Carpal Tunnel Syndrome
What is Carpal Tunnel Syndrome (CTS)?
Carpal Tunnel Syndrome is the compression of the median nerve at the wrist.
What are the symptoms of Carpal Tunnel Syndrome (CTS)?
Numbness, tingling and/or pins and needles in the thumb, index finger, middle finger or ring finger (NOT the small finger) are the highlight symptoms of CTS. Many people also have an achy or painful wrist on the palm side of their hand. A few patients feel the numbness/tingling sensation move up their arm, even to their shoulder (< 5%). As the symptoms and problem worsen, the frequency and intensity of the numbness/tingling worsens and at some point may become constant.
When, and how often, do most people experience Carpal Tunnel symptoms?
In the beginning, symptoms tend to come and go. When the Carpal Tunnel Syndrome worsens, symptoms become more frequent and they may become constant.
With periodic symptoms, many notice numbness/tingling/pain
- at nighttime, possibly waking them up from sleep
- in the morning upon awakening
- while using a hair dryer
- while driving
- while performing manual tasks
- with extended typing or writing
What do people notice when their Carpal Tunnel symptoms get worse?
As symptoms worsen over time there is a sense of clumsiness and weakness of the hands and patients complain that they drop things. People say that their ability to perform fine or exact movements of their fingers decreases. They report that their hand writing deteriorates, buttons and zippers become harder, and grasping objects becomes more difficult.
The numbness, tingling and/or pins and needles feeling becomes more frequent to the point that it is present to some degree all the time and may worsen based on activities and/or hand position.
How do I know if my Carpal Tunnel Syndrome is work related?
A thorough history and physical examination is the beginning of the process to evaluate this question. There are many factors that can contribute to any condition, including Carpal Tunnel Syndrome. After discussing the history of your symptoms, your medical and surgical history, and the details of your working history and circumstances, we will be able to determine if your symptoms are work related.
What if my ring finger and little finger get numb or tingly as well or if they are the only fingers to get numb or tingly?
You may have another condition called Cubital Tunnel Syndrome. The ring finger and small finger are controlled by a different nerve, the "funny bone" nerve or Ulnar Nerve which is located on the inside of the elbow. Cubital Tunnel Syndrome has separate and different treatments than those described here for Carpal Tunnel Syndrome.
What are the steps in treating Carpal Tunnel Syndrome (CTS)?
The Hand to Shoulder Center's physicians always consider a conservative or non-operative approach first.
The first step in treating CTS is to perform a formal examination to confirm that your problem is CTS and not something else. All too often the label of "Carpal Tunnel Syndrome" is placed in error on other conditions. An incorrect diagnosis will delay appropriate treatment of your actual problem.
The second step is to reduce activities that you know aggravate your symptoms.
The third step is to try an anti-inflammation and arthritis medication like Advil or Aleve in an effort to reduce swelling in the wrist. Only use these medications if you and your regular doctor know they are safe for you.
The forth step is to prevent your wrist from folding or flexing while you sleep by wearing a Carpal Tunnel Splint. Some people also find relief wearing these splints with daytime activities, such as extended driving.
The fifth step is to consider a steroid injection. Many people find relief with this painless steroid injection and some patients gain permanent relief.
The final step, if all the above steps fail, is surgery. The goal of the surgery is to remove pressure from the compressed nerve much like taking pressure off a garden hose.
What is surgery all about? I heard that there are several ways to perform the surgery.
The goal of surgery is to remove pressure off of the Median Nerve at your wrist to allow your body to begin to heal itself; like taking pressure off of a garden hose that will allow water to pass again.
There are two major ways to accomplish the goal of removing pressure off of the nerve: open carpal tunnel release and endoscopic carpal tunnel release. At the Hand Center of Waterbury we perform both styles of surgery but we highlight the endoscopic technique.
The Open Carpal Tunnel Release technique uses a 1 to 1 ½ inch incision in your palm. This area of skin tends to be much more sensitive for a longer period of time than the area of skin that is used in the endoscopic technique. As research has shown at the end of a year, the hand treated with an open carpal tunnel surgery technique generally feels the same as one treated with the endoscopic technique. Our patients have taken up to 6 to 12 weeks to return to the majority of their activities after having the open procedure.
The Endoscopic Carpal Tunnel Release technique, which we highlight, is for some reason also called "Laser" surgery by the public although there is no laser involved. For this technique, we use a very small incision on the palm side of your wrist, just up from the wrist crease, away from were you grasp objects. We are able to use this small incision because we use a telescope or Endoscope to perform the procedure. There is no incision in the palm. Most patients report very little post-operative pain from this procedure and most patients take just 2-3 pain pills for the entire post op course. Our endoscopic patients report a shorter recovery for simple and complex activities of daily living and are able to use their hand the very night of surgery for light activities such as eating and dressing. Within several days a patient that has had the endoscopic carpal tunnel procedure will be able to perform light typing and writing. In three to four weeks post-operatively, most patients feel little in the way of restrictions.
(Reference: Trumble TE, et al. Single-portal endoscopic carpal tunnel release compared with open release : a prospective, randomized trial. J Bone Joint Surg Am. 2002 Jul;84-A(7):1107-15.)
Is there a role for occupational or physical therapy to prevent surgery?
In some cases, patients report that occupational or physical therapy may help in reducing the symptoms of carpal tunnel syndrome. However, there is limited research data to support whether therapy interventions have long term curative effects for carpal tunnel syndrome.
I have heard a lot about non-traditional treatments for CTS including LASER treatment, acupuncture, and Vitamin B or other supplement therapy. Do they work?
While a variety of treatments, vitamins and supplements help a few patients, these treatments have not been studied or proven helpful in the mainstream, peer reviewed Orthopaedic and Hand Surgery literature.
How common is CTS?
Carpal tunnel syndrome is reported to occur in 0.5 to 10% of the general population and as much as 15% in high risk groups. Females are more prone with a Female:Male ratio of 2:1 to 3:1. The peak age for CTS is 45-60 years old.
Risk factors for carpal tunnel syndrome include:
- diabetes (15-30% of carpal tunnel syndrome patients)
- pregnancy (about 50% of pregnant women experience some carpal tunnel syndrome symptoms)
- kidney disease
- inflammatory arthritis such as Rheumatoid Arthritis
- acromegally (gigantism)
- being female
- some unknown genetic factors
- advancing age
- some occupational exposures
Can Carpal Tunnel Syndrome come back?
Yes, but rarely. At the Hand Center of Waterbury, our recurrence rate after complete relief is less than 1%.