Sunday, July 22, 2012

Carpal Tunnel Syndrome

            One recent patient I had was a pleasant old lady who had a condition called carpal tunnel syndrome.  Since I can’t think of a more boring orthopedic topic to cover right now, I decided to tackle this and see if I can offer something unique on the subject.
       My patient was a 70-year old lady who has been suffering from pins and needles sensation on her right hand.
       Her name is Lola Phoebe. Actually, her real name was Lola Pebang. But she told me she took a vacation in America, when she came back after 2 weeks, she was now called Lola Phoebe.
       Anyway, she has taken pain medications and vitamin B complex, as prescribed by an extended family member, specifically, a friend of her sister’s neighbor’s niece’s classmate (whew). She did not improve and told me she had episodes of dropping objects from her right hand because of pain and occasionally being awakened at night due to pain. Her symptoms gradually worsened until the pain and numbness became more often.  How often? Everytime she breathes.
      On examination, her hand has some evidence of atrophy or thinning around the ball of the thumb muscles, and symptoms isolated to the first 3 fingers of the hand. Thus, the clinical impression of carpal tunnel syndrome was made.
       So now, what then is a carpal tunnel syndrome?
    The carpal tunnel is the canal-like passageway on the palm side of the wrist through which several tendons and a pencil-sized nerve, called the median nerve, pass through on their way to the hand from the forearm. The canal is bordered by some of the bones of the wrist and the strong ligament the binds the bones together, called the transverse carpal ligament.  This ligament forms the roof of the tunnel.
     When the transverse carpal ligament thickens (parang kinalyo), the canal decreases in size, compressing the median nerve that leads to the occurrence of signs and symptoms such as those experienced by my patient. These symptoms are collectively referred to as carpal tunnel syndrome.
      Carpal tunnel syndrome (CTS) is a relatively common painful ailment that affects women more than men. People with CTS usually complain of pain in the hand associated with numbness and tingling over the thumb, index finger, middle finger and part of the ring finger. The pain may radiate into the forearm and occasionally into the shoulder and neck. It is aggravated by activity and may awaken the patient at night. If nothing is done to relieve the nerve compression, the signs and symptoms may progress and atrophy or thinning of the muscles at the ball of the thumb may ensue.
       Carpal tunnel syndrome can be secondary to conditions in the wrist such as inflammation of any of the tendons (tendinitis) that pass through the tunnel, fractures and tumors. Sometimes, it is one of the manifestations of a disease like rheumatoid arthritis, diabetes mellitus and thyroid disease. It is also associated with pregnancy and menopause.
      Most CTS patients have a history of holding jobs that require them to do repetitive motions with the hands and wrists for long periods of time. Hence, it is common in factory workers, seamstresses, housekeepers, even surgeons!
    Theoretically, people like you who extensively use computers to read my blog J should be prone to CTS. The only definitive cure for CTS is surgery.  It is a minor outpatient procedure where after the operation, the pain usually subsides within a few days and never recurs. Muscle strength also returns gradually except when the nerve has already been severely damaged.
       However, surgery, for most cases, is the last recourse for CTS. You should try non-surgical treatment first, which should include elevating the hand whenever possible,  splinting of the arm and hand, or physical therapy. If the above measures do not work, you could ask your orthopedic surgeon to inject your wrist with a steroid solution. But if conservative treatment fails, then consider surgery. 
        So what did I do with my patient?   She refused surgery for fear of dying during surgery (how morbid).   So I injected steroid into the carpal tunnel and so far, she is doing well.  She is also undergoing physical therapy right now.  As to how long this will help, nobody knows.   If you, however, want more definitive solution, then surgery should be considered. Remember, the problem is a compressed nerve. Therefore, the solution is to decompress the nerve.

       That’s it for now. Til the next blog post…..

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