Carpal Tunnel Syndrome Explained

Saturday, August 30, 2003 | 0

Carpal Tunnel Syndrome
Eugene Baciocco, M.D.
Orthopedic Surgery
Carpal Tunnel Syndrome (CTS) is, perhaps, one of the most common repetitive stress injuries in the industrial arena. While the increased incidence of CTS over the past ten years seems to have paralleled the increased use of computers, it is often overly diagnosed or misdiagnosed.

In many of these cases, causation is at issue keeping in mind that CTS can be caused and / or complicated by repetitive trauma, metabolic disease and / or fracture. More importantly, in order to treat CTS effectively, it is necessary to conduct a detailed history and complete a thorough physical examination to properly diagnose this condition.

The diagnosis of CTS is made on clinical grounds when the patient complains of numbness specifically in the thumb, index, middle and ulnar aspect of the ring finger. The numbness comes on with repetitive use and at night. It is relieved by rest and the use of wrist splints.

Physical examination will have a positive Phalen's, Tinel's and / or median nerve compression test and, in some advanced cases, thenar atrophy. The diagnosis is usually further confirmed by a positive electromyelogram which shows evidence of decreased median nerve conduction in the carpal canal.

When evaluating a patient, it is important to investigate the possibility of ancillary medical conditions that can, in and of themselves, cause CTS such as hypothyroidism, diabetes, gout, rheumatoid arthritis. Also, a mass or tumor caused by tissue filtration from leukemia, sarcoidosis, amyloidosis and / or rarely, neoplasm in and about the carpal tunnel can cause the syndrome.

In addition, a fractured dislocation of the lunate bone can impinge upon the median nerve. A displaced fracture of the distal radius can also cause impingement on the median nerve.

Evidence of a peripheral metabolic neuropathy, can be diagnosed in cases of diabetes by EMG. An X-ray of the carpal canal can rule in or rule out the possibility of a space occupying bony mass that could be causing pressure on the median nerve.

Treatment is first conservative, with the use of rest, wrist splints and anti-inflammatory agents. Further, aggressive treatment can include injection of the carpal tunnel with corticosteroids if needed.

Ultimately, if conservative treatment is unsuccessful, carpal tunnel releases can be performed surgically. This can be done, either in an open manner or endoscopically. In the past, endoscopy has been implicated in some untoward morbidity.

After surgery, the patient's condition is usually not permanent and stationary for three to four months. Success in the treatment of carpal tunnel syndrome is quite good and, over a period of time, conservative management can result in complete obliteration of symptoms. For the small number of patients in whom conservative management is unsuccessful, operative intervention can be 90% effective.

Dr. Baciocco is represented by MEDLink in the San Francisco and San Jose, CA. area. Appointments can be made through MedLink at: www.camedlink.com>.

(c) 2001 MEDLink -- Reprinted by Permission. Additional articles may be read at www.camedlink.com . MEDLink affiliated QME physicians may be reached by e-mail at: camedlink@camedlink.com .