MEDICAL SURFARI: ENDOSCOPIC CARPAL TUNNEL SURGERY USES TECHNOLOGY TO RELIEVE PAIN

With the growth in industrialization and computerization, nearly one percent of the population is affected by carpal tunnel syndrome caused by attendant repetitive hand and wrist movements.

Carpal tunnel syndrome is a constellation of signs and symptoms that result from entrapment of the median nerve as it passes through a "tunnel" formed by bones and ligaments in the wrist. Nine tendons, surrounded by a synovial sheath for lubrication, pass through the "tunnel" parallel with the median nerve in the wrist. If the tendon sheaths become swollen or irritated they may irritate the nerve resulting in a painful or uncomfortable condition called CTS.

Numbness or tingling in your hands that gets worse at night or that occurs after using your hands, such as typing or using hand tools, may be due to CTS. Some people experience decreased feeling in the thumb, index finger or middle finger and some notice clumsiness in the affected hand(s). Occasionally, some people may have pain radiating from the hand up to the shoulder. However, it is very important to remember that these symptoms may be caused by other conditions affecting the nervous system, consequently, if you suspect CTS seek an evaluation from a specialist with experience in nervous system disorders.

There are many causes of CTS. Some of the most common causes include repetitive, forceful grasping and wrist bending. Carpal tunnel syndrome may also result from wrist trauma, arthritis, thyroid problems, diabetes, or other hormonal changes that accompany menopause or pregnancy.

Protect your wrists if you must perform repetitive tasks on a daily basis. Don't rest your wrists on hard edges and adjust your chair height to reduce the bend in your wrist if you use a keyboard. Take breaks to prevent fatigue and overstress on your wrists. When you take a break exercise your hands by stretching and rotating your wrists to improve blood flow in the wrist.

One of the latest trends in surgery is toward minimally invasive techniques. Through a tiny entrance and exit incision, under local anesthesia, the endoscope (a specialized instrument that allows a camera view of the carpal tunnel) may be used to perform a minimally invasive carpal tunnel release. As a neurosurgeon, I operate on the brain, spine and peripheral nerves, especially the median nerve involved in CTS. Having performed this procedure I know firsthand that the operation takes less than five minutes. Once the operation is complete, only two stitches are placed at the entrance and exit sites and the patient is allowed to return home within a couple of hours after surgery. Depending on one's work, patients, are allowed to return to full duty within seven to ten days. Endoscopic carpal tunnel release uses modern technology to reduce postoperative hand discomfort thereby allowing people to return to work sooner.

Most cases of CTS can be treated conservatively with anti-inflammatory medications, reduction in repetitive wrist action and, in some cases, with a steroid injection in the wrist. Surgical treatment for CTS is reserved for patients who have been unable to get adequate long-term relief with nonsurgical measures.

World Wide Web resources

The Carpal Tunnel Information Page

www.carpal-tunnel.com/

This Web site provides information on symptoms, causes, anatomy, prevention, diagnosis, and treatment of carpal tunnel syndrome in a very clear and understandable format.

A Patient's guide for Carpal Tunnel Syndrome

www.sechrest.com/mmg/cts/ctsintro.html

This is a useful Web site for anyone who would like some basic information about carpal tunnel syndrome, including diagnosis and treatment options.

Dr. Scott Gibbs is a neurosurgeon and editor-in-chief of Mosby's Medical Surfari. You may e-mail questions to him at drgibbs@semissourian.com or write in care of the Southeast Missourian, P.O. Box 699, Cape Girardeau, Mo., 63701.