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Understanding Carpal, Cubital and Radial Tunnel Syndromes

Every year, thousands of Americans are diagnosed with carpal tunnel syndrome. Similar conditions, such as cubital and radial tunnel syndrome, while not as well-known, are just as prevalent.

In order to understand more about the symptoms, causes and treatments for these conditions, we spoke with Leonid Katolik, MD, orthopaedic hand surgeon at the Philadelphia Hand to Shoulder Center, assistant professor of Orthopaedic Surgery at Thomas Jefferson University School of Medicine and orthopaedic surgeon at Abington - Jefferson Health.

Carpal Tunnel Syndrome

Defined as compression of the median nerve at the wrist, carpal tunnel syndrome has some very specific symptoms to watch out for. The median nerve runs through the forearm to the palm of the hand and gives feeling and strength to the thumb, as well as feeling to the index finger, middle finger and half of the ring finger. “People with carpal tunnel develop numbness and pain in their fingers, which will get worse driving, reading and sleeping,” Dr. Katolik explains.

The causes for carpal tunnel syndrome are unknown, but it can be attributed to a naturally small carpal canal—the tunnel the median nerve runs through—or swelling that occurs after trauma. Simply put, if the carpal canal becomes cluttered or constricted, the nerve is compressed and causes numbness.

Surgery is not the primary solution for carpal tunnel syndrome. Instead, Dr. Katolik suggests wearing a splint at night. “If you give the nerve a rest,” he says, “it can heal itself.” Steroid injections can also provide relief and speed nerve healing in some cases. Surgery is typically required for patients who find only limited or temporary relief from steroids, to make room for the nerve and allow for more effective nerve healing.

Cubital Tunnel Syndrome

Cubital tunnel syndrome refers to pressure in the passageway containing the ulnar nerve where it crosses the inside of the elbow. Compression here causes numbness on the back and pinky side of the hand, as well as pain on the inside of the elbow.

Early detection of cubital tunnel syndrome is critical in preventing long-term problems. “People with severe cubital tunnel syndrome won’t have the strength to grasp things. It impacts muscles we don’t normally think about,” says Dr. Katolik. “For example, people with this condition complain they are becoming uncoordinated—they have trouble shaving or they can’t twist spaghetti on a fork.”

As with carpal tunnel syndrome, there is no definite explanation for what induces this condition, but there are plenty of treatment options available. While the location and anatomy of the ulnar nerve prevents steroid treatment, patients are advised to wear a splint at night to prevent pressure on the elbow. For more severe cases, surgery is encouraged to open the tunnel and alleviate pressure on the nerve.

Radial Tunnel Syndrome

The third most common compression, radial tunnel syndrome, is the pinching of the radial nerve by two muscles in the upper part of the forearm. Occasionally associated with tennis elbow, those suffering from radial tunnel syndrome experience pain in the elbow and forearm, especially with repetitive grasping and lifting activities. Forearm pain is the predominant symptom of radial tunnel syndrome, although occasionally patients will describe numbness in the back of their hand and thumb.

Dr. Katolik says treatment options for this condition are limited. “It will either resolve on its own or it will require surgery to release the constricting muscles,” he details. Physical therapy, anti-inflammatory medications and splinting are all considered treatment options, but if these methods don’t improve the condition it’s an indication that surgery is necessary.

Surgical Rehabilitation

For patients with one of these conditions proceeding with a surgical solution, Dr. Katolik says that the road to recovery can be quick. Typically, patients can start to use their hand immediately. And it’s important to note that the size of the incision does not correlate with recovery time. “In the age of minimally invasive and ultrasound procedures, the goal is no matter the surgery, it should be done safely and completely,” says Dr. Katolik. If you’re experiencing symptoms of numbness, tingling or pain in your hand, wrist or arm, you should consult an experienced hand surgeon for a diagnosis and best course of treatment.

To schedule a consultation, call 215-481-6334 or visit Jeffersonhealth.org/Abington for more information.

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