Carpal Tunnel Syndrome
What is carpal tunnel syndrome?
Carpal tunnel syndrome is the most common compressive neuropathy of the upper extremity. It involves compression of the median nerve in the carpal tunnel at the wrist.
How does carpal tunnel occur?
The carpal tunnel is a tight canal that is formed by bones at the bottom and a thick ligament at the top. The median nerve along with nine flexor tendons travel through the canal. The canal can narrow over time due to conditions like, diabetes, repetitive activity, and arthritis. The contents of the canal can swell due to things like pregnancy. Because the borders of the canal are rigid, the median nerve can become compressed resulting in numbness and tingling. The median nerve provides feeling to the thumb, index, middle and half the ring finger. It innervates the thenar muscles that provide strength to the thumb. The median nerve arises from the C5-C6 nerve roots. It travels from the neck, down the arm and forearm before traveling through the carpal tunnel.
What are the symptoms of carpal tunnel syndrome?
Patients with carpal tunnel experience numbness, tingling and pain in the thumb, index, middle and half the ring finger. These symptoms often occur at night, driving a car, using a phone and any activity that involves prolonged wrist flexion or extension. Patients often must shake out their hand to wake it up. Symptoms can radiate up the arm into the neck or shoulder. Patients often report weakness in the thumb and complain of dropping things. Although most patients experience numbness, some may predominately have pain. When patients start dropping things, noticing weakness, or noticing constant numbness, there may already be permanent nerve damage. Patients are cautioned to seek treatment early because if untreated for too long, the numbness and weakness may not improve after surgery.
Diagnosing carpal tunnel syndrome
The diagnosis of carpal tunnel is made through the history of symptoms, physical exam and occasionally electromyography/nerve conduction studies. Other conditions that can mimic carpal tunnel include a pinched nerve in the neck and diabetes. It is important for Dr. Kavi Sachar to examine you for symptoms of carpal tunnel. Patients are often mistakenly given a diagnosis of carpal tunnel by non experts in the field.
Nonsurgical treatment of carpal tunnel syndrome
Treatment of carpal tunnel often begins with a conservative approach. Avoiding repetitive activities, splinting and therapy to learn nerve glides can alleviate mild and early carpal tunnel syndrome. Often a certified hand therapist is recommended to both educate patients on activities to avoid and to teach preventative measures. If treated early, carpal tunnel can often be alleviated by the above measures. Dr. Kavi Sachar will perform a full assessment and determine what treatment is best for you.
Surgically treating carpal tunnel syndrome
Surgery is necessary if conservative treatment fails or if the condition is severe. Some signs of severe carpal tunnel include constant numbness, and thumb weakness with muscle atrophy.
Carpal tunnel surgery involves dividing the transverse carpal ligament to make more room for the median nerve. This ligament is about 3 inches long. This is an outpatient surgery done under either a light anesthetic or a local anesthetic. The surgery performed by Dr. Kavi Sachar is minimally invasive. The incision is about 1 inch long. The surgery itself takes less that 20 minutes. Invisible sutures are used so no sutures must be removed. Over the course of about three months, the ligament heals back but in a longer position allowing the volume of the carpal tunnel to increase and minimize the risk of carpal tunnel coming back.
Recovering from carpal tunnel surgery
After surgery, patients are usually placed in a light dressing and allowed to get the hand wet within 3 days. Patients are asked to be careful about the first week after surgery to allow for wound healing. Some patients require a short course of therapy after surgery to regain strength. Most patients resume normal activities including sports within 3 weeks. The strength continues to build over about 3 months.
Overall, patients tend to be very satisfied with carpal tunnel release. Their nighttime numbness resolves, and they regain normal strength.
Schedule a consultation
Board-certified and fellowship-trained hand surgeon Dr. Kavi Sachar is widely regarded as one the nation’s leading experts on carpal tunnel syndrome. Dr. Sachar has three office locations in Vail, Aspen, and Frisco, Colorado. If you or a family member suffer from carpal tunnel syndrome, contact Sachar today. Dr. Sachar is part of the world-renowned Steadman Clinic. Dr. Sachar and his team are here to help.
At a Glance
Dr. Kavi Sachar
- Specializing in Hand, Wrist, & Elbow Surgery
- Board Certified Orthopedic & Hand Surgeon
- Consultant to the US Ski & Snowboard Team & Colorado Avalanche
- Learn more