Carpal Tunnel Syndrome treatment in Los Angeles, Beverly Hills.

Carpal Tunnel Syndrome (CTS) is a condition in which there is excessive pressure on one of the nerves of the hand and wrist called the median nerve. Carpal tunnel syndrome is not arthritis, but can be associated with arthritis and tendonitis. Since the median nerve originates in the neck and travels all the way down the arm, any process that puts pressure on the nerve along its course could mimic the symptoms of CTS.

For example, arthritis and disc problems in the neck can cause similar symptoms to carpal tunnel syndrome by pressing on the nerves. It is also possible to have both carpal tunnel syndrome and a disc problem; this is the so-called “double crush phenomenon”.

What are the Causes of Carpal Tunnel Syndrome?

The carpal tunnel is formed by a shallow, bony groove in the wrist covered by a thick, fibrous ligament. The median nerve and nine tendons travel through this tunnel. Since there is no room for expansion in this tunnel, any process which increases the volume in this area causes excessive pressure on the nerve and thus, carpal tunnel syndrome.

Activities involving repetitive use of the hand, for example, typing or factory work, can lead to swelling of the tendons and subsequently CTS. Certain medical conditions such as diabetes and thyroid problems also increase the likelihood of CTS.

Pregnant women in their third trimester of pregnancy also have an increased incidence of developing CTS. In a large number of cases there is no explanation for development of carpal tunnel syndrome.

What are the Symptoms of Carpal Tunnel Syndrome?

Carpal tunnel syndrome can have a wide array of symptoms. Early on, patients experience intermittent tingling and numbness with certain activities and in certain positions.

Symptoms usually start gradually, with frequent burning, tingling, or itching; there is frequently numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers. Some carpal tunnel sufferers say their fingers feel useless and swollen, even though little or no swelling is apparent. The symptoms often first appear in one or both hands during the night, since many people sleep with flexed wrists. A person with carpal tunnel syndrome may wake up feeling the need to "shake out" the hand or wrist. As symptoms worsen, people might feel tingling during the day.

Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In chronic and/or untreated cases, the muscles at the base of the thumb may waste away. Some people are unable to tell between hot and cold by touch.

For example, one might experience numbness when driving, holding a newspaper, or using the computer. Night symptoms are common and often can awaken the patient.

As the condition progresses the numbness can become constant and one might develop different degrees of pain, clumsiness, and weakness.

How is Carpal Tunnel Syndrome Diagnosed?

Carpal tunnel syndrome is diagnosed primarily by obtaining a detailed history and doing a proper physical examination. Nerve studies can be used for confirmation. However, nerve studies are not 100% sensitive and they can miss CTS. This is why it is very important to do a proper history and physical examination.

If there is suspicion of neck arthritis or disc disease putting excessive pressure on the nerves, x-rays and MRI of the neck may be ordered as well.

What are the Treatments for Carpal Tunnel Syndrome?

It is very important to diagnose and treat this condition so there is no progression of the disease. In its early stages the nerve damage is minor and with treatment it is reversible. In advanced stages, nerve damage can be permanent and recovery after treatment can be partial.

In the early stages of the disease, the patient is advised to modify the aggravating activities and use a splint. Depending on the cause of CTS, the patient may be offered Physical Therapy or a Cortisone injection. In the early to moderate stages, most patients will improve with conservative management.

If the patient fails to improve with these measures, surgery may be recommended. Carpal tunnel release is one of the most common surgical procedures in the United States.

What Does Surgery for Carpal Tunnel Syndrome Involve?

Generally recommended if symptoms last for 6 months, surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve. Surgery is done under local anesthesia and does not require an overnight hospital stay.

Many patients require surgery on both hands. The following are types of carpal tunnel release surgery:

The traditional procedure, open release surgery, is used to correct carpal tunnel syndrome, consists of making an incision up to 2 inches in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel. The procedure is generally done under local anesthesia on an outpatient basis.

Endoscopic surgery may allow faster functional recovery and less postoperative discomfort than traditional open release surgery. The surgeon makes two incisions (about ½" each) in the wrist and palm, inserts a camera attached to a tube, observes the tissue on a screen, and cuts the carpal ligament (the tissue that holds joints together). This two-portal endoscopic surgery, generally performed under local anesthesia, is effective and minimizes scarring and scar tenderness, if any. One-portal endoscopic surgery for carpal tunnel syndrome is also available.

During surgery, the thick ligament covering the carpal tunnel is divided. This will heal in a longer position thus alleviating the pressure on the nerve. The patient is encouraged to move his or her fingers right away and can use the hand for very light activities.

How Long Is Recovery?

The procedure is generally done under local anesthesia on an outpatient basis. Sutures are removed at ten days and full activity can be resumed in 6-12 weeks depending on the patient’s level of activity.

Will Insurance Cover It?

Most insurance companies offer reimbursement for reconstructive procedures, if you are having surgery to correct an abnormality, insurance coverage can likely be obtained. Pre-authorization by the insurance company is required prior to surgery.

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