What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome is one of the most common hand issues that Dr. Marjoua encounters and treats in her practice as a board-certified orthopedic surgeon and hand specialist.
Contrary to popular belief, carpal Tunnel Syndrome is not an arthritic problem, nor is it tendonitis. It is a condition of nerve compression, where the median nerve in the carpal tunnel of the hand is compressed by the overlying ligament and results in numbness and tingling. The numbness and tingling are most commonly felt in the thumb, index, and middle fingers. Less frequently patients, however, will feel the numbness and tingling in half of the ring finger and may have associated hand weakness as well.
What causes Carpal Tunnel Syndrome?
There are numerous causes of carpal tunnel. They include:
- Medical conditions such as diabetes which can lead to nerve damage.
- Overuse, including repetitive flexing and use of vibratory tools and heavy equipment.
- Trauma – When patients sustain a severe injury of the wrist that leads to significant swelling in the area where the nerve travels to enter the hand, this can alter the available space and can lead to compression on the nerve. An example of this type of injury to the wrist is a distal radius fracture. Such injuries often lead to a more acute onset of Carpal Tunnel Syndrome.
- Pregnancy is associated with fluid retention that could potentially result in increased pressure in the carpal canal, which results in compression of the median nerve. In some patients, Carpal Tunnel Syndrome goes away after pregnancy. In others, however, it may remain constant, or even disappear only to return later—long after the patient is no longer pregnant.
What are the symptoms of Carpal Tunnel Syndrome?
Symptoms of Carpal Tunnel Syndrome usually start gradually and increase over time.
Symptoms can include:
- Tingling and/or numbness in your fingers and hand. Generally all fingers except the small finger can be affected. Some patients have reported the sensation of an electric shock in their hands. Numbness tends to become more apparent over time and can become constant. Symptoms can present through an array of activities including sleeping, gripping a steering wheel or phone, typing, and simply stretching or reaching—among many other activities.
- Weakness in the hand. Weakness often involves the thumb’s pinching muscles, which are also controlled by the median nerve in the carpal canal.
What fingers are affected by Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome typically presents as numbness and tingling mostly in the thumb, index, and middle fingers, and sometimes half of the ring finger.
Which nerve is compressed in Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome occurs when the median nerve becomes compressed or squeezed. The median nerve extends from the forearm into the palm of the hand and becomes compressed at the wrist.
Can Carpal Tunnel Syndrome be reversed naturally or go away on its own?
Once chronic symptoms become apparent, it is unlikely that Carpal Tunnel Syndrome will resolve on its own. This would place the patient at risk for irreversible damage due to the constant compression of the median nerve.
However, if a patient is diagnosed in a timely manner the symptoms can be treated and potentially reversed.
Additionally, Carpal Tunnel Syndrome caused by pregnancy will often reverse naturally. In general nerve problems do not spontaneously resolve, and progression rates vary from patient to patient.
What will happen with Carpal Tunnel Syndrome is not treated?
If Carpal Tunnel Syndrome is not treated, the continued compression of the median nerve may ultimately result in permanent damage.
Treatment of Carpal Tunnel Syndrome does not necessarily require surgery. Depending on the severity of the case, physical therapy, splinting, activity modifications, and steroid injections may be used in a patient’s treatment plan.
Does ice help with Carpal Tunnel Syndrome?
Ice may provide temporary pain relief, however will not reverse, halt or heal carpal tunnel syndrome.
Does heat help with Carpal Tunnel Syndrome?
Heat may provide temporary pain relief, however will not reverse, halt or heal carpal tunnel syndrome. Heating or the use of a warm paraffin hand bath can help relieve hand stiffness.
Does Vitamin B6 help with Carpal Tunnel Syndrome?
Vitamin B6 has not been proven to help reverse, halt or heal Carpal Tunnel Syndrome.
Can golf cause Carpal Tunnel Syndrome?
Technically, anything that involves repetitive use of the hands, particularly with the type of force that one would need to grasp a golf club, could lead to Carpal Tunnel.
Golf is not a specifically named cause of Carpal Tunnel Syndrome, but the maneuvers and the prolonged activity people experience while playing golf can potentially cause Carpal Tunnel Syndrome in the same way other repetitive activities can.
What are some non-surgical and surgical options to treat Carpal Tunnel Syndrome?
Non-surgical:
Depending on the severity of the case in question, non-surgical options that may be used to manage Carpal Tunnel Syndrome may include:
- Physical therapy including mobilization exercises
- Splinting
- Activity modifications
- Corticosteroid injections
- Symptom management with nerve specific medications
Surgical:
Dr. Marjoua primarily performs an endoscopic carpal tunnel release that is a minimally invasive, camera-assisted procedure which releases the band of tissue around the wrist to reduce pressure on the compressed median nerve. In this procedure, a small incision is made proximal to the wrist, so as not to impact a patient’s hand.
Typically, the procedure is done under local anesthesia and light sedation to ensure a patient’s comfort.
The small incision is closed and protected with a soft dressing before the patient is discharged home.
Can acupuncture help treat Carpal Tunnel Syndrome?
While acupuncture has not been proven to reverse, halt or cure Carpal Tunnel Syndrome, patients may benefit from it for symptom relief as an adjunct therapy in the treatment of Carpal Tunnel.
No studies have demonstrated that acupuncture can cure Carpal Tunnel, thus acupuncture is not advised to be the primary or only treatment option.
Can Carpal Tunnel Syndrome recur after surgery?
Yes, Carpal Tunnel Syndrome can recur after surgery. The causes of Carpal Tunnel recurrence fall into two categories, depending on when the recurrence happens:
1) If the recurrence is in a short-term period after surgery, it may be due to an incomplete release. This means that the ligament was cut, but not all the way—causing the nerve to improve for a period of time. However, as it swells it could become compressed again—causing recurrent symptoms.
While rare, that scenario would require a more immediate return to the operating room to complete the release of the Carpal Tunnel ligament.
2) The more common cause of recurrence involves scar tissue and time. When an incision heals, it forms a scar—on either or both inside and outside walls of the surgical site. If the Carpal Tunnel ligament is released, the body will heal that ligament and may develop enough of a scar bridge that could create the same type of compression of the median nerve that previously occurred.
In that scenario, another surgery would potentially be necessary. Carpal Tunnel Syndrome revision surgeries are mostly performed as open surgeries to minimize the risk of injuring the nerve given the history of prior exposure.
It is important to be evaluated very soon after symptoms begin to recur, as the recurrence of compression could lead to irreversible damage—even if the ligament has been surgically released in the past.
How can a patient sleep more comfortably with Carpal Tunnel Syndrome?
Sleep is one of the most limiting factors involved with Carpal Tunnel Syndrome.
If a patient’s symptoms only tend to occur inconsistently at night, splinting is the best treatment. Splinting keeps the rested wrist in a flat position and prevents the wrist from flexing down, which can put pressure on the median nerve and prompt the symptoms of Carpal Tunnel.
More consistent numbness and tingling would likely call for more extensive Carpal Tunnel Syndrome treatment in order to provide relief and more comfortable sleep.