Carpal Tunnel Syndrome: Symptoms, Treatments, and Surgery Options - Neurosurgery

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Carpal Tunnel Syndrome


The neurology clinic diagnosed me with carpal tunnel syndrome and treated me with corticosteroids for one week, along with almost daily rehabilitation (including heat therapy, electrical stimulation, and laser therapy).
As of my follow-up appointment on September 21, and now on October 26, there has been no improvement.
Initially, I experienced nighttime hand numbness and pain that disrupted my sleep, prompting the doctor to prescribe sleeping pills to help me rest.
During work or on my days off, I sometimes feel tingling in my fingers, similar to being shocked or bitten by ants.
My hands feel weak, my arms are sore, and my fingers are swollen, uncomfortable, and painful.
Pressing on my wrists still causes pain, and the muscles below my thumbs are also sore.
However, I do not have any atrophy in my thumbs.
I have been troubled by this for a long time.
Can I undergo surgery to directly alleviate my current condition? Thank you, doctor, for your response.

Fu Min, 30~39 year old female. Ask Date: 2016/10/26

Dr. Zhang Junwei reply Neurosurgery


Based on your description, it seems to be carpal tunnel syndrome.
If the outpatient examination confirms this, surgery can quickly resolve your issue!

Reply Date: 2016/10/26

More Info


Carpal Tunnel Syndrome (CTS) is a condition that arises when the median nerve, which runs from the forearm into the palm of the hand, becomes compressed at the wrist. This compression can lead to a variety of symptoms, including pain, numbness, tingling, and weakness in the hand and fingers. The symptoms often worsen at night and can significantly disrupt sleep, as you've experienced.

Symptoms of Carpal Tunnel Syndrome
The symptoms of CTS typically include:
- Numbness and Tingling: Often felt in the thumb, index, middle, and part of the ring fingers. This sensation can feel like "pins and needles" or a "crawling" sensation.

- Pain: Pain may radiate up the arm, and many patients report discomfort that can wake them from sleep.

- Weakness: Difficulty in gripping objects or performing fine motor tasks, such as buttoning a shirt or holding a pen.

- Swelling: Some individuals may notice swelling in the fingers or hand, which can exacerbate symptoms.


Non-Surgical Treatments
Initially, non-surgical treatments are recommended for CTS. These may include:
1. Medications: Corticosteroids, like prednisolone, can help reduce inflammation and swelling around the median nerve. Nonsteroidal anti-inflammatory drugs (NSAIDs) like diclofenac can also alleviate pain.

2. Physical Therapy: Rehabilitation techniques such as heat therapy, ultrasound, and electrical stimulation (like TENS) can help relieve symptoms. Stretching and strengthening exercises may also be beneficial.

3. Wrist Splinting: Wearing a splint at night can keep the wrist in a neutral position, reducing pressure on the median nerve.

4. Activity Modification: Avoiding repetitive wrist movements and taking frequent breaks during activities can help alleviate symptoms.


Surgical Options
If non-surgical treatments do not provide relief after a reasonable period (usually several weeks to months), surgical intervention may be considered. The most common surgical procedure for CTS is carpal tunnel release. This surgery involves cutting the ligament that is pressing on the median nerve, thereby relieving the pressure.

When to Consider Surgery
You mentioned that despite a week of steroid treatment and ongoing rehabilitation, your symptoms have not improved. If you continue to experience significant pain, numbness, and weakness, and if these symptoms are affecting your daily life and work, it may be time to discuss surgical options with your healthcare provider. Surgery can often provide immediate relief from symptoms, especially if there is significant nerve compression.


Post-Surgery Recovery
Recovery from carpal tunnel surgery typically involves:
- Rest: Allowing the hand to heal is crucial. You may need to wear a splint for a few weeks post-surgery.

- Physical Therapy: Engaging in rehabilitation exercises can help restore strength and flexibility to the wrist and hand.

- Follow-Up Care: Regular follow-ups with your surgeon or neurologist will be necessary to monitor your recovery and manage any complications.


Conclusion
In summary, while non-surgical treatments can be effective for many patients with CTS, surgery is a viable option when conservative measures fail to alleviate symptoms. Given your ongoing discomfort and the impact on your sleep and daily activities, it would be prudent to have a detailed discussion with your healthcare provider about the potential benefits and risks of surgery. They can provide personalized advice based on the severity of your symptoms and your overall health.

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