Hand Surgery- 2

The carpal tunnel is a narrow, fibrous passage in the wrist that protects the median nerve, which runs down the length of arm and through the wrist into the hand. It controls some hand movement, and sensation in the thumb, index and middle fingers, and half of the ring finger. Irritation or compression of the median nerve within the carpal tunnel can cause tingling and numbness in the fingers, a condition known as carpal tunnel syndrome (CTS).

Diagnosis of Carpal Tunnel Syndrome

Carpal tunnel is usually diagnosed through a complete medical history and physical examination. Diagnostic tests such as an electromyogram, which records the electrical activity of nerves and muscles, may be performed.

Symptoms of Carpal Tunnel Syndrome

CTS develops gradually, usually beginning as an ache in the wrist that extends up the forearm or down into the hand. As CTS worsens, there may be tingling or numbness in the fingers, or pain radiating through the entire arm. Some people also experience weakness in the hand and arm, and have difficulty grasping small objects. These symptoms are usually most severe when a person first wakes up.

Although most people associate carpal tunnel syndrome with pain and tingling in the fingers, it should be noted that the "pinky" finger is not affected. Anyone experiencing symptoms in the pinky may be suffering from another condition.

Carpal Tunnel Release

Carpal tunnel release is an outpatient procedure performed to relieve pressure on the median nerve in the wrist. It is performed in order to reduce carpal tunnel syndrome symptoms, which include tingling and numbness in the fingers.

Carpal tunnel release helps to restore muscle strength and dexterity to the hand, and is typically performed on patients who have had symptoms that persist for months and have not responded to more conservative treatment methods.

Carpal tunnel release can be performed either as an open-surgery procedure or endoscopically. In either case, the transverse carpal ligament is cut to relieve pressure on the median nerve. Each type of surgery has advantages and disadvantages. Open carpal-tunnel-release surgery involves a 2-inch incision in the middle of the palm, providing the surgeon with a direct view of the treatment area. The advantage to this approach is that it carries less risk of accidentally damaging nerve tissue than does an endoscopic procedure.

Endoscopic carpal-tunnel-release surgery, on the other hand, is less invasive than open surgery. It involves only two tiny incisions, so patients have less postoperative pain, less scarring, and a speedier recovery than with the open procedure.

Carpal Tunnel Injections

The carpal tunnel is a narrow, fibrous passage in the wrist that protects the median nerve, which runs down the length of arm and through the wrist into the hand. It controls some hand movement, and sensation in the thumb, index and middle fingers, and half of the ring finger.

Irritation or compression of the median nerve within the carpal tunnel can cause tingling and numbness in the fingers, as well as pain in the arm, a condition known as carpal tunnel syndrome (CTS).

CTS is linked to, among other conditions, wrist injuries and diabetes, and inflammatory diseases such as rheumatoid arthritis. And although no link has conclusively been shown to exist, certain repetitive motion activities seem to cause CTS.

An effective treatment for CTS is corticosteroid injection, which reduces the swelling of tendons, easing pressure on the median nerve. Injected directly into the inflamed area, the corticosteroid works by minimizing the body's reaction to inflammation. Pain, numbness, weakness and tingling typically subside within a few days of the patient's being injected. The relief provided by the injections lasts for a few weeks to a few months.

Cubital tunnel syndrome is a condition that causes pain and numbness in the outside of the hand and wrist as a result of compression or inflammation of the ulnar nerve, which allows for sensation with the little finger and half of the ring finger.

Beginning in the side of the neck, the ulnar nerve travels all the way down the arm, including through the cubital tunnel, which is located just inside the elbow. When the elbow is bent, the cubital tunnel can stretch and may irritate the nerve over time.

This condition may develop as a result of a frequent bending of the elbow from lifting or reaching, as well as from direct pressure on the elbow over time.

Cubital Tunnel Syndrome Treatment

Treatment for cubital tunnel syndrome usually begins with anti-inflammatory medication to minimize pain and other symptoms. Taking frequent breaks during physical labor can also help prevent symptoms from occurring, while wearing a splint or brace can control pain overnight.

If symptoms do not improve with conservative treatments, surgery may be needed to release pressure on the ulnar nerve as it passes through the cubital tunnel. This can be done through ulnar nerve transposition or medial epicondylectomy, both of which are outpatient procedures that are performed under general or regional anesthesia.