Carpal Tunnel Syndrome
Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers (although not the little finger), as well as impulses to some small muscles in the hand that allow the fingers and thumb to move.
Symptoms usually start gradually, with frequent burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers. Some carpal tunnel sufferers say their fingers feel useless and swollen, even though little or no swelling is apparent. The symptoms often first appear in one or both hands during the night, since many people sleep with flexed wrists. A person with carpal tunnel syndrome may wake up feeling the need to "shake out" the hand or wrist. As symptoms worsen, people might feel tingling during the day. Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In chronic and/or untreated cases, the muscles at the base of the thumb may waste away. Some people are unable to tell between hot and cold by touch.
Often it is necessary to confirm the diagnosis by use of electrodiagnostic tests. In a nerve conduction study, electrodes are placed on the hand and wrist. Small electric shocks are applied and the speed with which nerves transmit impulses is measured.
Carpal tunnel release is recommended if symptoms last for 6 months. Surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve. Surgery does not require an overnight hospital stay. Many patients require surgery on both hands.
Ulnar Neuropathy
Ulnar neuropathy is an inflammation of the ulnar nerve, a major nerve in your arm that runs down into your hand. It supplies movement and sensation to your arm and hand. Ulnar neuropathy causes numbness, tingling, or pain into the arm and hand on the side of the little finger. The diagnosis is usually confirmed with nerve conduction studies and an electromyelogram (EMG).
The most common indication for surgery is pain. The surgical procedure of choice is referred to as an Ulnar Transposition. As constant stretching and compression of the nerve in the Olecranon notch is the culprit, simply moving the nerve to the topside of the elbow, is often sufficient in stopping pain. This transposing of the nerve will often stop further muscle wasting as well, but any atrophy present in the hand, is generally irreversible.
