Carpal Tunnel Syndrome

Patients with carpal tunnel syndrome experience finger numbness and occasionally hand weakness as a result of pressure on the median nerve. Carpal tunnel syndrome is the most common upper extremity compression neuropathy.

The median nerve is responsible for supplying sensation and movement to the “thumb side” of your hand, meaning the palm, thumb, index finger, middle finger and “thumb side” of your ring finger. The area in your wrist where the median nerve enters the hand is called the carpal tunnel. The tunnel is naturally narrow, so when any swelling occurs, the nerve becomes compressed and numbness, tingling and/or weakness results. These symptoms are referred to as “carpal tunnel syndrome.” This condition is common in people who perform repetitive wrist and hand motions, such as typing on a computer keyboard.

Diabetic patients, due to abnormal glucose metabolism, can develop swelling of the nerve, as well as narrowing of the tunnel itself. This alters the normally perfect relationship between the nerve and its tunnel which results in carpal tunnel syndrome. Indeed, diabetic patients are at a much higher risk for experiencing symptoms of carpal tunnel syndrome than the rest of the population. (Carpal tunnel syndrome is about three times more common in diabetics than in the general population.) Numbness of the fingers in diabetics that is present despite good blood glucose control requires evaluation by a peripheral nerve surgeon, and early surgical treatment before the nerve is irreversibly damaged. Carpal Tunnel Syndrome can be surgically treated and reversed with surgery, if treated in a timely manner.

Common symptoms of carpal tunnel syndrome include:

• Numbness or tingling in the thumb, index, middle and/or ring fingers
• Numbness or tingling in the palm of the hand
• Symptoms may start as intermittent, progressing to constant
• In more advanced cases, thumb and fine finger weakness may result
• Pain is usually not a predominating symptom of carpal tunnel, although may be present

You should see Dr. Ducic for carpal tunnel syndrome if your symptoms persist:

• Despite the medical care prescribed to you by your physician
• Despite supportive medical care, such as activity and work adjustments
• Beyond three months of prescribed medical and conservative care
• Despite good medical diabetic care
• If you had surgery for a different, non-nerve related problem that was complicated by an acute median nerve functional loss (numbness, weakness or pain), timely evaluation and intervention within 6 or (at the most) 12 weeks after its onset is critical to maximize the likelihood of a positive outcome. Restoration of nerve function may be significantly reduced if decompression is done after 3 months from neuropathy onset. This is unfortunately often overlooked by many who instead choose physical therapy and a “let’s wait and see” approach.

Surgical Treatment for Carpal Tunnel Syndrome

Carpal tunnel release is a surgical procedure during which the surgeon cuts into the ligament which is pressing on the nerve. The success of the surgery depends on how long the nerve has been compressed, the severity of the compression, extent of intrinsic nerve damage due to injury and possible presence of underlying medical or spine problems. I use advanced, minimally invasive techniques that spare other nerves in the hand and wrist. Advantages of using a minimally invasive approach include a quicker recovery, reduced possibility of infection and faster return to full function of the affected hand. In addition, a shorter scar is aesthetically better appealing to all.

Pronator syndrome is a condition where the median nerve is compressed not only at the wrist, but also in the proximal forearm. It can result in weakness of thumb and index finder, resulting in weak or poor pinch between these two fingers. In addition, patient can have pain in proximal forearm, and or numbness over palmar skin at the base of the thumb. In this situation, both compression sites can be addressed during the same operation.

I often perform revision surgeries, which address continued neuropathy following previous surgery in patients who failed to get relief after procedures performed elsewhere.

During Carpal Tunnel Release Surgery:

1. You will receive anesthesia so you won’t feel any pain during the surgery.
2. When performing an “open” carpal tunnel release, I will make a small incision in the proximal part of your palm. The transverse carpal ligament is then released to ease the pressure on the median nerve; sometimes, tissue around the nerve is removed if found to be abnormal. The skin is then closed in anatomical layers.
3. When performing an endoscopic carpal tunnel release, I will make a small horizontal incision where your wrist meets your palm. A tiny camera attached to a monitor is then inserted into the tunnel and special instruments are used to release, under direct visualization, the transverse carpal ligament.
4. Carpal tunnel release is an outpatient procedure; your dressing will stay on for about a week, while the sutures are removed two to three weeks later.

If you are not sure about your eligibility for surgery, and if you are not in the Washington, D.C. area, you can send me your records so I can determine if you are a good candidate for treatment. Visit my patient forms page for a downloadable form.