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CARPAL TUNNEL SYNDROME

Symptoms of Carpal Tunnel Syndrome is the single most common nerve symptom of the hand and wrist, impacting millions of people.

CARPAL TUNNEL SYNDROME

AN INTRODUCTION

Carpal Tunnel Syndrome Symptoms impact as many as 12 million people in the U.S with annual medical expenses in excess of $1 billion dollars. The condition can cause numbness, pain, and tingling of your hand and fingers. At times, the symptoms can also be felt in the wrist and lower arm.

Carpal tunnel syndrome occurs when the main nerve for your hand is squeezed or under pressure. This nerve is called the median nerve and extends from the palm side of your hand up to your wrist and into the lower arm. The median nerve carries sensation for your thumb, index finger, middle finger, and part of the ring finger. The muscles surrounding your thumb are controlled by a branch of this nerve as well.

Signs of carpal tunnel syndrome include numbness, tingling, weakness, and hand pain or wrist pain. Any pressure on the median nerve can cause symptoms as the nerve travels through a small space in the wrist. The small space where the nerve is located is called the carpal tunnel, giving the condition its name. This “tunnel” is a closed space that doesn’t expand much.

Carpel tunnel syndrome symptoms can occur in either hand and over 50% of those effected have it in both hands. Carpal tunnel syndrome often gets worse as time progresses, so early evaluation and treatment from a specialist are important.

Carpal Tunnel Syndrome Symptoms Score

CARPAL TUNNEL SYNDROME RISK FACTORS

There are multiple risk factors in developing carpal tunnel syndrome. Women experience carpal tunnel syndrome three times more often than men. The condition is also diagnosed more often in people who range in age from 30 to 60.

Carpal tunnel occurs more often in people with certain medical conditions. People with diabetes, rheumatoid arthritis, high blood pressure, and thyroid disorders are at an increased risk for developing the condition.

Pregnant women also commonly experience carpal tunnel symptoms because of the extra fluid associated with pregnancy. Some people have naturally smaller carpal tunnel canals and are more likely to experience symptoms because of this.

Patients with injuries to their wrists might be at an increased risk of having carpal tunnel symptoms. Previous fractures or wrist trauma can result in a higher chance of developing carpal tunnel symptoms and hand pain.

Finally, certain lifestyle factors can influence the development of carpal tunnel. If you smoke, eat salty foods, are not active, or are obese, you may be more likely to have carpal tunnel symptoms.

There is increasing evidence that points to repetitive motion activities as a potential factor in developing the syndrome. Typing, playing the piano, construction work, and assembly line work may all contribute to carpal tunnel problems.

CARPAL TUNNEL SYNDROME

DIAGNOSIS

 

A diagnosis of carpal tunnel is made by an assessment of your symptoms and a physical examination. Your specialist doctor may also order tests to determine if the muscles and nerves in your hand and wrist are working properly. A modern method to diagnose carpal tunnel syndrome is to have a physician specialist perform an ultrasound examination of the wrist.

Carpal Tunnel Syndrome Diagnosis OKC

SYMPTOMS OF CARPAL TUNNEL SYNDROME

Symptoms of carpal tunnel syndrome tend to develop slowly. While your symptoms may come and go at first, often the condition progresses and there less time between episodes. As the condition becomes more severe, you may begin to experience continuous symptoms and daily discomfort. The image here shows the typical area of the hand over which symptoms are typically experienced.

Carpal Tunnel Syndrome Symptoms

Classic Carpal Tunnel Symptoms include:

1

Tingling of the hand and fingers

2

Numbness of the hand and fingers

3

Pain radiating from the wrist into the hand or fingers

4

Fingers involved include thumb, index finger, middle finger

5

The ring finger may be involved

6

Pain may travel into the arm or forearm

OTHER SIGNS OF CARPAL TUNNEL PROBLEMS:

Carpal tunnel syndrome can also present as difficulty using your hands. For instance, if you hold something with your arms or wrists bent for a while, your symptoms may become worse.

You may also experience symptoms during your sleep if you tend to have your arms and wrists bent. Many patients say they have to shake their hands to make them return to normal or “wake up” their hands.

Some patients also experience problems with gripping items like an ink pen or a fork. The weakness caused by carpal tunnel can also make it difficult for you to make a fist.

You may feel more clumsy and drop things more often. You may even find it hard to button your shirt.

 

 

CARPAL TUNNEL EVALUATION

Your specialist will evaluate your condition by gathering your medical history and performing a physical exam. In addition, you will benefit from specialized testing including high-frequency ultrasound wrist examination and/or an electromyography (EMG) study of the hands and arms.

 

EXAMINATION OF CARPAL TUNNEL SYMPTOMS

During the physical exam, your specialist will inspect your fingers and hands to determine if you have decreased feeling or more weakness than is normal. It is also important to examine the muscles of your thumb. If your condition is untreated for too long, the muscles of your thumb can begin to waste away and severely weaken.

