Carpal tunnel prognosis
Neurological examination includes testing the muscle that abducts the thumb away from the palm (called the abductor pollicis brevis), as well as the ability to bend the thumb toward the palm (flexion) and ability to move the thumb toward the other fingers (opposition). Tinel’s sign (tapping the palm sharply produces tingling) and Phalen’s sign (pressing the backs of the hands together for about 1 minute produces pain and numbness) are also evaluated. Nerve conduction velocity (NCV) and electromyography (EMG) are used to evaluate nerve and muscle function. NCV involves placing electrodes on the skin above the median nerve to monitor the speed at which an impulse travels along the nerve. EMG involves placing small electrodes into the abductor pollicis brevis muscle to detect abnormalities that may indicate that the median nerve supplying the muscle is damaged. These tests may reveal delayed nerve conduction in the median nerve. Other diagnoses to consider include inflammation (radiculopathy) of nerve roots C6 and C7 in the cervical spine and compression of the median nerve outside the carpal tunnel. Treatment for carpal tunnel syndrome involves activity modification and rest, splinting, medication (including injection therapy), and surgery. The first line of treatment usually involves resting the wrist and avoiding activity and movement that worsen symptoms. The wrist may be immobilized using a removable splint. For most patients, wearing the splint at night relieves symptoms, and for others, wearing the splint while at work helps. When the condition is work related, a work-site evaluation may be performed. An occupational therapist, physical therapist, or rehabilitation consultant is often able to suggest modifications to relieve the condition. Wrist and body positioning can often be improved using ergonomics (science used to fit a job to a person’s anatomy and physiology). Improving body position, stretching periodically, and changing positions frequently may help alleviate symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxyn may be used to relieve pain. A corticosteroid may be injected into the area around the carpal tunnel to reduce inflammation and nerve compression. Lidocaine (a local anesthetic) may be combined with cortisone to relieve pain. Surgery is another option when other treatment measures fail. Carpal tunnel release involves cutting the transverse carpal ligament to relieve entrapment of the median nerve. It is usually performed on an outpatient basis, using local, regional, or general anesthesia. Carpal tunnel release can be performed as open or endoscopic surgery. In open surgery, an incision is made through underlying tissue in the palm of the hand to reach the carpal ligament. In endoscopic surgery, a smaller incision is made in the wrist and an endoscope is used to locate the carpal ligament. Surgical instruments are inserted through the incision or through a small incision in the palm and the ligament is cut. Recovery usually takes 3 to 12 months. If compression has caused permanent nerve damage, carpal tunnel release surgery may not be effective. Complications associated with the surgery include the following: • Adverse reaction to anesthesia
A much newer and much less invasive technique is percutaneous ultrasound guided release. In this technique, a small needle is inserted using local anesthetic and using ultrasound guidance multiple small holes are made in the flexor retinaculum (the tough fibrous roof over the carpal tunnel that compresses the median nerve). At the same time, fluid is injected to spread and weaken the fibers. At the end of the procedure, the wrist is flexed (bent) and the weakened retinaculum is released. A splint is applied and the patient has full use of their hand by the next day.
Nonsurgical and surgical treatment for carpal tunnel syndrome relieves symptoms in approximately 90% of cases. Approximately 1 percent of individuals with carpal tunnel syndrome develop permanent injury. The majority recover completely and can avoid reinjury by changing the way they do repetitive movements, the frequency with which they do the movements, and the amount of time they rest between periods when they perform the movements. Most people with CTS recover completely and can avoid re-injury by changing the way they do repetitive movements, the frequency with which they do the movements, and the amount of time they rest between periods when they perform the movements. Approximately 1 percent of individuals with CTS develop permanent injury.
A study that directly addressed the issue of prognosis…
Carpal tunnel syndrome--course and prognosis. Muhlau G, Both R, Kunath H.
In a retrospective study 157 patients with electrophysiologically proven carpal tunnel syndrome (CTS) were followed up. Of the 85 operatively treated patients, 86% showed clear improvement or cure, as did 32% of the patients not operated upon. Multivariate analysis of variance (MANOVA) and linear discriminant analyses indicated atrophy and length of history as effective predictors of clear improvement. The optimized discriminant point was ascertained in the receiver operator characteristics (ROC) curve. A predictive value of positive test of 0.89 was found for the course form "not cured" and a predictive value of negative test of 0.75 for the course form "cured" with a prevalence of one-third for the good course form. The prognosis was bad if atrophy occurred or the history exceeded 7 months. The determination of distal motor latency is indispensable for diagnosing CTS. For prognosis, however, length of history and clinical findings have been more helpful.
Maintaining proper posture, body position, and technique when performing repetitive wrist movements may help to prevent carpal tunnel syndrome. It is important to relax, move around, and change positions frequently when performing any one task for an extended period of time. See your physician as soon as possible after symptoms develop.
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