Carpal Tunnel Syndrome

Definition

Carpal tunnel syndrome is caused by pressure on a nerve in your wrist. This occurs in women 5 times more frequently than men. Pain usually occurs in the wrist and hand you use most often, but may occur in both arms. Some of the symptoms you may experience are burning pain and numbness in the thumb, index, and middle fingers. This pain may radiate up your arm. The pain may awaken you at night.

Common Tests:

X-Rays: to check for any abnormal bone growth or injury.

EMG (Electromyelogram): used with nerve conduction studies to check for any muscle abnormalities and to determine if the nerve is able to transmit electrical impulses.

Common Treatments:

  1. Splint: immobilization/rest of the affected wrist and hand. This is usually helpful at work and/or during the night.
  2. Injection of steroids (cortisone): decreases the swelling around the nerve. The medication spreads around the swollen synovial membranes surrounding the tendons and shrinks them, relieving the pressure on the median nerve.
  3. Use of NSAIDS (nonsteroidal anti-inflammatory drugs): decreases the swelling around the nerve.
  4. Gentle manipulation of the bones: eases pressure on the nerves in the wrist.
  5. Occupational/Physical Therapy: self-stretching and nerve gliding exercises taught by Occupational Therapy. Joint protection and a home exercise program will be taught. General exercise, good use of body position/posture, to prevent symptoms from recurring, job/leisure activity analysis, and use of ice and heat. Symptoms may reoccur if measures are not taken to change the cause of the injury.
  6. Surgical Decompression and release: Your surgeon may make an incision at the base of your hand which is about two inches long or may do your surgery through an endoscope, in which case the incision will be much smaller. The surgical site is made pain free by use of a local anesthetic. Your surgeon will cut or release the ligament at the base of your hand that forms the roof of the carpal tunnel to relieve the pressure on the median nerve. The surgery is usually performed on an outpatient basis, so you are usually not required to stay overnight. If you have had surgical intervention, generally you would attend Occupational/Physical Therapy two or three times a week initially. Your physician will let you know when you are able to begin therapy.
  7. In severe cases, it is possible to have prior partial permanent nerve damage which the surgery cannot repair or reverse.

If you have had a surgical procedure to correct the carpal tunnel syndrome:

  1. Do not expect an instant relief of symptoms. The nerve needs time to regenerate (repair itself) within the carpal tunnel which can take 6 months to 1 year. Manipulation of the tissues during surgery causes swelling and this puts pressure on the affected nerve. Any numbness your feel after surgery should gradually subside.
  2. Apply an ice pack to incision area for 20 minutes, at least 4 times per day for the first 48 hours and then as needed. Keep the affected arm elevated higher than your heart to decrease swelling.
  3. It is common for your surgeon to use a long acting anesthetic during your surgery. Each person's body reacts differently to anesthetic and it takes longer (in some people) for the anesthetic to wear off.
  4. Smoking, excessive alcohol intake, and poor nutrition slows the healing process after surgery.
  5. You may leave your post-op dressing (bandage) in place until you are seen by the office. This will usually be in about 1 week, unless you are told differently by your surgeon. As soon as you get home from the hospital, please call to set up your follow-up appointment.
  6. Sutures (stitches) are usually removed in approximately 10 to 14 days after surgery.
  7. If your post-op dressing (bandage) becomes soiled or wet:
    • Remove the entire dressing.
    • Cleanse incision area with mild soap and water.
    • Rinse gently.
    • Blot dry with a clean towel.
    • Allow to air dry.
    • Inspect the incision area for any signs of infection. *
    • Apply a clean dressing over the area and a clean elastic bandage. (You may wash the soiled elastic bandage in a mild soap solution and rinse with clear water. Allow to air dry for use at another time.)

    * Signs of infection include: redness (inflammation) and increased skin temperature around the incision area, pus draining from the incision, and a fever of 101 degrees Fahrenheit or higher.

  8. Please call our clinic if something looks unusual to you but you are not sure what it is. (We would prefer that you call and ask questions rather than overlook something important.)
  9. You may shower after your surgery as soon as you are able to stand without difficulty or dizziness for 20 minutes. Be sure to cover your bandage with a plastic bag to insure that the dressing will remain dry.

General precautions after surgery

  1. Do not do any strenuous lifting with the hand that had surgery until you discuss this with your physician. Avoid vigorous activities (such as sports, weight lifting, heavy lifting, pushing, and pulling) for 4-6 weeks.
  2. If you have had an endoscopic carpal tunnel procedure you may wear your splint as comfort dictates.
  3. If you have had an open incision carpal tunnel procedure you must wear your splint for 2-3 weeks. (You may remove your splint to bathe.)
  4. You may notice some bruising around your incision a couple of days after your surgery. This happens frequently due to minor internal bleeding into the adjacent tissues. This bruising usually disappears within a week or two.
  5. Expect a bulky dressing on the palm of your hand. Very often your wrist is supported with a fiberglass splint. This is to prevent extreme movement of your wrist and fingers as well as to provide some mild compression on the incision. This is usually removed in a few days and a regular sterile bandage is applied. You will probably still need to wear some sort of splint, however, this may vary depending on each situation.
  6. You may use the hand you had surgery on for daily activities (i.e. dressing, hygiene, eating) at 2 weeks after surgery. Avoid repetitive or extreme motions of your wrist.
  7. Please call our clinic if you notice any changes in circulation, sensation, or motion, for example, if your hand becomes cold and will not warm up, inability to move your fingers, or increasing numbness.
  8. Remember these are general precautions and if you have problems or questions please call our West Allis Clinic at 414-328-8600 or our Brookfield Clinic at 262-780-4400. You may also discuss your concerns with your therapist who may contact your doctor.
  9. Typically you may return to work within 4-8 weeks depending on your job demands.