Robert M. Szabo, MD
Carpal tunnel syndrome, termed such in 1947, refers to any of the signs or symptoms related to median neuritis, median neuropathy and tardy median nerve palsy. These abnormalities, all of which relate to a compression syndrome of the median nerve at the wrist, are responsible for symptoms of numbness and discomfort of the fingers, particularly night pain. There are three primary treatment modalities: conservative, steroid injections and surgical.
Conservative Therapy — Often successful for mildly symptomatic patients with normal clinical and electromyelographic studies. Treatment consists of:
- Splinting the wrist in the neutral position
- Oral anti-inflammatory medications to reduce synovitis
- Diuretics for edema
- The management of any underlying systemic disease, i.e., hypothyroidism or diabetes mellitus.
Steroid Injections — The majority of patients who have experienced carpal tunnel syndrome for less than 12 months will obtain transient relief from steroid injections. However, only approximately 25% of patients having received injections will remain symptom-free after 12 months. Carpal tunnel injections and splinting are not effective for patients with severe symptoms or symptoms exceeding 12 months.
Surgical — Surgery is indicated without delay for those patients displaying moderate to severe symptoms of: prolonged duration (one-plus year); weakness/atrophy of the thenar muscles; abnormal thenar muscle as revealed by electromyelographic studies; or prolonged distal motor or sensory latencies. It is important to counsel patients that even if symptoms can be relieved via steroid injection, their nerve is in jeopardy.
In this case presentation for the VJO, Dr. Robert M. Szabo, associate professor of orthopaedic surgery, University of California, Davis, provides the viewer a detailed assessment of important anatomical landmarks and structures prior to exposure. With the administration of a regional anesthetic and application of a tourniquet, the carpal tunnel is approached through a longitudinal incision. An ulnar side release of the transverse carpal ligament is completed while maintaining both light rubber-band traction and constant visualization of the median nerve. In addition, Dr. Szabo releases the antebrachial fascia 3 centimeters proximal to the wrist's distal flexion crease.
In interview, Dr. Szabo relates to several issues pertaining to carpal tunnel syndrome surgical management, including: the routine execution of tenosynovectomy, the need for internal neurolysis, the necessity of exploring releasing Guyon's canal, and expectations for the postsurgery patient.
- Gelberman RH, Szabo RM, Mortensen WW Carpal Tunnel Pressures and Wrist Position in Patients with Colle's Fractures Jrnl of Trauma 24(8):747-749, 1984
- Gelberman RH, Szabo RM, Williamson RV, Dimick MP Sensibility Testing in Peripheral Nerve Compression Syndromes– A Human Experimental Study JBJS 65A:632-638, 1983
- Gelberman RH, Redevik BL, Pess GM, Szabo RM, Lundborg GN Carpal Tunnel Syndrome — Scientific Basis for Clinical Care Ortho Clin N Amer January 1988
- Szabo RM Carpal Tunnel Syndrome In: Compression Neuropathies: Diagnosis and Treatment Slack, Inc 101-120, 1989
- Szabo RM, Gelberman RH, Dimick MP Sensibility Testing in Patients with Carpal Tunnel Syndrome JBJS 66A:60-64, 1984
- Total Run Time: 20:35 minutes
- Catalog Number: 3003
- VJO Publication Date: April, 1990