About Us
About Us
Carpal Tunnel Clinic in Dallas, Texas has been providing quality medical services since 1992. Additionally, our owner has also been in the industry for more than 30 years. With our experience and commitment, our patients can rest assured that we will provide them with safe and effective services that help treat or prevent carpal tunnel syndrome. Get in touch for more information.
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome
Carpal Tunnel syndrome was a term first used in the 1930's to describe an entrapment neuropathy of the median nerve at wrist. There is nothing new whatsoever about carpal tunnel syndrome. Human beings have had carpal tunnel syndrome for as long as there have been carpal tunnels. The first open carpal tunnel release was described in 1947 and nothing changed very much for 50 years until the advent of the endoscopic procedure in 1990. Along about the same time, the media publicized the fact that some individuals involved in repetitive type work activities, such as those who work on computers all day, have an increased incidence of carpal tunnel syndrome. in point of fact, most people who go to hand surgeon's office with carpal tunnel syndrome are perplexed as to why they have this disease because they do not engaged in classic repetitive type work activities.
Anatomy of Carpal tunnel syndrome
Anatomy of Carpal tunnel syndrome
Carpal tunnel syndrome is easily understood if one begins with the anatomy. The carpal tunnel is formed by a semi-circle of carpal bones on three sides. The fourth side that forms the carpal tunnel is the transverse carpal ligament. The ligaments cannot stretch. Thus the carpal tunnel is a defined space that cannot enlarge. There is only so much room in that opening. Though that opening passes the median nerve, nine tendons, and spongy tissue around the tendons called tenosynovium.
How does it happen?
How does it happen?
We start our lives with that extra space. When we run out of extra space due to the swollen tenosynovium then pressure is placed on the nerve. When this happens, one begins to develop carpal tunnel symptoms. Classic textbook carpal tunnel syndrome symptoms are tingling and numbness in the thumb, index and middle finger (median nerve distribution), aching in the forearm which can radiate to the shoulder and clumsiness or weak grip. Only about one or two patients out of ten presents with a classic textbook carpal tunnel picture. Some present with tingling in all fingers while others present with tingling only in the thumb or the middle finger. Some present with aching and pain in the hand while others have radiating pain just medial to the back.
Statistics
1.According to the compiled information from the Bureau of Labor and Statistics and the National Institute for Occupational Safety and Health (NIOSH), Carpal Tunnel surgery is the second most common type of surgery, with well over 230,000 procedures performed annually.
2.The U.S. Department of Labor has concluded that Carpal Tunnel Syndrome is the "chief occupational hazard of the 90's"-disabling workers in epidemic proportions.
3.According to NIOSHA, only 23% of all Carpal Tunnel Syndrome patients were able to return to their previous professions following surgery.
4.Women are twice as likely to develop Carpal Tunnel Syndrome as opposed to their male counterparts.
5.Ergonomic disorders are the fastest growing category of work-related illness. According to the most recent statistics from the U.S. Bureau of Labor Statistics, they account for 56 percent of illnesses reported to the Occupational Safety and Health Administration.
6.United States, employers spend more than $7.4 billion in workers compensation costs, and untold billions on medical treatment, litigation costs, hidden costs and lost productivity. U.S. Bureau of Labor and Statistics.
7.More than eight million people are affected by carpal tunnel syndrome each year. Surgery for carpal tunnel syndrome is the second most common type of musculoskeletal surgery, (back surgery is #1) with well over 230,000 procedures performed annually.
8.If you type 40 words a minute: you press 12,000 keys per hour or 96,000 keys per 8-hour day.
9.Approximately 8 ounces of force is necessary to depress one key. Almost 16 tons of force will be exercised by your fingers.
Diagnosis
Diagnosis
A nerve test is done to confirm the diagnosis. Once the patient has been diagnosed with carpal tunnel syndrome, a decision verses treatment must be done. One must keep in mind what is going on with the nerve. The nerve is being squeezed. If one has a wedding band on the ring finger and hand is crushed between two objects, then the entire hand begins to swell and the ring acts as a tourniquet cutting off the flow of blood to the finger. It is easy to understand that the ring has to be cut off the finger or else the finger will die. Likewise the nerve is being pinched and they will be deprived of blood flow and undergo irreversible changes and ultimately die unless the pressure is released before those irreversible changes take place.
