Carpal tunnel syndrome typically involves compression of the median nerve typically at the wrist. By entrapment of the median nerve can occur elsewhere along the course of this anatomic structure the most common site that produces classic numbness and tingling into the radial 3 fingers is entrapment at the wrist.
There is a host of reasons both anatomically and environmentally that can produce carpal tunnel syndrome. This disorder can also be age-related. As we age, the volar carpal retinaculum becomes thickened, oftentimes compressing the median nerve. This, in conjunction with lifelong repetitive activity, can cause a thickening of this ligament, thereby producing compression along the median nerve as it enters into the wrist. This neurologic structure, the median nerve, has multiple variations with respect to its motor branch that innervates the muscles of the thumb that the surgeon must be cautious of during surgery. Typically, carpal tunnel can be managed nonsurgically with night splints, corticosteroid injections, platelet rich plasma, nonsteroidal medications and rest from any precipitating activity that is repetitive in nature.
While we obviously know much about this condition, patients often present in myriad ways. We have seen several instances of patients in our practice who have had significant neck and shoulder pain with only mild numbness and tingling in the wrist and hand which has resolved with a successful carpal tunnel surgery. This is probably a result of the electrical circuit nature of our neurologic system. In other words, radiating pain back up the circuit in the shoulder and neck region could be simply related to carpal tunnel entrapment.
Typically before surgery and electromyelogram from a board certified physiatry or neurologist is typically recommended. This study allows us to determine the side of nerve entrapment and whether there is any other issues such as neuropathy from diabetes or some other disorder.
The results of carpal tunnel surgery are generally outstanding. Patients are very gratified . Recovery is very quick and many of the vague painful symptoms associated with neck and shoulder pain resolve very quickly with a carpal tunnel release. Surgery is typically done with light sedation and always on an outpatient basis. Despite the high success rate of this simple procedure it should be approached with a very thorough workup to make sure that entrapment at the carpal canal of the wrist is the offending area. Even though the surgery by most standards is very straightforward and done on an outpatient basis the operating physician must be in tune to all the anatomic variance of this very special nerve.
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