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January 2010: Carpal Tunnel and Cubital Tunnel Syndromes

28 Dec 2009

Dr. Mark Gonzalez is a board-certified orthopedic surgeon at Weiss Memorial Hospital with a special interest in upper extremity surgery.

Dr. Mark Gonzalez
Orthopedic Surgeon
Weiss Memorial Hospital
(312) 444-1145

The two most common causes of nerve compression in the upper extremity are carpal tunnel syndrome that affects the wrist and cubital tunnel syndrome that affects the elbow.

What is carpal tunnel syndrome?
Carpal tunnel syndrome is caused by increased pressure about the median nerve at the wrist. The patient experiences pain and tingling in the thumb index long and ring fingers. The pain is commonly more severe at night. Patients with carpal tunnel syndrome often complain of night waking caused by tingling and numbness. Patients try to shake their hand to get the feeling back. Prolonged median nerve compression can cause permanent numbness and weakness in the hand.

The true cause of carpal tunnel syndrome is unknown. Blunt trauma to the wrist in the absence of a fracture or dislocation is usually not a cause of carpal tunnel syndrome. Although it can be made worse by repetitive work activities there is no proof that work activities cause carpal tunnel syndrome. Carpal tunnel syndrome is frequently seen in pregnant women and in diabetics. In pregnant women the symptoms often resolve after giving birth.

The diagnosis of carpal tunnel syndrome is made by a physical exam from your doctor and by an electromyogram/nerve conduction velocity (EMG). The EMG will demonstrate median nerve dysfunction at the wrist. About 10 percent of patients with carpal tunnel syndrome will have a normal EMG.

Treating carpal tunnel syndrome
The initial treatment for carpal tunnel syndrome is oral nonsteroidal anti-inflammatory medication such as ibuprofen and wrist splinting. Some surgeons offer a cortisone injection in the carpal tunnel. Splinting and injection can give early relief, but with time symptoms tend to recur. A majority of patients eventually require surgical treatment for carpal tunnel syndrome. The surgical treatment opens and releases the transverse carpal ligament that overlies the nerve at the wrist. The operation  relieves the pressure on the nerve and in most cases cures the problem.

The operative release can be performed with an open incision in the palm of the hand or with an endoscope through a small incision at the wrist. The long term results of the two methods are equivalent. The doctor and patient can decide which method is appropriate for the individual.

After surgery patients can perform light activities after several weeks. Patients can return to lifting and heavier work eight to 12 weeks after surgery.

What is cubital tunnel syndrome?
Cubital tunnel syndrome is compression of the ulnar nerve at the elbow. Patients generally complain of tingling and numbness in the outer half of the ring finger and the small finger. Severe or prolonged cubital tunnel syndrome can cause profound weakness of the hand and even a claw hand deformity. Tingling in the hand is made worse by bending the elbow and is often worse at night.

The causes of cubital tunnel include blunt trauma about the elbow, fractures to the elbow, and congenital deformity of the elbow. In many cases the cause is unknown. Flexion (bending) of the elbow causes increased pressure on the nerve and often elicits symptoms.

The diagnosis is made by a physical exam by your physician and by an electromyogram/nerve conduction velocity.

Treating cubital tunnel syndrome
The initial treatment for cubital tunnel syndrome is oral nonsteroidal anti-inflammatory medication and splinting of the elbow. The elbow is splinted in extension. The splint can be worn all the time but splinting at night is particularly useful.

Failure of  splinting and medicine to relieve the symptoms and permanent numbness and weakness in the hand are indications for operating on the cubital tunnel. There are several surgical procedures for cubital tunnel that include releasing the nerve at the elbow and transposing (moving) the nerve to the front of the elbow. The physician will decide which is better for the patient. Surgical results are good and most patients are relieved of symptoms after surgery. Depending on the type of surgical procedure some patients will be splinted for several weeks after surgery. Return to jobs requiring heavy lifting can be delayed for several months after surgery.

In summary
Nerve compression of the hand and arm is common and treatable. Early diagnosis and treatment can avoid permanent nerve damage and/or weakness. If you are experiencing weakness or numbness in your hands see your doctor.

For more information
If you would like more information about carpal tunnel syndrome or cubital tunnel syndrome, or would like an appointment, please call Dr. Gonzalez at(312) 444-1145.