Carpal tunnel syndrome is a painful and disruptive health condition that often results from repetitive motions like typing, painting or playing a musical instrument. This condition may appear to be only a minor inconvenience for people who have never experienced the pain, numbness or weakness that accompanies carpal tunnel syndrome, but it may become a debilitating condition that requires surgery to correct.
There is an epidemic of carpal tunnel syndrome in the United States. It is estimated that more than 8 million Americans suffer from carpal tunnel syndrome annually, and almost 230,000 surgeries to remedy carpal tunnel syndrome are performed every year. That makes carpal tunnel syndrome surgery the second most common musculoskeletal surgery in the nation.
How to Recognize Carpal Tunnel Syndrome
If you experience numbness, weakness or tingling in your hands, you may be feeling the first signs of carpal tunnel syndrome. This should prompt you to schedule an appointment with your doctor as soon as possible. Like many ergonomic injuries, early medical intervention may prevent a more serious health condition that may require more extreme and costly treatments later.
This condition is well understood by doctors. Your wrist has a variety of bones, tendons and nerves, but it is the median nerve, which controls the fingers and passes through the carpal tunnel, that is injured with this condition. A tendon that attaches to the base of the thumb traverses the carpal tunnel. If the hand is positioned incorrectly repeatedly, this tendon may become inflamed and press on the median nerve, causing pain and other neurological symptoms.
Symptoms of carpal tunnel syndrome include
- Pain in the hand and wrist
- Numbness
- Burning feeling in the fingers
- Electric-like shock in the wrist or hand
- Worsening pain at night
- Intensified symptoms when the wrist is bent
Although the most common cause of carpal tunnel syndrome is repetitive stress, there are other factors that may raise your risk for this condition, including
- Obesity
- Diabetes
- Pregnancy
- Menopause
- Thyroid problems
- Broken or dislocated bones in the wrist
- Genetic predisposition
When to See a Doctor
Naturally, you should always see a doctor if you suspect that you have a condition as serious as carpal tunnel syndrome, but there are some red flags that warrant immediate medical attention. If you experience any of the following, see a physician immediately or visit an emergency room.
- Symptoms continue for two weeks or more
- Persistent symptoms that interfere with sleep or daily tasks
- Atrophy of muscles at base of thumb
- Loss of feeling in your upper arm
If you fail to treat carpal tunnel syndrome early enough, some symptoms could be permanent. This is because the inflamed tendon compresses the median nerve, strangling its blood supply. After a sustained period without oxygen and nutrients, the nerve can become permanently damaged. This leads to permanent numbness and loss of manual dexterity. Chronic pain may also result from lack of treatment.
Treatments for Carpal Tunnel Syndrome
There are many available treatment options for carpal tunnel syndrome, although some are only effective if applied in the early stages of the condition.
- Rest—if you have developed carpal tunnel syndrome as a result of repetitive stress from an activity like typing or manual operation of equipment, then it may be possible to recover merely by avoiding those activities. You should discuss your daily habits with your doctor to determine which motions may be straining your wrist, and how best to modify them.
- Wrist brace—another treatment for mild to severe carpal tunnel syndrome is splinting. You may find wrist splints in local drug stores or your physician may prescribe one for you. Follow your doctor’s directions regarding how long you should wear the splint each day; in some cases, your doctor may recommend that you wear it even while asleep.
- NSAIDs-– Nonsteroidal anti-inflammatory drugs or NSAIDs may help alleviate some of the pain and inflammation that accompanies carpal tunnel syndrome, but drugs like Advil and Motrin do not improve the underlying health issue.
- Corticosteroids—an even more powerful anti-inflammatory is a corticosteroid like cortisone. The more effective steroid therapy is injections rather than oral.
Surgical Options for Carpal Tunnel Syndrome
If your symptoms continue for six months or longer, or worsen even if you are on more conservative treatments, then your doctor may recommend that you consider a surgery to correct the condition. There are two primary options for surgical treatment:
- Open surgery involves a two-inch incision that allows the surgeon to cut the transverse carpal ligament. This incision enlarges the carpal tunnel and decompresses the median nerve.
- Endoscopic surgery is almost identical to the open surgery, but instead of making a large incision, the surgeon makes two half-inch incisions in the wrist and palm. A camera is inserted in one and a cutting device in the other.
In almost all cases, the surgery is performed on an outpatient basis, meaning you should be able to return home that day. Your wrist will be bandaged and splinted for one or two weeks to prevent re-opening the incisions and allow for healing. Your doctor may also direct you to keep your hand elevated—even while sleeping—to limit swelling. Pain symptoms can be managed with medications.
Following the procedure, your doctor should set up an appointment with a physical therapist. The physical therapy program should help expedite healing and re-instill natural wrist mobility. It may take days or months to fully recover from carpal tunnel release surgery, depending on how long your median nerve has been compressed. During this recovery period, you may not be able to take on your normal duties.
You should understand that there are some risks associated with carpal tunnel release surgery.
- As with any surgery, there is the risk of bleeding or infection.
- It is possible that the incision could damage the median nerve or surrounding nerves.
- Scarring may occur.
- There is no guarantee of full recovery even with surgery. A small percentage of patients never fully recover full manual dexterity or normal sensation.
Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care
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