Hands-on help for carpal tunnel syndrome

When it comes to carpal tunnel syndrome (CTS), yes or no? 

• Repetitive hand and wrist activities required by your job can be blamed for a larger percentage of cases of CTS.

• Aches and pain of the hands and wrist are almost always attributable to CTS.

• Surgery is usually the only option for treating CTS.

• CTS surgery is often unsuccessful and can lead to significant lost time from work.

 If you answered affirmatively to any of these statements, then read on to learn the facts.

Symptoms of carpal tunnel syndrome are specific and telltale. They begin gradually, worsen over time and involve a persistent burning, tingling or numbness in the fingers, vague pain in the wrist and forearm and decreased hand strength, due to compression — a pinching — of the median nerve, which runs from forearm to hand through the narrow, rigid carpal passageway on the wrist’s palm side. The nerve shares that tunnel with nine tendons, which control flexing of fingers and thumb, whose roof is a broad ligament called the ransverse carpal ligament.

Constant use of fingers, hands or wrists, such as long hours of typing on a computer keyboard or performing carpentry, painting, food preparation and similar functions, may aggravate a CTS condition already present, although research has not determined any definitive cause-effect relationship between repetitive work and CTS. In most instances, musculoskeletal aches and pains that workers develop on the job are just that — aches and pains.

Risks for CTS are multiple.They include:

• Age: The reported average age of CTS patients is between 40 and 50 years old.

• Gender: Women are three times more likely than men to experience CTS. The higher risk is attributed to females’ anatomically narrower wrist channels through which the median nerve travels and the disorder’s suspected relationship to metabolic and hormonal-level changes during pregnancy and menopause.

• Heredity: CTS can run in families.

• Wrist injury

• Underlying medical conditions like rheumatoid arthritis, diabetes and a dysfunctional thyroid.

CTS is like a leaky faucet. Delaying repairs only makes the problem worse. If untreated, CTS symptoms can increase in duration and intensity, eventually making it difficult for patients to form a fist or coordinate their fingers in order to do simple tasks like buttoning a shirt or blouse, tying shoelaces or holding a fork. The condition may even result in permanent nerve damage and wasting of hand muscles, particularly at the base of the thumb.

Contacting orthopedic specialists experienced in advanced treatment techniques for disorders of the upper limbs is imperative if a person suspects he or she may have CTS. Before making a diagnosis, the specialist will run several simple tests, such as imaging diagnostics to find signs of arthritis or abnormal wrist issues that can cause pressure on the median nerve. Wrist injuries such as fractures or ligament lesions can be associated with CTS, so in many cases the hand specialist will address the potential pinched nerve at the time of the procedure for trauma. 

Confirmation of CTS does not automatically mean surgery. For milder cases, recommended therapies tend to be conservative, involving wearing of wrist splints (mostly at night), taking anti-inflammatory medications and/or receiving an injection of corticosteroid. Physical or occupational therapy has been shown to alleviate certain symptoms but not cure the condition.

If surgery does prove necessary, newer techniques, including a breakthrough procedure called endoscopic release, are proving truly effective in permanently resolving the condition. The goal, of course, is to relieve pressure on the nerve by simply dividing the offending ligament tissue that is cramping it. The ligament simply reforms but with a much larger tunnel diameter, as much as 40%, according to some MRI studies published.

In standard open CTS surgery, performed in an outpatient setting under local anesthesia, the specialist divides the ligament tissue that serves as the roof of the carpal tunnel to increase space in the wrist canal. With an endoscopic approach, the surgeon will divide the carpal tunnel ligament through a tiny cut in the crease of the wrist without making a larger, open incision. The end result is the same, but the endoscopic technique simply allows a much faster return to work, play or sports. Indeed,, most office work can be done within days of the procedure and even surgeons have returned to the OR in well under a week after endoscopic release. 

Either way, most patients recover very quickly, despite the myths and urban legends that abound. One of my patients who underwent endoscopic CTS procedure was back on her computer at work within 90 minutes following surgery. Many orthopedic practices, like OrthoNOW, offer one-stop care — from diagnosis to treatment to instructional rehabilitation.

CTS cannot always be prevented, but risks and symptoms may be reduced. Here are some tips:

• Be cautious of hand position during sleep. Wrist flexion (bending) typically occurs during REM sleep (dreaming) therefore using a night splint will avoid that and minimize painful night symptoms. 

• Taking vitamin B6 has had some protective effects in early stage nerve compression.

• Relax your grip on tools, pens or other items and take frequent breaks, allowing the fingers to stretch and extend fully.

• Keep hands warm in a cold environment. Cold hands are a risk factor for CTS.

• Practice good posture. Hunching places strain on arms, wrists and hands. Avoid bending wrists too much in either direction (full extension or flexion).

• Take breaks when doing prolonged activities with hands or wrists.

Alejandro Badia, M.D., is a hand and upper-limb surgeon and founder of the Florida-based Badia Hand to Shoulder Center and OrthoNOW, a walk-in orthopedic care clinic in Miami. For more, visit drbadia.com and orthonowcare.com. 

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