Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is a condition caused by a narrowing of the carpal tunnel causing a compression of the structures within the tunnel, including the median nerve. This compression of the median nerve is what causes the uncomfortable symptoms of tingling, numbness and pain.

The median nerve is the nerve that travels down the arm into the hand. With CTS, the nerve is squeezed as it passes through the narrow path (or tunnel) at the wrist. To enter the hand, the median nerve must pass through the narrow opening at the wrist joint. On one side of the wrist joint are bones, and on the other is a strong ligament, flexor retinaculum, that runs across the wrist. The ligament and the bones form a firm channel that has little ability to expand.

The pressure on the wrist can cause the fingers and thumb to feel tingly and numb. They may even feel weak. The symptoms will most likely begin as mild increase to moderate and eventually become severe if left untreated. Mild symptoms will most likely begin with tingling and numbness in one or more than the tips of your fingers. This may be accompanied by pain around the wrist area and interruption in sleep. Symptoms can increase to include the whole hand, numbness for an increased amount of time, and more severe pain.

Signs and Symptoms

Numbness or tingling are most common in the thumb, index, middle, and adjacent half of the  ring fingers. Patients often suffer particularly severe nighttime numbness, making sleep difficult. Patients may complain of clumsiness of their hands, including dropping items.

In severe cases, sensation may be permanently damaged and the muscles at the base of the thumb shrink (thenar atrophy), creating difficulty to pinch.

 

Causes

 

  • Repeated movements and heavy use of the hand and wrist may play a role. Some people who have jobs or hobbies that make them use their hands and wrists in this way may be at greater risk of getting CTS.
  • Work stress on hands.
  • People with diabetes & hypothyroidism may get CTS.
  • There may be a link between CTS and hormones. Some women get CTS after a change in certain hormones, such as during pregnancy.
  • Different kinds of arthritis that cause the wrists to swell can also cause CTS.

Diagnosis

 

Non Operative Treatment

 

Once CTS is diagnosed, depending on severity and the time elapsed since onset, one or more therapies may be recommended, including splinting, reduction and avoidance of movements that exacerbate the condition and/or cortisone shots.

What are the benefits of platelet-rich-plasma (PRP) therapy vs steroid injections ? 

The procedure is minimally invasive. The risk is minimal because the procedure involves using only your own blood, there are less side effects than steroid injections. There is a longer duration of relief of symptoms vs steroid injections. ( up to 6-12 months)

Treatment cost : $1,400.00

Surgical procedure

If symptoms continue unabated for six months or more, surgery should be considered. Timing is important. People who decide to put up with the symptoms for too long risk irreversible muscle atrophy that can lead to more weakness and poorer recovery from the postponed surgery.

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Endoscopic carpal tunnel release

  • SMALL incision in wrist
  • Short procedure
  • Quick recovery
  • Surgical fee $4,500.00
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Open SMALL incision carpal tunnel release

  • SMALL incision in palm
  • Short procedure
  • Quick recovery
  • Surgical fee $3,700.00

After surgery Dr Zadeh will give you guidelines to follow

Risk and Complications

 

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As with any surgery there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. Dr Zadeh informs you of these risks before the surgery takes place.

 

The majority of patients suffer no complications; however, complications can occur and may include:

  • Infection
  • Nerve injury
  • Tendon injury
  • Stiffness to the finger and wrist
  • Sensitive scar
  • CTS can return
  • Persistent numbness

 

Risk factors that can negatively affect adequate healing after surgery include:

  • Poor nutrition
  • Smoking
  • Alcoholism
  • Chronic illness
  • Steroid use

Post Operative Guidelines

Post-Operative Instructions

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Dr. Zadeh will provide a detailed consultation, explaining available options, benefits, and risks associated with each procedure.