Carpal Tunnel Synrdome
This is the most common site of nerve compression in the upper extremity. This involves the compression of the median nerve at the level of the wrist causing classic numbness and burning sensation in the thumb, index and middle fingers. Common complaints consist of pain that does not allow the patient to sleep, difficulty using the hand in flexion, such as driving a car and/or writing and typing on the computer. Long term compression can cause atrophy of the muscles about the thumb with significant dysfunction and weakness in the hand. The diagnosis of carpal tunnel syndrome is made by electro diagnostic studies which evaluate the conduction of the nerve across the level of the carpal tunnel. In addition, this allows the doctor to assess the function of the muscles in the hand that are innervated by the median nerve and whether their ability to function is being compromised.
In mild cases, treatment can include splinting, injection of cortisone and/or therapy. In more advanced cases, surgical intervention is warranted. This is a procedure that can be done under local anesthesia on an outpatient basis and allows the patient to return to active use of the hand immediately. Sutures remain in the hand subsequent to the procedure for approximately 2 weeks and the patient can utilize the hand for all activities. However, the patient is encouraged to keep the hand clean and dry during this time. After removal of the sutures in 2 weeks, a brief period of therapy may or may not be indicated. Other possible sites of compression in the median nerve, although less common, are at the level of the elbow. Here, the median nerve can be decompressed between several muscles. When compression occurs at this level as well as the carpal tunnel, diagnosis of double crush syndrome is made.