Thus the goal of treating carpal tunnel syndrome is not simply to reduce the pressure on the nerve so that the symptoms are tolerable and patient can live with it but rather to alleviate teh pressure entirely. Waiting "until it gets too bad" is not advised and one may actually end up with permanent nerve damage.
Carpal Tunnel Syndrome Testing Assessment :
How is carpal tunnel syndrome treated?
How is carpal tunnel syndrome treated?
Treatments for carpal tunnel syndrome should begin as early as possible, under a doctor's direction. Underlying causes such as diabetes or arthritis should be treated first.
Non-surgical treatments
Splinting. Initial treatment is usually a splint worn at night.
Avoiding daytime activities that may provoke symptoms. Some people with slight discomfort may wish to take frequent breaks from tasks, to rest the hand. If the wrist is red, warm and swollen, applying cool packs can help.
Over-the-counter drugs. In special circumstances, various medications can ease the pain and swelling associated with carpal tunnel syndrome. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and other nonprescription pain relievers, may provide some short-term relief from discomfort but haven’t been shown to treat CTS.
Prescription medicines. Corticosteroids (such as prednisone) or the drug lidocaine can be injected directly into the wrist or taken by mouth (in the case of prednisone) to relieve pressure on the median nerve in people with mild or intermittent symptoms. (Caution: individuals with diabetes and those who may be predisposed to diabetes should note that prolonged use of corticosteroids can make it difficult to regulate insulin levels.)
Alternative therapies. Acupuncture and chiropractic care have benefited some individuals but their effectiveness remains unproved. An exception is yoga, which has been shown to reduce pain and improve grip strength among those with CTS.
Surgery
Carpal tunnel release is one of the most common surgical procedures in the United States. Generally, surgery involves severing a ligament around the wrist to reduce pressure on the median nerve. Surgery is usually done under local or regional anesthesia (involving some sedation) and does not require an overnight hospital stay. Many people require surgery on both hands. While all carpal tunnel surgery involves cutting the ligament to relieve the pressure on the nerve, there are two different methods used by surgeons to accomplish this.
Open release surgery, the traditional procedure used to correct carpal tunnel syndrome, consists of making an incision up to 2 inches in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel. The procedure is generally done under local anesthesia on an outpatient basis, unless there are unusual medical conditions.
Endoscopic surgery may allow somewhat faster functional recovery and less postoperative discomfort than traditional open release surgery but it may also have a higher risk of complications and the need for additional surgery. The surgeon makes one or two incisions (about ½ inch each) in the wrist and palm, inserts a camera attached to a tube, observes the nerve, ligament, and tendons on a monitor, and cuts the carpal ligament (the tissue that holds joints together) with a small knife that is inserted through the tube. Following the surgery, the ligaments usually grow back together and allow more space than before. Although symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery can take months. Some individuals may have infections, nerve damage, stiffness, and pain at the scar. Almost always there is a decrease in grip strength, which improves over time. Most people need to modify work activity for several weeks following surgery, and some people may need to adjust job duties or even change jobs after recovery from surgery.
How can carpal tunnel syndrome be prevented?
How can carpal tunnel syndrome be prevented?
At the workplace, workers can do on-the-job conditioning, perform stretching exercises, take frequent rest breaks, and use correct posture and wrist position. Wearing fingerless gloves can help keep hands warm and flexible. Workstations, tools and tool handles, and tasks can be redesigned to enable the worker’s wrist to maintain a natural position during work. Jobs can be rotated among workers. Employers can develop programs in ergonomics, the process of adapting workplace conditions and job demands to the capabilities of workers. However, research has not conclusively shown that these workplace changes prevent the occurrence of carpal tunnel syndrome.