QC Family Focus: October 2014

Is All Numbness and Tingling in the Hand Carpal Tunnel Syndrome?
By: Orthopaedic Specialists
Although carpal tunnel syndrome is the most common
condition of the hand and upper extremity, not all cases of numbness
and tingling in the hand are caused by carpal tunnel syndrome.
There are over 30 other possible causes of hand numbness.
However, alternative diagnoses, such as cubital tunnel syndrome
(nerve compression at the elbow) and cervical radiculopathy (nerve
compression in the neck), can occasionally be overlooked as the
root cause of the problem and may need to be considered in some
cases.
If you think you may be suffering from carpal tunnel
syndrome, it is important to understand what carpal tunnel
syndrome is. This condition is a result of a compressive neuropathy
that causes numbness and tingling of the hand. A compressive
neuropathy means that the nerve is trapped or compressed. This
usually happens when the nerve passes through a tight passage or
tunnel on its way to the hand. Similar to carpal tunnel syndrome,
cubital tunnel syndrome and cervical radiculopathy are other
compressive neuropathies that cause hand tingling and numbness.
The differences in these conditions depend on the nerve or nerves
that are involved and the location of nerve compression.
Carpal tunnel syndrome is caused by pressure on the
median nerve where it passes through the carpal tunnel along with
the flexor tendons as they travel from the forearm to the hand and
fingers. The carpal tunnel is a bony canal formed by the carpal
(wrist) bones. A strong ligament, called the transverse carpal
ligament or flexor retinaculum, closes the palm side of the canal.
This ligament serves as a pulley for the flexor tendons. The most
common cause of the pressure causing carpal tunnel syndrome is
“idiopathic”, meaning the cause is not proven or known. Many
believe that the synovial lining around the tendons proliferates, or
thickens, resulting in increased contents in the carpal tunnel and
thereby pressing the median nerve against the transverse carpal
ligament.
People who suffer from carpal tunnel syndrome often
experience worse symptoms following sustained gripping
activities, such as driving a car or holding a book or a newspaper.
Another very common complaint is waking at night with numbness
and tingling or pain in one or both hands. This is thought to
potentially be the result of abnormal wrist posture during sleep,
which places increased pressure on the nerve in the wrist. This
theory is supported by the fact that wrist splints used to hold the
wrist in a more open, physiologic position during sleep are one of
the most effective nonoperative treatments.
The location of nerve pressure in cubital tunnel syndrome
occurs in the elbow and involves the ulnar nerve. In the case of a
cervical radiculopathy, nerve entrapment occurs in the neck. The
specific nerve or nerves that are involved affect the location of
hand numbness. For cases of carpal tunnel syndrome, the location
of numbness is distributed along the course of the median nerve;
thus, the thumb, index, middle, and a portion of the ring finger will
be involved. In cases of cubital tunnel syndrome, the location of
symptoms is distributed along the course of the ulnar nerve; thus,
pain, numbness, and tingling will be located in the pinky and ring
finger. Cervical radiculopathies may affect several nerves therefore
causing the whole hand to be numb.
I THINK I HAVE CARPAL TUNNEL SYNDROME…WHAT
TREATMENTS ARE AVAILABLE?
Nonsurgical treatments may include non-steroidal antiinflammatories
such as aspirin or ibuprofen, occupational therapy,
chiropractic or other manipulative techniques, and cortisone
injections. Patients that do not respond to these conservative
36 October 2014 - QC Family Focus
treatments are usually treated surgically to relieve the pressure
on the median nerve. Without surgery, permanent nerve damage
may occur. Research has shown that nerve damage is a result of
the length of time and amount of pressure on the nerve.
The most common surgery for carpal tunnel syndrome
involves dividing the transverse carpal ligament to alleviate
pressure on the median nerve. The ligament is cut to open the
carpal tunnel about 5 mm; the larger passage relieves the pressure
on the median nerve. In about six weeks, the ligament heals,
allowing for return of normal strength. This older, more traditional,
open surgical procedure requires a large incision through the skin,
subcutaneous tissues, nerves, and muscles in order to allow the
surgeon to see and cut the transverse carpal ligament. This results
in longer healing times and more scar tissue than the newer,
minimally invasive approach performed by Dr. Tyson Cobb. Dr.
Cobb performs the newer surgical technique of endoscopic carpal
tunnel release. Using an endoscope (tiny video camera smaller
than a pencil), the surgeon is able to see and divide the transverse
carpal ligament from inside the carpal tunnel through a very
small incision called a “portal”. The surgery is performed without
having to cut through tissue overlying the transverse carpal
ligament. The incision is so small that no stitches are required
following the procedure. Patients recover faster and experience
less postoperative scarring, pain, and stiffness than patients that
undergo the older, open surgical technique. For patients that do
not want any sedation, Dr. Cobb offers wide-awake anesthesia.
Whereby the name implies, patients can be wide-wake during the
surgery and can even watch the surgery on the monitor if they
want.
A study was conducted to compare the outcomes of
endoscopic versus open carpal tunnel release on patients with
carpal tunnel syndrome in both hands; they underwent an open
procedure on one side and an endoscopic procedure on the other.
The results of this study showed that patients universally preferred
the endoscopic carpal tunnel procedure. Patient preference for the
technique that Dr. Cobb uses was also later backed by a larger
research study (a meta-analysis) showing similar results. One
of Dr. Cobb’s patient’s who previously had an open surgery by
another surgeon stated, “It was amazing the difference between
the two surgeries and the recovery…I would recommend this
surgery to anyone.” (Watch this patient’s success story at http://
youtu.be/zGDIYXN4PLk)This minimally invasive, no-stitches
approach requires only tape (Steri-Strips) to close the wound. The
incisions are so small that many patients are unable to see their
scars. Most of Dr. Cobb’s patients return to work in a matter of
days instead of months.
For more information on other procedures that Dr. Cobb performs or to
learn more about Orthopaedic Specialists, visit our website at www.osquadcities.
com. For a request for an evaluation, contact our office at 563.344.9292 or click
here. Find us on facebook and like us to stay up to date with treatment options and
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