Case Studies

For nearly two years, this female office worker, 45, noticed a progressive loss of grip strength and grip control in her right hand. A tingling sensation was felt in that hand throughout the day at her desk or while out and about. She frequently awoke at night to discover her hand numb.

After 18 months of trying various over-the-counter remedies, the woman took her complaint to a primary care physician. He prescribed night splints and anti-inflammatory medications. These were tried for approximately two months without success. The doctor then referred the woman to us.

A comprehensive evaluation of her hand, wrist, arm and shoulder was made – an evaluation that included X-rays.

Physical examination of her hand made the diagnosis of carpal tunnel syndrome apparent. (Phalen’s test and Tinel’s sign were both positive.)

Since conservative treatment had already failed, we recommended decompression surgery over another available option, that of local corticosteroid injections. The patient agreed and was scheduled for outpatient surgery. The five-minute operation was performed under local anesthetic only. At the close of surgery, the patient’s wrist was  splinted  and bandaged. A brief stay in the recovery area for observation was followed by discharge home. The patient was instructed to continue wearing her bandaging for two weeks in order to protect the surgical site. During those two weeks, the patient was restricted from using the wrist for anything more than light activities. She returned to our office at the end of those two weeks to have the dressing and stitches removed and follow-up evaluation. A wraparound wrist support was prescribed for the next seven days.

Significant symptomatic relief was experienced within minutes after surgery. She was fully symptom-free three days later. The patient regained total use of her wrist within one month.

Data presented at the 2007 meeting of the American College of Rheumatology by researchers from Madrid indicates that decompression surgery produces a better long-term outcome in carpal tunnel syndrome patients than does local corticosteroid injections. Close to one-half of patients opting for injections over surgery experience therapeutic failure within seven years, whereas only about a tenth of patients who have decompression surgery suffer failure in that same time frame, according to the findings. There exists literature proposing a link between repetitive motion and carpal tunnel syndrome. However, we are of the opinion that the evidence of this linkage is still inconclusive. It is not clear, therefore, that this patient could have delayed or entirely avoided the onset of her impingement neuropathy through strengthening and conditioning exercises or other preventive measures. Even though carpal tunnel decompression surgery is a routine procedure here at The Indiana Orthopaedic Center, the approach we take is tailored to meet the wishes and needs of each patient while keeping safety, comfort and satisfaction uppermost in mind.