Lymphedema and Carpal Tunnel Syndrome

Introduction

The median nerve passes through the carpal tunnel.

Carpal tunnel syndrome (CTS) occurs when the median nerve, which runs from the forearm into the hand, is pressed or squeezed at the wrist. Rather than being a problem with the nerve itself, this condition is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel. One of the causative factors is the swelling of lymphedema of the arm.[1]

Symptoms of Carpal Tunnel Syndrome

CTS occurs when the median nerve is pressed or squeezed at the wrist where it passes through the carpal tunnel.

• This can cause symptoms that include: pain, tingling, numbness, and weakness that radiates up the arm. [2]
• Other contributing factors include injury to the wrist, arthritis, diabetes, and swelling due to lymphedema.
• In the past this condition was associated with repetitive motions, such as computer keyboarding; however, there is little clinical data to prove this theory.

The Diagnosis of Carpal Tunnel Syndrome

A physical examination of the hands, arms, shoulders, and neck can help determine if the patient's complaints are related to daily activities or to an underlying disorder and can rule out other painful conditions that mimic carpal tunnel syndrome.

• The wrist is examined for tenderness, swelling, warmth, and discoloration.
• Each finger should be tested for sensation. 
• The muscles at the base of the hand should be examined for strength and signs of atrophy.
• Routine laboratory tests and X-rays can reveal diabetes, arthritis, and fractures.
• It is often necessary to confirm the diagnosis by use of electrodiagnostic tests. These can include Electromyography which is a nerve conduction study. In this test, electrodes type needles are placed through the skin and into the muscles of the hand and wrist. 

 If you have lymphedema electromyography is not usually recommended because this test involves inserting a fine needle through the skin and into a muscle.

The Treatment of Carpal Tunnel Syndrome

• Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms, and immobilizing the wrist in a splint to avoid further damage from twisting or bending.
• If there is inflammation, applying cool packs can help reduce swelling.
• A wrist support splint should not interfere with lymphedema treatment in this area.
• Oral drugs such as nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and other nonprescription pain relievers, to ease symptoms; however, some of these drugs are known to increase swelling. Some physicians recommend diuretics to decrease swelling. 
• Corticosteroids are sometimes injected directly into the affected joint.  Some Corticosteroids, such as prednisone, can be administered orally.
• If you have lymphedema, it is usually recommended that you avoid any injection in the affected area because this causes a break in the skin.

Surgical Treatments

Carpal tunnel release, which is generally recommended if symptoms last 6 months or longer, is one of the most common surgical procedures in the US. This surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve.

• Open release surgery, which is the traditional procedure used to correct carpal tunnel syndrome, consists of making an incision up to 2 inches in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel. This procedure is generally done under local anesthesia on an outpatient basis, unless there are unusual medical considerations.
• Endoscopic surgery may allow faster functional recovery and less postoperative discomfort than traditional open release surgery. The surgeon makes two incisions (about ½" each) in the wrist and palm, inserts a camera attached to a tube, observes the tissue on a screen, and cuts the carpal ligament (the tissue that holds joints together). Endoscopic surgery is generally performed under local anesthesia and on an outpatient basis. This procedure is effective and minimizes scarring and scar tenderness, if any.

Lymphedema and Carpal Tunnel Surgery

If the joint is affected by lymphedema, it is usually recommended to avoid surgery; however studies have indicated that when necessary, this surgery can be performed successfully.

• It is important to discuss with your surgeon that you have lymphedema. Because of the location of the surgery, you will not be able to wear a compression sleeve during the operation; however, you should make arrangement to restore use of compression as soon as possible.
• You should also arrange with your lymphedema therapist to have an MLD treatment close to the time of surgery and to wear your compression garment until it is time for surgery.
• Because the possibility of infection is a risk for all patients, and a greater risk for lymphedema patients, discuss with your surgeon the use of antibiotics before and after the surgery.

Post-Operative Recovery

Although symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery can take months.

• Some patients may have infection, nerve damage, stiffness, and pain at the scar.
• Occasionally the wrist loses strength because the carpal ligament is cut.
• Patients should undergo physical therapy after surgery to restore wrist strength. Some patients may need to adjust job duties or even change jobs after recovery from surgery.

The Recovery Rate

Recurrence of carpal tunnel syndrome following treatment is rare and the majority of patients recover completely.

References

[1] Centers for Disease Control and Prevention

[2] NINDS Carpal Tunnel Fact Sheet, Nov 2002

[3] Physical Therapy Intervention Following Surgical Treatment of Carpal Tunnel Syndrome in an Individual With a History of Postmastectomy Lymphedema by J.E. Donachy and E.L Christian. Physical Therapy Vol 82 Number 10 October 2002.

[4] Hand Related Disorders Following Axillary Dissection for Breast Cancer by D. J. Bozentka MD, P. K. Beredjiklian MD, et al. UOP Orthopedic Journal Vol. 14 Spring 2001 Pages 35-37.

© LymphNotes.com 2011. This information does not replace the advice of a qualified health care professional.

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Category: Lymphedema and Other Conditions Updated: 2011-09-07