Carpal Tunnel Release Health Article

Definition

A carpal tunnel release is a surgical procedure performed to relieve pressure on the nerve located inside the carpal tunnel, an area in the wrist that supplies nerve function to the fingers. The condition for which the release is performed is called carpal tunnel syndrome.

Purpose

Carpal tunnel syndrome is a relatively common problem affecting the wrist and hand. Individuals afflicted with carpal tunnel syndrome complain of numbness, tingling, and pain in the hand, with pain radiating up into the arm, shoulder, and even the neck. Some patients may experience an aching or burning sensation in the affected hand. The fingers may feel swollen, although they are no larger in size. If the condition is left unattended, symptoms may begin to awaken the individuals during sleep. If left unattended medically, muscle weakness can develop, leading to an inability to grasp objects or engage in any action requiring the opposition of the thumb and the other fingers in the affected hand. It is known as a repetitive stress injury, as it most commonly occurs in individuals who engage in motions that require the hands to repeat the same movements over and over again, especially with strong, forceful hand movements or ones that involve vibrating tools. Many individuals develop carpal tunnel syndrome in both hands. For some the condition is worse in the dominant hand.

Demographics

Individuals who perform repetitive wrist movements, either at work or play, are at risk of developing carpal tunnel syndrome. Repetitive movements include computer work, typing, computer games, sports such as tennis, scanning items at the supermarket checkout, playing musical instruments for extended periods of time on a daily basis, assembly-line work, especially that requiring heavy gripping or the use of vibrating machinery, and the use of power tools such as for lawn care. It is more common in women, perhaps as much as three to seven times more than in men, especially during pregnancy, and also in individuals who are obese, or have diabetes or rheumatoid arthritis. It is also more common with advancing age. Carpal tunnel release is one of the most common hand surgeries performed in the United States.

Description

The carpal tunnel is a channel inside the hand, on the palm side, that surrounds and protects the main nerve and the tendons that help bend the fingers. This nerve is called the median nerve. The symptoms start gradually and continue to increase if the problem is not addressed. Numbness and tingling in the fingers are usually the first signs of the condition. It may come on while driving, sleeping, holding a telephone, or reading a book. It may also occur after a long bicycle ride, which involves gripping the handlebars. The pain or tingling might begin to travel up the arm to the shoulder. The individual may appear clumsy, drop objects, or have difficulty holding on to a glass. There may be a decrease in the ability to feel sensations in the hand. Once the problem interferes with daily activity, including sleep, or persists for longer than two weeks, it is important to seek medical advice. This is because the symptoms, even if they are not terribly disabling, can become permanent, as the damage to the tissues themselves becomes permanent.

Because of the nerve innervation routes, the one finger that is not involved in carpal tunnel syndrome is the pinkie.

Conditions associated with carpal tunnel syndrome, or that appear to put the individual at higher risk for developing the condition include:

• obesity
• pregnancy
• certain thyroid conditions
• arthritis, especially rheumatoid
• diabetes
• menopause
• taking oral contraceptives
• conditions involving hormonal changes
• gout
• cigarette smoking

Conditions such as carpal tunnel syndrome are sometimes referred to as cumulative trauma disorders. In these disorders, the injury is not related to one major incident that causes damage, such as a fall that results in a fractured limb, but is the build up of small microtraumas, in which the affected area is repeatedly damaged. Each small injury causes the area to become irritated or inflamed, and there is not enough time in between injuries for complete healing to occur. Treatment focuses on relieving the compression of the nerve and decreasing or eliminating the irritation and inflammation of the area. A term often associated with microtraumas or repetitive stress injuries is ergonomics, which means the way in which the body is set up to perform a certain function. If the function is typing, an ergonomic assessment would include looking at the height of the desk, the height of the chair in which one is sitting to work at the desk, the height of the hands in relation to the work area, such as the keyboard, and the angle of the wrist, elbow, hips, and knees. An ergonomically designed work station would have all components at the right height and angle for work so that there is no strain put on any joint as it performs its necessary function, and therefore no injury can take place. For those who use vibrating tools at work, special gloves exist that are padded and designed to decrease the effect of the vibration.