Carpal Tunnel Syndrome / Entrapment Neuropathies Treated by Orthopedic Doctors and Neurologists

Entrapment neuropathies are a group of disorders of the peripheral nerves or the nerves outside of the brain and spinal cord. Information sent to the brain and spinal cord is transmitted through the nerves that move along the upper and lower extremities across a variety of joints.

Entrapment neuropathies occur when the nerves become compressed or entrapped at certain extremities. The most common entrapment is carpal tunnel syndrome.

Carpal tunnel occurs when repetitive wrist motion leads to inflammation and swelling of the flexor tendons of the fingers at the wrist. This swelling causes narrowing of the carpal tunnel, the space in which these tendons and the median nerve enter the hand, resulting in compression of the median nerve at the wrist.

What causes Entrapment Neuropathies?

There are several reasons why entrapment neuropathies may develop including:

• External forces such as repeatedly resting one’s elbows on the arms of a chair or table (ulnar nerve)
• Diabetes
• Genetic Condition – HNPP (Hereditary Neuropathy with Pressure Palsies)
• Overweight
• Tumor

The symptoms of entrapment neuropathies are based on the particular nerve involved. The earliest indication of the disorder may include:

• Pain
• Prickling and tingling sensation
• Numbness
• Muscle weakness

For more chronic entrapment neuropathies, symptoms may include:

• Dry, thin, hairless skin
• Ridged, thickened, cracked nails
• Recurrent skin ulcerations

Nerve conduction studies or electromyography (EMG) may be performed to help diagnose carpal tunnel syndrome or other entrapment neuropathies.

The treatment for entrapment neuropathies is primarily based on the medical condition that is causing the symptoms. For the most common types of entrapment neuropathies, such as carpal tunnel and cubital tunnel syndrome, surgery is recommended to relieve the pressure on the impacted nerve. In other cases, medication may be offered.

Carpal tunnel treatment options include:

• Rest
• Ice
• Modification of risk factors
• Anti-inflammatory medications
• Splinting
• Physical therapy
• Corticosteroid injections

If carpal tunnel symptoms persist, surgical repair may be the best treatment option. The ligament pressing on the nerve is cut to release pressure on the nerve. As the ligament heals, more room is provided for the main nerve. This surgery can be performed either by endoscopic or traditional open surgery.