Let MetroHealth experts give you a hand in understanding carpal tunnel syndrome.
One of the best things about living in the modern world is that we have technology literally at our fingertips: We type, we text, we swipe, we tap.
What we may not realize is the repetitive motions required by these tasks could have a negative impact on our hands and wrists.
If you’re experiencing tingling or pain in your hands and fingers during the day or pain in your hands and wrists that wakes you up at night, you may be suffering from carpal tunnel syndrome, a condition that compresses the nerve traveling through the wrist.
“It’s a problem you don’t want to ignore,” said Kyle J. Chepla, MD, a surgeon with MetroHealth’s Hand and Upper Extremity Center. That’s because the condition usually worsens over time, making many daily tasks, like driving, more difficult. “Once there is a certain degree of nerve injury, the tingling sensation may never go away completely, and you may have permanent muscle loss and weakness in your hand.”
Fortunately, the Center’s team of specialists offer effective treatment options.
The Cause
The median nerve runs from your forearm to the palm of your hand through a narrow passageway — the carpal tunnel — in the wrist made of ligaments and bones. Sometimes that nerve can become compressed, leading to tingling, numbness or even shooting pain through the hand. This common condition is called carpal tunnel syndrome.
“A lot of people say their fingers feel swollen or fat or like they are touching sandpaper,” said Dr. Chepla. The pain often becomes worse for patients at night, he added, because we tend to sleep with our wrists bent, which can increase pressure on the nerve.
“We don’t really know why people develop the condition, and it may not be associated with repetitive wrist motion as previously believed,” said Dr. Chepla. Some risk factors include:
- Being over 40.
- Pregnancy (which causes a build-up of fluid in the wrist).
- Diabetes.
- Hypothyroidism.
An initial carpal tunnel diagnosis can be made by a primary care provider based on patient complaints and medical history. First level treatment may include nonsteroidal anti-inflammatory drugs (like ibuprofen) and splints or braces to limit movement of the wrist. If symptoms persist, patients are typically referred to a specialist for evaluation.
To diagnose the condition, specialists at the Hand and Upper Extremity Center perform nerve conduction studies and electromyography (EMG) to determine whether a patient’s symptoms are being caused by carpal tunnel syndrome. The EMG assesses muscle fibers’ electrical activity and the severity of damage to the median nerve. This test helps rule out other reasons for tingling in the hands and fingers such as diabetic neuropathy.
The Control
Depending on the severity of the condition, carpal tunnel syndrome may initially be managed non-surgically, including options such as:
- Wearing a splint or brace to keep the wrist in a neutral position.
- Avoiding or limiting activities that trigger symptoms.
- Taking over-the-counter, non-steroidal, anti-inflammatory pain relievers.
- Using prescription steroid injections.
Symptoms of carpal tunnel syndrome don’t always stick around. If it’s related to pregnancy, it may go away after giving birth. If diabetes, weight gain or hypothyroidism is to blame, managing the condition may help to alleviate symptoms.
The Cure
Most often, carpal tunnel syndrome is a progressive condition that will likely require surgery at some point, said Dr. Chepla. “The outpatient procedure takes about 15 minutes from start to finish and can be done with the patient awake or under ‘twilight’ anesthesia,” he said. Here’s what to expect for carpal tunnel surgery:
- Local anesthesia is used to numb the hand and wrist.
- With the patient’s palm up, the surgeon makes a one-inch incision at the base of the hand and repairs the carpal ligament to reduce pressure on the median nerve.
- The surgeon stitches up the incision and places a soft bandage on the wrist, which patients wear for about three days. They can use their fingers right away.
- After being monitored for a short time after surgery, patients go home.
- Pain around the scar usually resolves within six to eight weeks.
- Patients usually notice drastic improvements in symptoms within the first two weeks to several months after surgery, depending on how severe their condition was.
“When done properly, the surgery is very effective,” said Dr. Chepla.
If you’re experiencing symptoms of carpal tunnel syndrome, call MetroHealth’s Hand and Upper Extremity Center at 216-778-HAND (4263) to make an appointment with one of our doctors.
The team is located throughout the community, in Lyndhurst, Middleburg Heights, Westlake, Brecksville and more.
For more locations, visit our Hand and Upper Extremity Center website.
Contributor:
Kyle J. Chepla, MD
Plastic Surgeon
