Do you wake up with a numb hand or fingers? Do you often have a pins and needles sensation in your hand and wrist? It may be carpal tunnel syndrome, a common orthopaedic condition.
Neil Singh, DO, an orthopaedic surgeon specializing in hand and upper extremity surgery, answers your carpal tunnel questions.
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What Is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is a compression of your median nerve. This is the nerve that runs from the forearm to the palm of your hand. This nerve sometimes gets compressed as it travels through a passageway in the wrist called the carpal tunnel.
The carpal tunnel holds both the median nerve and the tendons responsible for bending some of your fingers. The tunnel sometimes thickens and swells, which irritates the nerve and tendons. This is what causes numbness, tingling, and pain in the hand.
Carpal tunnel syndrome is a common condition, but it sometimes goes untreated.
Where, specifically, do people feel carpal tunnel?
People usually feel numbness and tingling in the thumb, the index and middle fingers, and half of the ring finger.
People tend to notice it when they wake up in the morning. They feel like they have to shake their hands out. Or they feel a pins and needles sensation or even pain.
Why does sleeping impact it?
At night, we are mostly unaware of what we are doing when sleeping. Oftentimes, people sleep with their wrists bent. This causes compression of the nerve, which can worsen symptoms.
Does carpal tunnel tend to get worse over time?
Carpal tunnel syndrome does often worsen over time, and there are different stages. With mild carpal tunnel, you may have some numbness right when you wake up. It can start becoming more frequent during the day.
Eventually, you may start having pain. It may get to the point where it affects the muscles in your hand, making them feel weak or clumsy. Sometimes, people complain they drop items due to numbness or weakness.
Who is at risk for getting carpal tunnel?
It can affect anyone. But people who perform daily repetitive hand activities or operate certain machinery are at risk.
Your risk also increases as you age, and there may be a genetic component, too. Conditions that increase your risk include diabetes, rheumatoid arthritis, and surprisingly, pregnancy.
How does pregnancy increase the risk for carpal tunnel?
There’s a lot of swelling that can happen during pregnancy. The carpal tunnel nerve can become irritated because of this swelling. Wrist splinting can help, and after the pregnancy is over, symptoms usually get better.
What can you do if you work at the computer all day?
Having an ergonomic keyboard can be really helpful. Certain anti-inflammatory medications can help, too. I can also teach people some simple exercises, which may keep the symptoms at bay.
How do you diagnose carpal tunnel?
In order to diagnose carpal tunnel syndrome, I look at the patient’s history and pay attention to what the patient is telling me, which can offer insight. We also do a physical exam, doing different maneuvers with the wrist and the hand.
How Do You Treat it?
First, I talk to patients about the condition and explain it, so that they are better informed. It’s always good to establish a relationship with people.
Our first line of treatment is usually conservative, including night splinting and anti-inflammatory medication. And there are different carpal tunnel exercises that I can show patients whenever they come to the office. We might also try cortisone injections, which can bring pain relief.
What about splinting?
Splinting the wrist at night keeps you from bending your wrist, and it can be very effective. It keeps the nerve from getting repetitively injured at night.
When do some people need surgery?
Carpal tunnel can become a really debilitating problem. After a period of monitoring and conservative treatment, I might recommend surgery, especially if other treatments haven’t helped or the symptoms progress. It is generally not advised to wait until the symptoms are constant or severe, as this can affect nerve recovery and one’s prognosis. We can also order a nerve conduction study to get an objective reading on how badly the nerve is compressed.
Can you describe the carpal tunnel release surgery?
The traditional approach would be an incision through the palm of the hand. But we’ve had good success doing a minimally invasive surgery, through an endoscopic approach. This uses an incision in the wrist, along the crease, which is more hidden.
People like the endoscopic approach because you don’t see the scar as much. People also say they have less postoperative pain and can get back to work more quickly.
Also, depending on someone’s age, we can tailor what type of surgery they might need. If they are unable to have anesthesia, we have techniques we can use that don’t require any anesthesia at all.
What’s the Recovery Like?
Recovery can range from two to four weeks, depending on the type of approach, incision, and patient’s lifestyle. The first days after surgery, I let people start moving their hand and fingers. And then I see you in the office in about two weeks to look at the wound.
But I always tell people that nerve recovery is different than the recovery from the wound. Once we take pressure off the nerve, we have to give the nerve more time to recover. So, while you are getting back to the things that you want to do, you may still notice gradual improvement of your carpal tunnel symptoms over time.
At two weeks, people who have the endoscopic approach tend to be ready to return to work, depending on their occupation. People with the traditional approach sometimes are ready to return to work, but sometimes need a little bit of extra time.
What Do You Say to People Struggling With the Idea of Surgery?
People can be miserable, and still think, “There is no way I can have surgery.”
But there are different things that we can do, tailored to what you’re comfortable with. We can do the surgery with minimal anesthesia, or under local only. So just have the conversation with us — don’t wait until the pain is unbearable or symptoms are constant, as we want to avoid long-term nerve issues.
Learn more about orthopaedic care at UPMC Jameson.
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