Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) causes tingling and numbness in the hand with pain often going all the way to the elbow. Loss of sensation occurs first then weakness later as up to 5 muscles in the hand may become paralyzed. Waking up at night with symptoms is common.
The median nerve compression at the wrist occurs in the carpal tunnel which has 3 walls made of bone and the roof which is a tight thick ligament. The carpal tunnel contains 9 flexor tendons and one nerve, the median nerve. Swelling of the tissue (the synovium) supplying nutrition to these structures may compress the blood supply travelling with the median nerve. This makes the nerve malfunction causing pain, tingling, and numbness. Releasing the strong ligament connecting the 2 bone walls decompresses the nerve to allow return of better blood flow to the nerve and normal function in most cases.
Prolonged compression of the median nerve may cause scar tissue to form inside the nerve that may be permanent and result in incomplete return of function after surgery.
Carpal tunnel syndrome may be associated with diabetes, obesity, thyroid disease, trauma, pregnancy, and other conditions. Some associated causes like diabetic peripheral neuropathy will not be corrected by carpal tunnel release. Neck problems may also give numb fingers. This is why nerve conduction studies, electromyography (EMG), are done to localize the cause of the problem.
Cubital Tunnel Syndrome
Decreased sensation in the 4th and 5th fingers plus weakness in the hand occur due to compression of the ulnar nerve in the cubital tunnel at the elbow. Mechanical compression and lack of blood supply to the nerve may be caused by arthritis, swelling, abnormal muscles around the elbow, traumatic injuries with secondary scarring and repeated elbow flexion.
Diagnosis is made on the basis of clinical examination, history, and electromyographic (EMG) nerve studies which may show slowing of the ulnar nerve across the elbow.
Treatment of ulnar nerve neuropathy depends on the severity of the condition. This may include medication, exercises, splints, and sometimes surgery. The surgery is to decompress the cubital tunnel or sometimes to move the nerve from behind the elbow to in front of the elbow to reduce the stretching and stress on the nerve.
Non-surgical therapies may involve splinting, oral medications, steroids, and treatment of underlying medical problems.
CTS surgery is performed as an outpatient at a day care surgery facility. The patient may be awake or asleep (regional anesthesia or general anesthesia). Long acting local anesthesia given during the surgery minimizes post-operative discomfort.
Light activities may be resumed within one week. Heavy construction jobs may require 6 weeks off work. Sutures are removed two weeks after surgery with activity levels increasing thereafter.