Topic: Carpal Tunnel Syndrome

Greetings colleagues,

Welcome to the Hands-On The East Bay Newsletter, summarizing key topics in hand surgery for providers in the front lines. I'm Dr. Jesse Dashe, an orthopedic hand surgeon at the East Bay Hand Medical Center.

Question:

What is carpal tunnel syndrome?

Answer: 

Carpal tunnel syndrome (CTS) is the compression of the median nerve as it passes through the carpal tunnel in the wrist. This causes numbness, tingling, and weakness in the thumb, index, middle finger, and radial half of the ring fingers.

Question:

What are the symptoms of CTS?

Answer: 

Symptoms include:

• Numbness/tingling in median nerve distribution (thumb, index, middle, and radial ring fingers)

• Pain in hand/wrist, especially at night

• Shaking out the hand

• Weakness with gripping

• Clumsiness of hand

Question:

How is CTS diagnosed / what to get when referring a patient?

Answer: 

• CTS is typically diagnosis based on symptoms and exam. The CTS-6 criteria can help make the diagnosis:

1. Numbness/tingling in median nerve distribution (thumb, index, middle, and radial ring fingers)

2. Nocturnal symptoms

3. Thenar atrophy and/or weakness

4. Positive Phalen's maneuver

5. Decreased sensation in median nerve distribution on 2-point discrimination (<5 mm)

6. Positive Tinel's sign

• It can be helpful to order electrodiagnostic studies but this is not mandatory. It can be used to confirm and measure carpal tunnel severity or in cases of uncertain diagnosis.

Question:

How is CTS treated?

Answer: 

• Start treatment by splinting the wrist in a neutral position to be used at night but can be used during the day

• Steroid injections into the carpal tunnel

• Surgery to release transverse carpal ligament if the above fail or in severe cases

Please feel free to reach out if you have any questions or would like to refer any patients. You can refer patients at handreferral.com or by using this link:

If you need to reach me directly, please respond to this email or email me at [email protected].

Please contact me so I can come by your facility to meet face-to-face and/or give presentations, splinting sessions, etc.

Lastly, let me know if you have any other hand topics you would like covered in the future!

Sincerely,

Jesse Dashe, MD