Why Choose Cedars-Sinai Marina del Rey Hospital for Carpal Tunnel Syndrome Treatment?
The highly-skilled, well-trained doctors and surgeons at Cedars-Sinai Marina del Rey Hospital will evaluate patients with carpal tunnel syndrome and propose an individualized treatment plan that is most appropriate for their condition.
Carpal tunnel syndrome (CTS) is a condition that occurs as a result of the compression of the median nerve in the wrist. The median nerve, along with the tendons that keep the wrist joint flexible, are housed in a narrow but rigid canal made up of bones and ligaments called the carpal tunnel. Excessive swelling of the tissue around the tendons can lead to the narrowing of this canal, which puts an abnormal amount of pressure on the median nerve. Factors that contribute to the development of CTS include traumatic injuries to the wrist, thyroid disorders, rheumatoid arthritis, and pregnancy-associated fluid retention in the body. Symptoms of CTS develop gradually and usually include tingling, numbness, pain, and weakness in the wrist, thumb, index, or middle fingers. Some people may experience difficulty grasping small items and performing daily tasks. Early detection and treatment of CTS are very important, as the condition may worsen over time. If left untreated, CTS can cause median nerve damage, along with heightened symptoms. in these cases, surgery may be required.
Surgical Procedures Performed at Cedars-Sinai Marina del Rey Hospital for Carpal Tunnel Syndrome
Surgical treatment is usually recommended when conservative treatment methods fail to alleviate a patient's pain or symptoms. For patients with continuous numbness and muscle weakness lasting for more than six months, surgery is the best option to avoid permanent nerve damage. Carpal tunnel release is the surgical procedure used to treat CTS. Carpal tunnel release involves cutting a ligament in the carpal tunnel and reducing pressure on the median nerve. There are two surgical techniques that can be used to release the carpal tunnel. Most cases of carpal tunnel release are performed as outpatient procedures under general anesthesia, local anesthesia, or intravenous sedation.
- Open carpal tunnel release surgery: This traditional technique, usually performed under local anesthesia, involves making a two-inch long incision in the wrist. The carpal ligament present on the roof of the carpal tunnel is then cut to enlarge the tunnel and reduce the pressure on the median nerve.
- Endoscopic carpal tunnel release surgery: This technique involves making one or two smaller incisions of about ½ inch in the palm and the wrist. Through one of these incisions, an endoscope with a camera attached to it is inserted, which allows the surgeon to see the tissue inside. Using a specialized knife, the carpal ligament is then cut to enlarge the carpal tunnel. Endoscopic surgery involves a minimal amount of postoperative discomfort, minimal scarring, and a faster recovery time.
Drugs and Other Treatments for Carpal Tunnel Syndrome
Patients with CTS should begin treatment as early as possible after being diagnosed. The first step in treating CTS is treating any underlying diseases, such as arthritis or diabetes, if necessary. The second step requires at least two weeks of rest and immobilization of the hand and wrist in order to avoid further damage. Application of ice packs may help decrease swelling.
Regular Exercises »
Braces Or Splints »
Acute Carpal Tunnel Syndrome »
Bilateral Carpal Tunnel Syndrome »
Pregnancy-associated Carpal Tunnel Syndrome »
Symptoms of Carpal Tunnel Syndrome
The symptoms of CTS develop gradually, with the exception of cases when an injury is involved. Most often, CTS symptoms are initially transient and then become more intense and persistent as the syndrome progresses. Symptoms commonly occur during the night. If symptoms appear during the day, it's usually due to holding an object for an extended period of time with the wrist bent forwards or backwards (i.e. reading a book, driving, holding a phone). CTS symptoms include:
- Pain, tingling, numbness, and a burning sensation in the palm, thumb, index, and middle fingers
- Pain and tingling sensations that radiate up to the forearm and shoulder
- Wrist pain during the night that causes sleep disturbances
- Feeling that the fingers are swollen in the absence of any actual swelling
- A weakness of the hand muscles, especially at the base of the thumb
- Difficulty making a fist, grasping small objects, and performing simple tasks such as buttoning clothes
Diagnosis of Carpal Tunnel Syndrome
CTS is diagnosed on the basis of a patient's medical history, a careful physical examination of the hand and wrist, and specialized tests, such as nerve conduction studies.
Physical examination: A doctor will perform a complete evaluation of the hand, wrist, and shoulder to determine the causes of nerve compression. They will also check the wrists for signs of swelling, tenderness, and deformities, and evaluate the strength of the hand muscles and the sensation in the fingers.
Electrophysiological tests: Electrophysiological tests are performed to check the functions of the median nerve and determine the amount of pressure it is being subjected to. These tests also check for other sites of nerve compression. There are two types of electrophysiological tests:
- Nerve conduction studies: The purpose of these studies is to measure the signals that are conducted through the nerves of the hand and arm. They help detect problems involved in the conduction of nerve signals.
- Electromyogram (EMG): This test can reveal neuromuscular damage by measuring the electrical activity in the muscles.
- Ultrasound: Ultrasounds are used to check for signs of median nerve compression. In these tests, high-frequency sound waves are used to produce pictures of the bones and tissue in the wrist.
