to be worn at all times except during therapy exercises and when showering for 4 weeks.
- Therapist will address scar management, edema management, and range of motion exercises.
- Hand therapy will continue for approximately 6 weeks.
4 Weeks Post Op:
- Follow up appointment in clinic with Nurse or P.A.
- Splint may be discontinued.
- Begin strengthening exercises, and gradually return to daily use of hand.
8 Weeks Post Op:
- Follow up appointment in clinic with P.A. or M.D. for final check.
- Full activity without restrictions often possible, depending on job requirements.
- Patients with severe carpal tunnel pre-operatively may continue to experience numbness and tingling symptoms for several months following surgery, and may have permanent loss of sensation and/or thumb strength.