Carpal tunnel syndrome
The carpal tunnel is a narrow passageway formed by wrist tissue and bones. Nerves, ligaments, and tendons run from the forearm through the carpal tunnel to the palm. When tendons or other parts of the wrist swell up (often as a result of diseases like diabetes), they press against the carpal tunnel and cause it to shrink. Carpal tunnel syndrome occurs when the median nerve, which controls movement and feeling in your thumb and first three fingers, is pinched or pressed inside the carpal tunnel as a result of this narrowing.
Carpal tunnel syndrome is most common among middle-aged women.
Symptoms of carpal tunnel syndrome include:
- Clumsiness in handling objects
- Numbness or tingling in the hand and fingers
- Pain that goes up your arm to your shoulder
Contrary to popular belief, there is no evidence that carpal tunnel syndrome is caused by repetitive motion such as typing. However, its symptoms can be aggravated by repetitive hand and wrist motions.
Carpal tunnel syndrome diagnosis & treatment
To diagnose your condition, we will perform a nerve conduction velocity test or an electromyography (EMG). A nerve conduction velocity test involves placing electrodes along your skin to measure how fast your body’s nerve signals travel. An EMG involves inserting needles into a muscle to record the electric activity of nerve signals being sent to it. These tests help us determine if carpal tunnel syndrome has damaged your nerves.
To relieve carpal tunnel syndrome symptoms, we may recommend that you wear a wrist brace or splint, rest your injured hand, modify your work environment, or take an anti-inflammatory medication or aspirin to reduce swelling in your wrist. If these treatments don’t alleviate the problem within six months, you likely will need surgery.
Brachial plexus injury (BPI)
The brachial plexus is the collection of nerves near the shoulder that controls the muscles and provides feeling in the shoulders, arms, and hands. Brachial plexus injury (BPI) most often occurs as a result of arm or shoulder trauma – particularly from motor vehicle or sports accidents.
BPI can cause paralysis of the arm, shoulder, elbow and hand. You may also lose sensation and experience pain or weakness in these areas.
A different form of BPI, brachial plexus palsy, typically affects newborn babies. This condition can be caused by excessive pulling on the shoulders during a head-first delivery or on the raised arms during a breech delivery (feet first). Most children or infants with brachial plexus palsy are treated without surgery.
Your nerves might heal on their own in mild to moderate cases, but treating BPI often requires surgery. First, we’ll perform a neurolysis, removing the scar tissue that surrounds the damaged nerve. Next, we’ll replace the scarred nerve segments with a bypass graft, which uses a segment of a different nerve in your body. Finally, we’ll perform a nerve transfer to bridge the new nerve segment with the existing one to restore function to the brachial plexus.
The doctor likely will recommend physical therapy as part of your treatment to help your nerves heal properly.
Ulnar nerve compression
The ulnar nerve starts at the side of the neck and joins three main nerves that travel down the arm. These nerves provide feeling and muscle control to the little finger and half of the ring finger. The ulnar nerve is responsible the tingling feeling you get when you “hit your funny bone.”
When the ulnar nerve is pinched (compressed) at the elbow, it can cause cubital tunnel syndrome. This condition, the most common nerve compression affecting the ulnar nerve, is characterized by numbness in the ring finger and little finger.
Other symptoms of cubital tunnel syndrome include feeling your ring and little fingers “fall asleep,” particularly when you bend your elbow, as well as difficulty moving these fingers and weakening of your overall grip.
Cubital tunnel syndrome diagnosis & treatment
Cubital tunnel syndrome often is confused with carpal tunnel syndrome. It’s important for an orthopedic specialist to diagnose your condition so you can learn what to expect and how to alleviate your symptoms.
If the ulnar nerve has been compressed for a long time, the muscles in your hand can atrophy (become weak). If you’re experiencing severe nerve compression symptoms, you should be treated as soon as possible to prevent irreversible muscle damage.
Typically, we treat cubital tunnel syndrome by recommending that patients avoid putting pressure on the ulnar nerve at the elbow (this can happen by flexing the elbow muscles, for example). If the nerve’s connection to the rest of the nervous system has been interrupted (a condition known as denervation), you may need surgery to relieve the compressed nerve and restore function to your fingers.