Carpal Tunnel Syndrome
Numbness in the hand and fingers is usually caused by nerve entrapment at the wrist.
Carpal Tunnel Syndrome History: The patient complains of pain, burning, paresthesias or numbness involving thumb, index or middle finger. The symptoms usually are worse at night, while driving, holding a telephone, or fixing one's hair. As the symptoms progress, the patient may complain of clumsiness, loss of dexterity, and dropping things. When occurring as a work-related condition, the patient frequently complains of pain with any work activity. Often the patient will shake their fingers or rub their hands saying that it makes the feeling come back for short periods.

Signs on the physical examination include paresthesias or numbness in the median nerve distribution (thumb, index, and middle finger) that is accentuated by provocative tests (Phalen's, reverse Phalen's, percussion, direct pressure, and pronator test), altered two-point or monofilament testing, and possible thenar muscle atrophy. The diagnosis can be supported by appropriate x-rays, nerve conduction tests, and the patient's response to conservative treatment.

Non Surgical Intervention:
Non surgical treatment is appropriate when symptoms are mild, of recent onset, or aggravated by pregnancy. This treatment includes education about nerve entrapment and expectation from treatment, non-steroidal anti-inflammatory drugs (NSAID), splinting, steroid injection, and modification of activities (workplace and home). Estimated duration of treatment is up to three months.

Failure of non-surgical treatment, progression of symptoms, objective sensibility loss, intolerable numbness or pain, or thenar atrophy are indications for surgery. Surgical options include release of the transverse carpal ligament by open (mini verses standard) or endoscopic usually as outpatient surgery using a regional block. The benefits of each technique has been debated but several studies show outcomes are similar at six months for the mini open and endoscopic. There does appear to be a slightly greater initial risk from the endoscopic method due to the learning curve required. Estimated duration of treatment is up to twelve months.

After Surgery:
The method and time of immobilization varies with each physician. In addition to return to work, scar management and therapy starts around 2 to 14 days postoperative.

Return to Work:
Modified light work with Band-Aid or cast on and depending on job may be the day after surgery. As pain decreases encourage gradual increasing activities.

Decrease or elimination of paresthesias, decreased pain, improved sensation, improved thenar motor function, pillar pain decreases over six months. Recurrence of symptoms at a later date in about 5%.48-51 Most patients can return to regular work activities with some modifications.