Symptoms & Treatments

Carpal Tunnel

Patients with complaints of numbness and tingling radiating from the forearm into the fingers are being seen with increasing frequency. These symptoms may be secondary to repetitive activities and often reflect an individual's employment or recreational activities. These complaints may be secondary to a compression neuropathy or pinched nerve of which carpal tunnel is the most common. The median nerve, travels down the forearm and gains entry into the hand by passing under the transverse carpal ligament at the wrist. An impingement on the median nerve can occur at this location and result in numbness and tingling into the middle fingers of the hand.

Other nerves about the forearm and wrist are occasionally involved. The ulnar nerve to the small and ring fingers occasionally can be pinched about the elbow and also at the wrist. Symptoms are similar to carpal tunnel, but are localized more to the small finger side of the hand. The radial nerve to the thumb area can also be pinched about the elbow as the nerve crosses in between the larger muscle groups of the upper forearm.

Treatment for all of these compression neuropathies is initially rest, a forearm splint, and anti-inflammatories. Occasionally, vitamin B6 is helpful in moderate doses. When symptoms persist, in spite of activity restrictions, often EMG studies are obtained. These neuroelectro diagnosis studies can determine the site of nerve pinching and give information as to the relative magnitude of the condition and likelihood of recovery. Significant nerve entrapment usually requires a surgical release of the pinched nerve. Most of the surgery is performed as an outpatient under local or regional anesthesia. Rarely is a general anesthetic required. After two or three hours in the hospital, the patient is usually discharged home with an ace bandage or removal splint in place. Physical therapy modalities are usually not necessary as long as the individual works on moving their fingers and wrist daily. Return to work is usually possible after two or three weeks, with full strength and motion returning after six weeks. Recurrence is unusual, and most people are able to resume all activities after a limited period of disability.