Carpal Tunnel Syndrome: What You Need to Know


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An overview of carpal tunnel syndrome from Dr. Joseph Barmakian, including its symptoms, other conditions which may imitate it, risk factors, how the diagnosis is made and a review of operative and non-operative treatment methods.

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Carpal Tunnel Syndrome: What You Need to Know

  1. 1. Carpal Tunnel Syndrome: What you need to know… Presented by: JOSEPH T. BARMAKIAN, MD May 9, 2012
  2. 2. What is it? Compression of the median nerve at the wristCarpal tunnel contains median nerveplus 9 flexor tendons
  3. 3. Who gets it?• Adults• Women 3X more than men• Diabetics• Kidney, Thyroid• Pregnancy• Assembly line work (& Data entry)
  4. 4. How and Why do you get it?• Most of the time—unknown cause• Idiopathic = Doctor is an Idiot + Patient is Pathetic
  5. 5. How and Why do you get it?• Anything causing increased swelling & pressure in the tunnel• Hormonal• Metabolic• Trauma• Inflammation• Vibration/pressure in palm
  6. 6. The Problem• Most common nerve compression of upper extremity• Affects 1% of the population• 260,000 carpal tunnel releases per year  250,000 Appendectomies• 47% of cases are work related
  7. 7. Symptoms TinglingPain NumbnessLater: Clumsiness & Weakness
  8. 8. Not All Numbness is CTS• Pinched nerve in neck• Neurologic disorders• Other areas of median nerve compression• Other nerves (ulnar nerve or radial nerve)
  9. 9. How is it diagnosed?• **History and physical exam**• Xrays – only show bone problems• MRI – usually not indicated• Nerve tests• Blood tests
  10. 10. Nerve Tests• Associated problems (pinched nerve in neck or other neurologic disorder)• Severity• Helps to predict prognosis
  11. 11. Nerve Tests• EMG/NCV• EMG=Electromyogram  Tests muscles that the nerve controls• NCV=Nerve Conduction Velocity  How fast the nerve conducts an impulse
  12. 12. Blood tests• If diabetes, thyroid problems, or rheumatologic disease are suspected
  13. 13. Treatment• Preventative• Non-surgical• Surgical
  14. 14. Prevention• Take breaks/Stretching• Ergonomic work station at work & home• Avoid repetitive pressure in palms• Keep medical conditions under control (diabetes, thyroid, gout, etc.)• Watch wrist position
  15. 15. Treatment – Non-surgical• Eliminate cause if possible• Splint• Injection of cortisone• Beware of Snake Oil Salesmen• ? Vitamin B6• Don’t wait too long
  16. 16. Treatment• Injection  Temporary  Helps sort out diagnosis  Predictor of relief from surgery
  17. 17. Treatment• Surgery• Goal is to open the roof of the tunnel by dividing the carpal ligament• Open or Endoscopic – debate continues
  18. 18. Surgery• Outpatient• Local anesthesia with sedation• Soft dressing• Drive the next day
  19. 19. Recovery from Surgery• Depends on severity and duration of compression• High success rate• Pain relief – Immediate• Tingling & Numbness – Up to 6 months• May have some permanent loss
  20. 20. Surgery: Open vs Endoscopic• ―Open‖ is now ―mini-open‖• Endoscopic can be one incision or two incisions
  21. 21. Surgery: Open vs Endoscopic• Both are safe and effective• Endo, faster recovery, higher risk of injury and incomplete release• Open, slower recovery, less risk• Studies have not shown one method to be better.• Same at 6 weeks
  22. 22. Summary• Common – Women > Men• Cause – Probably hormonal/metabolic• Diagnosis – Exam, EMG• Treatment – Splint, Ergonomics, Surgery• Open vs. Endoscopic
  23. 23. Associated problems• Trigger fingers
  24. 24. For more information Call (908) 273.4300Visit: Connect with us on Facebook/SummitMedicalNJ Twitter: @SummitMedicalNJ