Q&A With Dr. Zhang

By: Dr. Andrew Y. Zhang MD.

“I have heard about Carpal Tunnel Syndrome, and often have pain in my hands and wrists. Can you tell me specifically what is Carpal Tunnel Syndrome and the causes?” Carpal Tunnel Syndrom, CTS

Carpal tunnel syndrome, or CTS, is very prevalent, affecting one in twenty people. The classic sign of carpal tunnel syndrome is waking up at night with numbness and burning pain in the affected hand, prompting the patient to shake his/her hand in an attempt to alleviate the discomfort. There are many other signs and symptoms of CTS, ranging from the pain of hands and wrists, sometimes traveling all the way up the shoulders, to a weakness of grip and pinch. CTS may involve both hands in 60% of the patients.

CTS is caused by excessive pressure over the median nerve in the middle of the patient’s palm. The increase in pressure is caused by swollen tendons. Although traditionally overuse of the hand is thought to be the main factor leading to tendon swelling, studies showed that this physiologic change is likely multifactorial.

Treatment of CTS begins with a simple carpal tunnel splint, available at most drug stores. If symptoms do not improve or resolve in the next 3-4 weeks, one should seek help from a hand specialist.

Surgical release of the carpal tunnel is needed when conservative therapy fails. Without surgery, ongoing damage to the nerve will lead to permanent numbness of the thumb, index and middle fingers, as well as a loss of muscles in the thumb, leading to a much weaker grasp and pinch.

Carpal tunnel release surgery is highly successful. Most patients no longer wake up from discomfort related to Carpal tunnel on the first night after surgery. There are two main techniques, open and endoscopic. Many studies have compared the two and found similar safety and efficacy profiles. I prefer the endoscopic technique, in most of my cases, because of the resulting smaller scar, shorter operative time and quicker recovery. Patients are allowed to use their hand immediately following surgery but should avoid lifting anything heavier than half-gallon of milk for 3 weeks.

Interesting Fact: The endoscopic release technique used by most hand surgeons in the United States, including myself, was invented by Dr. John Agee, a Texas native born in Texas City!