Understanding carpal tunnel syndrome and it's treatments

Dr. Herb Von Schroeder, MD, FRCSC, Orthopaedic Surgeon, talks about carpal tunnel syndrome and the various treatment options available to patients.

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Dr. Herb Von Schroeder, MD, FRCSC, Orthopaedic Surgeon, talks about carpal tunnel syndrome and the various treatment options available to patients.
Video transcript

Dr. Herb Von Schroeder, MD, FRCSC, Orthopaedic Surgeon Title: Understanding carpal tunnel syndrome and it's treatments

Duration: 3:26

The carpal tunnel syndrome is a very common condition of the hand and is characterized by numbness and tingling at the fingertips but also weakness of the hand, and more on this later. We're going to start by talking about what causes carpal tunnel syndrome, the median nerve is the major nerve that comes from the forearm up through the tight carpal tunnel into the palm and into the digit tips. This tunnel is only two centimeters wide and it contains the median nerve, but also the nine tendons that go to the fingers are responsible for flexing the fingers and making a grip, any excessive change in position of the wrist or inflammation within the carpal tunnel, puts pressure on the nerve, and results in the typical symptoms. These include numbness and tingling in the thumb and the index finger in the long finger as well as part of the ring finger but not the small finger since that's innervated by a different nerve.

Because of the lack of sensation, the hand is weaker and feels weaker, but the nerve also controls the muscles of the base of the thumb, adding to the weakness of the hand. The condition is rarely painful but there can be pain and issues such as numbness and tingling or they go up into the forum and into the evenings the shoulder.

It is worse with aging it is worse with heavy lifting, it is worse with anything that involves excessive vibration, it's particularly worse at nighttime and patients will awaken and want to shake their hands to try to get the feeling back is also worse with certain medical conditions such as diabetes and thyroid disease as well as rheumatoid arthritis, and worse with pregnancy, patients notice it when holding a steering wheel or in holding a book for prolonged periods of time, because it's a condition of positioning and inflammation and pressure on the nerve, the treatment is directed at this, the three treatments are firstly, using a splint at nighttime. This keeps the wrist in the straight position and helps reduce the excess of pressure and the inflammation in the carpal tunnel.

Secondly, a corticosteroid injection or cortisone injection can be very helpful. This is a strong anti inflammatory as injected into the carpal tunnel, it's very safe, very effective. But like splinting is rarely effective and long term. Surgery is commonly recommended and surgery is done an outpatient basis with local or regional anaesthetic, a small incision is made in the skin and the tight ligament of the roof of the carpal tunnel is incised to create more room within the carpal tunnel stitches are used to close the skin and light dressings applied finger range of motion is encouraged and light lifting can begin soon but heavy lifting might take a month or longer.

The operations tolerated very well. Most patients will notice some relief the first night after the surgery. All operations do have risks for these are very rare. Patients may for example have tenderness around the incision and deep massage and occasionally physiotherapy are helpful for this infection rate and other other complications are very rare.

So to summarise carpal tunnel syndrome is the numbness and tingling in the weakness of the hand, due to pressure on the nerve is treated by splinting a corticosteroid injection, and by surgery, you should talk to your family doctor, or your surgeon to determine what treatment is most effective for you. Thank you.

Presenter: Dr. Herb Von Schroeder, Orthopaedic Surgeon, Toronto, ON

Local Practitioners: Orthopaedic Surgeon

This content is for informational purposes only, and is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare professional with any questions you may have regarding a medical condition.

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