- X-ray: X-rays of the wrist may be done to rule out any other disorders, such as ligament injury, arthritis, and fractures.
- Magnetic resonance imaging (MRI) Scan: MRIs create better images of soft tissue. These can help detect nerve problems, tumors, any injuries resulting in scarring, and the presence of abnormal tissues that might press on the median nerve.
Risk Factors for Carpal Tunnel Syndrome
Various risk factors contribute to the development of CTS. Studies have shown that women are three times more likely to be affected by carpal tunnel syndrome than men. Other risk factors include:
- Repetitive use of hands: Doing activities that require repeated hand and wrist movements for a prolonged period of time can aggravate the swelling of tendons and lead to pressure being placed on the median nerve. The condition is more common in people with manufacturing occupations, such as assembly line work, sewing, and cleaning.
- Pregnancy: Swelling of the tendons in the wrist is also attributed to hormonal changes that occur during pregnancy.
- Heredity: Certain traits, such as smaller carpal tunnels and other anatomical differences that can decrease the space for the median nerve, may run in the family.
- Health disorders: People with diabetes, rheumatoid arthritis, thyroid disorders, and other metabolic disorders that affect nerves are at a higher risk of developing CTS due to their susceptibility to nerve compression.
Causes of Carpal Tunnel Syndrome
CTS commonly occurs in people with smaller carpal tunnels, which creates an increased amount of pressure on the median nerve and tendons. Other reasons for the development of CTS include traumatic injuries to the wrists, such as sprains or fractures that cause swelling, fluid retention in the body during pregnancy or menopause, hypothyroidism, rheumatoid arthritis, tumors/cysts in the carpal tunnel, pituitary gland overactivity, and repetitive use of vibrating hand-held instruments.
Alternative therapies may be incorporated into your regular treatment plan to alleviate the symptoms of CTS. It is always necessary to consult your doctor before starting any alternative treatment method. A comprehensive treatment plan may be derived from the following alternative treatment options:
- Avoid food allergens, such as dairy products, soy, wheat, corn, chemical food additives, and preservatives.
- Avoid eating refined foods, such as baked goods, white bread, sugar, and pasta.
- Avoid coffee, alcohol, and tobacco.
- Include foods rich in vitamin-B, iron, and antioxidants, such as dark green leafy vegetables, whole grains, and fruits.
- Use healthy oils, such as olive oil and vegetable oil.
- A daily dose of multivitamins containing vitamins A, D, E, C, and B-complex, along with trace minerals such as magnesium, zinc, selenium, and calcium can help treat nutritional deficiencies.
- Fish oil rich in omega-3 fatty acids (1-2 capsules, or 1 tablespoon of oil each day)
- Alpha-lipoic acid (25-50 mg two times a day)
Herbal remedies: Herbal remedies, such as extracts of green tea, bromelain, cat’s claw, and turmeric are known to help alleviate symptoms of CTS.
Homeopathic remedies: A person’s physical shape, emotional state, and psychological profile should be taken into account before prescribing any homeopathic remedies. Some of the most common remedies used for CTS include Arnica montana, Guaiacum, and Apis mellifica.
- Contrast hydrotherapy: Alternate applications of hot and cold can help relieve symptoms of CTS by reducing inflammation. This technique involves the complete immersion of the wrist in hot water for three minutes, followed by immersion in cold water for one minute. This should be repeated three times in each session and done two or three times a day.
- Massage therapy: Massage and trigger point therapies can help relieve the symptoms of CTS. Thirty-minute sessions of massage therapy two times a week are recommended.
Acupuncture: Studies have shown that acupuncture can restore the functions of nerves and provide relief from the pain associated with CTS.
Chiropractic treatment: Chiropractic treatment involves the manipulation of the wrist and elbow joints, upper spine, and wrist support, as well as ultrasound therapy. It has been shown to cause a significant improvement in range of movement, pain relief, and muscle strength in people with CTS. Ultrasound therapy involves the use of high-intensity ultrasound to increase the temperature of a targeted area in the body in order to reduce pain and facilitate healing. Doing several weeks of ultrasound therapy can help relieve symptoms of CTS.
Yoga: Yoga postures that focus on stretching, strengthening, and balancing the joints of the upper body can help alleviate the pain and improve the grip strength associated with CTS.
The first step in preventing CTS is making lifestyle changes that reduce the risk factors associated with the condition. It is also important to properly treat conditions such as diabetes, arthritis, and high blood pressure. Physical therapy exercises can also be helpful in preventing CTS. Here are some useful tips that can be used to prevent carpal tunnel syndrome, and alleviate its symptoms:
- At the workplace, stretch and flex the arms and fingers before starting work and during breaks.
- Use splints that maintain the correct wrist position.
- Replace or avoid doing activities that overextend or exert too much pressure on the wrist, and alternate between tasks to decrease repetitive use of the hand and wrist.
- If you work on the computer for long hours, it is advisable to modify your workstation by adding an adjustable keyboard table and a chair with a wrist rest.
Are you enciphering signs of carpal tunnel syndrome? Doctors and surgeons at Cedars-Sinai Marina del Rey Hospital can answer any questions and provide information and guidance related to the treatment of CTS.