An overview of carpal tunnel syndrome from Dr. Joseph Barmakian, including its symptoms, other conditions which may imitate it, risk factors, how the diagnosis is made and a review of operative and non-operative treatment methods. http://www.summitmedicalgroup.com/

1. Carpal Tunnel Syndrome:
What you need to know…
Presented by:
JOSEPH T. BARMAKIAN, MD
May 9, 2012

2. What is it?
Compression of the
median nerve
at the wrist
Carpal tunnel contains
median nerve
plus 9 flexor tendons

3. Who gets it?
• Adults
• Women 3X more than men
• Diabetics
• Kidney, Thyroid
• Pregnancy
• Assembly line work (& Data entry)

4. How and Why do you get it?
• Most of the time—unknown cause
• Idiopathic =
Doctor is an Idiot +
Patient is Pathetic

5. How and Why do you get it?
• Anything causing increased swelling &
pressure in the tunnel
• Hormonal
• Metabolic
• Trauma
• Inflammation
• Vibration/pressure in palm

6. The Problem
• Most common nerve compression of
upper extremity
• Affects 1% of the population
• 260,000 carpal tunnel releases per year
 250,000 Appendectomies
• 47% of cases are work related

7. Symptoms
Tingling
Pain Numbness
Later: Clumsiness & Weakness

8. Not All Numbness is CTS
• Pinched nerve in neck
• Neurologic disorders
• Other areas of median nerve
compression
• Other nerves (ulnar nerve or radial
nerve)

9. How is it diagnosed?
• **History and physical exam**
• Xrays – only show bone problems
• MRI – usually not indicated
• Nerve tests
• Blood tests

10. Nerve Tests
• Associated problems (pinched nerve in
neck or other neurologic disorder)
• Severity
• Helps to predict prognosis

11. Nerve Tests
• EMG/NCV
• EMG=Electromyogram
 Tests muscles that the nerve controls
• NCV=Nerve Conduction Velocity
 How fast the nerve conducts an impulse

12. Blood tests
• If diabetes, thyroid problems, or
rheumatologic disease are suspected

13. Treatment
• Preventative
• Non-surgical
• Surgical

14. Prevention
• Take breaks/Stretching
• Ergonomic work station at work & home
• Avoid repetitive pressure in palms
• Keep medical conditions under control
(diabetes, thyroid, gout, etc.)
• Watch wrist position

15. Treatment – Non-surgical
• Eliminate cause if possible
• Splint
• Injection of cortisone
• Beware of Snake Oil Salesmen
• ? Vitamin B6
• Don’t wait too long

16. Treatment
• Injection
 Temporary
 Helps sort out diagnosis
 Predictor of relief from surgery

17. Treatment
• Surgery
• Goal is to open the roof of the tunnel by
dividing the carpal ligament
• Open or Endoscopic – debate continues

18. Surgery
• Outpatient
• Local anesthesia with sedation
• Soft dressing
• Drive the next day

19. Recovery from Surgery
• Depends on severity and duration of
compression
• High success rate
• Pain relief – Immediate
• Tingling & Numbness – Up to 6 months
• May have some permanent loss

20. Surgery: Open vs Endoscopic
• ―Open‖ is now ―mini-open‖
• Endoscopic can be one incision or two
incisions

21. Surgery: Open vs Endoscopic
• Both are safe and effective
• Endo, faster recovery, higher risk of
injury and incomplete release
• Open, slower recovery, less risk
• Studies have not shown one method to
be better.
• Same at 6 weeks

22. Summary
• Common – Women > Men
• Cause – Probably hormonal/metabolic
• Diagnosis – Exam, EMG
• Treatment – Splint, Ergonomics,
Surgery
• Open vs. Endoscopic

23. Associated problems
• Trigger fingers

24. For more information
Call (908) 273.4300
Visit: summitmedicalgroup.com
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