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Carpal Tunnel Syndrome: What You Need to Know

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. http://www.summitmedicalgroup.com/

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Carpal Tunnel Syndrome:
  What you need to know…
               Presented by:
         JOSEPH T. BARMAKIAN, MD
                May 9, 2012
What is it?
 Compression of the
   median nerve
    at the wrist

Carpal tunnel contains
    median nerve
plus 9 flexor tendons
Who gets it?
•   Adults
•   Women 3X more than men
•   Diabetics
•   Kidney, Thyroid
•   Pregnancy
•   Assembly line work (& Data entry)
How and Why do you get it?
• Most of the time—unknown cause


• Idiopathic =
  Doctor is an Idiot +
  Patient is Pathetic
How and Why do you get it?
• Anything causing increased swelling &
  pressure in the tunnel
• Hormonal
• Metabolic
• Trauma
• Inflammation
• Vibration/pressure in palm
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

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Carpal Tunnel Syndrome: What You Need to Know

  • 1. Carpal Tunnel Syndrome: What you need to know… Presented by: JOSEPH T. BARMAKIAN, MD May 9, 2012
  • 2. What is it? Compression of the median nerve at the wrist Carpal tunnel contains median nerve plus 9 flexor tendons
  • 3. Who gets it? • Adults • Women 3X more than men • Diabetics • Kidney, Thyroid • Pregnancy • Assembly line work (& Data entry)
  • 4. How and Why do you get it? • Most of the time—unknown cause • Idiopathic = Doctor is an Idiot + Patient is Pathetic
  • 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. 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. Symptoms Tingling Pain Numbness Later: Clumsiness & Weakness
  • 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. How is it diagnosed? • **History and physical exam** • Xrays – only show bone problems • MRI – usually not indicated • Nerve tests • Blood tests
  • 10. Nerve Tests • Associated problems (pinched nerve in neck or other neurologic disorder) • Severity • Helps to predict prognosis
  • 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. Blood tests • If diabetes, thyroid problems, or rheumatologic disease are suspected
  • 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. Treatment – Non-surgical • Eliminate cause if possible • Splint • Injection of cortisone • Beware of Snake Oil Salesmen • ? Vitamin B6 • Don’t wait too long
  • 16. Treatment • Injection  Temporary  Helps sort out diagnosis  Predictor of relief from surgery
  • 17. Treatment • Surgery • Goal is to open the roof of the tunnel by dividing the carpal ligament • Open or Endoscopic – debate continues
  • 18. Surgery • Outpatient • Local anesthesia with sedation • Soft dressing • Drive the next day
  • 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. Surgery: Open vs Endoscopic • ―Open‖ is now ―mini-open‖ • Endoscopic can be one incision or two incisions
  • 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. Summary • Common – Women > Men • Cause – Probably hormonal/metabolic • Diagnosis – Exam, EMG • Treatment – Splint, Ergonomics, Surgery • Open vs. Endoscopic
  • 24. For more information Call (908) 273.4300 Visit: summitmedicalgroup.com Connect with us on Facebook/SummitMedicalNJ Twitter: @SummitMedicalNJ