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Healthy Tips

Digging in to Carpal Tunnel Syndrome

When to See a Physician for Wrist Pain

This article originally appeared in Kane County Magazine.

Your hands do a lot: They scroll through your phone, type emails, cook your food and support you when you ride your bike. It’s your wrists that often pay the price.

Carpal tunnel syndrome (CTS) is a common orthopaedic condition that causes pain, numbness/ or tingling in your hands and/or arms.

The carpal tunnel is a hollow passageway in your wrist and forearm, bordered by small carpal bones and a ligament that forms the roof of the tunnel. Your median nerve and the tendons that bend your fingers run through this tunnel. In CTS, either the tissues surrounding the carpal tunnel swell, or the tissues covering your tendons swell. In both instances, the swelling compresses your median nerve, limiting normal blood flow to the nerve. Without normal blood flow, the nerve can’t function properly.

Numbness typically occurs in the tips of the thumb, index finger, middle finger and half of the ring finger. Pain can accompany numbness or tingling, especially as the pressure on your median nerve increases.

Risk factors

  • Family history. Sometimes, smaller carpal tunnels run in the family. While there’s no way of knowing the size of your carpal tunnel from the outside, if someone in your family has experienced CTS, it is possible that you may also be at risk.
  • Improper use or overuse of your hands or wrists. If your job or hobby necessitates use of vibratory tools, requires forceful gripping activities, or requires forceful repetitive wrist movement, you have a greater risk of developing CTS.
  • Pregnancy. Hormonal changes can cause fluid retention, which can make your extremities swell and cause increased pressure on the median nerve.
  • Other diseases. Rheumatoid arthritis, thyroid gland imbalance and diabetes have been linked to CTS.

When should I see a physician about CTS?

If you have numbness, tingling and pain in your hands and/or arms that is constant, or has been coming and going for several weeks, it’s time to consult an orthopaedic physician about treatment.

To detect CTS, your physician will start by talking to you about your lifestyle and personal history. They can then test for CTS through a physical examination to evaluate numbness, fingertip sensation and muscle weakness. An electromyogram/nerve conduction velocity test (EMG/NCV) can be performed to assess the median nerve’s function.

Treatment for CTS

Treatment, as prescribed by your physician, could include:

  • Wearing wrist splints at night to prevent your wrists from bending. This can decrease compression on the median nerve at your wrist, decrease your symptoms and help you sleep better.
  • Rest and remediation of improper or repetitive wrist movement.
  • Cortisone injections into the carpal tunnel to reduce swelling and decrease nerve compression.

If the above methods fail to relieve your CTS symptoms, surgical carpal tunnel release can be very effective. While surgery can’t reverse permanent median nerve damage, it can stop more damage from occurring. That’s why it’s so important for the nerve to be treated before permanent damage occurs from chronic CTS.

The surgery involves incising the ligament overlying the carpal tunnel through one or two small incisions in the palm/wrist. This increases the size of your carpal tunnel to relieve compression on the median nerve, restore normal blood flow, and promote nerve healing to help resolve symptoms. Light use of your hand is permitted immediately following surgery. You will be able to resume full activity in four to six weeks, and there’s a minimal chance of CTS recurrence after surgery.

Thomas W. Kiesler, MD
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