Question

Carpal Tunnel Syndrome

How do carpal tunnel syndrome and ulnar nerve entrapment differ?

A Answers (1)

  • AAnthony Komaroff, MD, Internal Medicine, answered
    With carpal tunnel syndrome, a large nerve (called the median nerve) is squeezed as it travels through a narrow portion of the wrist (called the carpal tunnel). Common symptoms include pain, numbness and tingling in the fingers and thumb weakness.

    Ulnar nerve entrapment is similar. But in this case, it's the ulnar nerve that's squeezed as it travels along the inside of your elbow or wrist. This nerve is very close to the surface at the elbow. So just leaning on it for a while or a getting a minor injury can cause shooting pain, numbness or tingling down the arm. This is commonly called "hitting your funny bone."

    Nerve entrapment is sometimes related to pregnancy and improves after delivery. Other associated conditions include:
    • Diabetes
    • Rheumatoid arthritis (or other causes of wrist or elbow swelling)
    • Thyroid disease
    • Trauma
    Treatment of these conditions may improve the nerve entrapment.

    Other treatment options include braces or splints, cortisone injections or oral medications (such as anti-inflammatory drugs or medicines for nerve disease such as gabapentin (Neurontin).

    Surgery is usually reserved for people who have troublesome symptoms that are not improving with other treatments.

    Nerve release surgery is a minor operation to make more room for the irritated or injured nerve. For example, with carpal tunnel surgery a surgeon makes a small incision in the wrist and cuts a ligament (the transverse carpal ligament.). This "releases" the median nerve that is being compressed.

    For ulnar nerve entrapment, a similar operation can be performed. Here, the surgeon cuts a ligament in the wrist or elbow to give the nerve more room. Or the ulnar nerve can be moved (a procedure called transposition) so that the nerve is less likely to be compressed. Another option is to remove a bit of bone from the elbow. This is another way to give the nerve more room.

    In general, surgery is a treatment of last resort. The usual indications for surgery are muscle weakness, pain or numbness that do not get better with non-surgical treatments.
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