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Beverly Hills
9301 Wilshire Boulevard
Beverly Hills, California 90210
West Hills
7301 Medical Center Drive
West Hills, California 91307
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Carpal Tunnel Syndrome
Causes of Carpal Tunnel Syndrome (CTS)
Signs & Symptoms of CTS
Diagnosis & Medical History
Non-Surgical & Surgical Treatments
Carpal tunnel syndrome (CTS) is a wrist condition resulting from increased
pressure on the median nerve at the wrist, much like if the nerve
was pinched.
Patients with CTS often experience symptoms such as numbness or tingling,
and pain in the fingers, hand, or arm. Inside the wrist nine tendons
pass from the wrist to the hand through a space called the carpal
tunnel, and CTS occurs when the tunnel swells and pressure is put
on the nerve. When the swelling and pressure gets large enough to
affect the nerve's workings, then pain, numbness, or tingling may
be felt in the hand and fingers.
| Causes of Carpal Tunnel Syndrome (CTS) |
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The cause of carpal tunnel syndrome is frequently unknown because
the pressure on the nerve can come from a variety of conditions. CTS
can occur when the lining of the flexor
tendons swell, a condition known as tenosynovitis. However, the
tunnel can also be narrowed as a result of joint
dislocations or fractures, or even from arthritis or keeping the
wrist bent for long periods of time. The swelling and symptoms of
CTS can also result from fluid retention during pregnancy although
this condition usually passes shortly after giving birth. Carpal tunnel
syndrome has also been linked with diabetes, some thyroid conditions,
and rheumatoid arthritis,
and a combination of causes is likely.
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| Signs & Symptoms of CTS |
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The most common symptoms of carpal tunnel syndrome include pain, numbness,
or tingling in the thumb, index, middle, and ring fingers. The symptoms,
which may come in combination, are more pronounced at night. Additionally,
symptoms are often noticed when performing routine daily activities
(e.g., turning pages or driving).
A weaker grip or tendency to drop things is common, and occasional
clumsiness may be a sign. If the syndrome advances to a severe case,
sensation in the thumb or digits may be permanently lost, and the
muscles of the thumb may slowly shrink in a condition called thenaratrophy.
Thenaratrophy can cause difficulty with pinching.
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| Diagnosis & Medical History |
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To correctly diagnose carpal tunnel syndrome, one of our hand surgeons
will take a detailed medical history during your initial visit. This
history will include any prior injuries as well as how the hands are,
or have been, used. Arthritis or fractures may be checked with an
x-ray, and laboratory tests may be used to check for the presence
of other medical conditions associated with CTS. To confirm the diagnosis,
a nerve conduction study or NCV may be performed along with an electromyogram
or EMG. In addition to confirming CTS, these tests may identify other
possible nerve conditions.
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| Non-Surgical & Surgical Treatments |
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Many of our patients are relieved of the pain, numbness, and tingling
associated with carpal tunnel syndrome without surgery.
| Such symptoms are often treated by properly identifying and
treating medical conditions, by changing habitual patterns of
how the hands are used, or by keeping the wrist in a splint
that will keep it straight, thereby reducing the pressure on
the effected nerve. A wrist splint worn at night may lessen
the symptoms that interfere with sleep, and an injection of
steroids into the carpal tunnel may reduce the swelling around
the nerve and help relieve the pain, numbness, or tingling. |
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If the symptoms are severe or don't respond to the above treatments,
a physician then considers the possibility of surgery to make more
room around the nerve. The surgery will trim the ligament on the top
or palm side of the tunnel (fig 3) to relieve pressure on the nerve.
While the location of the incision used for this surgery may vary,
enlarging the tunnel and reducing pressure on the nerve is the desired
result. After the surgery is performed, there may be soreness around
the incision for several weeks or months, and several months may pass
before wrist and hand strength returns to normal. In severe cases,
the symptoms of carpal tunnel syndrome may not be entirely eliminated,
not even following surgery.
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