Your physician specialist may also perform a couple of tests that sometimes bring on the symptoms of carpal tunnel. One is called the Tinel test. In this test, the doctor taps the nerve at the wrist. The other test is the Phalen’s maneuver. In that test, the doctor will have you bend your wrist for up to 60 seconds. If you develop numbness, pain, or tingling in either test, it’s suggestive of carpal tunnel syndrome.

Carpal Tunnel Syndrome Examination OKC

ELECTROMYOGRAPHY (EMG)

To evaluate your condition, your doctor may order an EMG. Electromyography, or EMG, is a test of the muscle function in your arms and hands. This is a useful test because of the ability to measure small changes in small muscle function, often before you notice the changes.

It’s optimal to detect carpal tunnel at an earlier stage. At an earlier stage, you have a better chance of benefitting from less invasive treatments. For example, medical studies report that most people with mild to moderate carpal tunnel disease can resolve symptoms with injection therapy. At a later stage, your condition might be more difficult to treat and surgery becomes more likely.

NERVE CONDUCTION VELOCITY (NCV)

The other test that your doctor will likely order is a nerve conduction velocity study. This test can check the nerves from your neck, to your arm, to your wrist and hand. A problem with nerve conduction indicates the nerve may be under significant pressure or may be injured.

In order to understand this test, think of the nerve as a water hose. If anything is blocking the hose, water won’t flow well. The median nerve in the arm and wrist is similar to the hose. If the nerve signal (water) can’t travel down the nerve (hose), your hands and fingers won’t work normally.

ULTRASOUND FOR CARPAL TUNNEL EVALUATION:

MODERN TECHNIQUES

Over the last ten years, advances in ultrasound imaging have continually improved our ability to painlessly take pictures inside the body. The latest generation of high-frequency ultrasound equipment, which is used by our Elite Pain & Health specialists, enables imaging of individual nerves in the wrist.

The median nerve, which is responsible for carpal tunnel syndrome symptoms, is normally less than 3.5 millimeters in diameter or approximately twice as thick as a quarter. Given the small size of the nerve, specialized equipment is necessary to be able to identify and evaluate the median nerve within the carpal tunnel. This method of evaluating the nerve by directly measuring is a very sensitive way to determine if you have carpal tunnel syndrome.

Other advantages of high-frequency ultrasound evaluation of carpal tunnel involve the valuable information that can help in treatment. It is important for you to know that most cases of carpal tunnel syndrome can be treated non-surgically if diagnosed early enough. High-frequency ultrasound guided injection of the carpal tunnel space is a highly effective treatment that we at Elite Pain & Health specialize in providing. In addition, a more advanced technique called median nerve hydro-dissection which can free the nerve from sticking to surrounding tissue.

Carpal Tunnel Syndrome Ultrasound Exam

CONSERVATIVE TREATMENT FOR MILD CARPAL TUNNEL SYMPTOMS

PREVENTION – ERGONOMICS – EXERCISE

The old saying that “an ounce of prevention is better than a pound of cure” is true for many things including preventing carpal tunnel syndrome symptoms. Performing stretching exercises at work, taking frequent breaks, and using proper ergonomics can all be useful in prevention of carpal tunnel.

Ergonomics is about maintaining good posture and proper wrist position to avoid placing unnecessary stress on the body. Ergonomic computer work environments focus on maintaining ideal seat height, keyboard positions, and screen height. Considering the increased use of computers and mobile phones, many healthcare professionals are reporting more patients with significant conditions like carpal tunnel.

WRIST SPLINTS – WRIST BRACES

There is some evidence that utilizing wrist bracing or wrist splints at night can help reduce mild symptoms of carpal tunnel syndrome. Bracing of the wrist is thought to reduce pressure on the nerve by keeping the wrist in a neutral, non-bent position. This thought to limit the pressure within the carpal tunnel because you are unable to bend the wrist in your sleep. The risk of using a splint is very low and therefore commonly used in conjunction with other treatments as needed.

PHYSICAL THERAPY

Due to the low risk and ability to perform exercises at home, physical therapy and associated home exercise programs have helped patients with mild carpal tunnel syndrome improve. In our experience, moderate and more serious cases of carpal tunnel with sustained numbness, tingling, pain, or weakness are not likely to respond as well. However, it can be helpful to use physical therapy in combination with bracing and injection therapy in an effort to maximize response and get faster results.

MEDICATIONS IN CARPAL TUNNEL TREATMENT

NSAIDS - NERVE PAIN MEDS - STEROIDS

 

Ibuprofen and naproxen are examples of NSAIDs used for all types of pain, including carpal tunnel syndrome symptoms. However, limited information is available on using NSAIDs alone for the treatment of CTS. Many, if not most patients, don’t get significant relief when using these medications and there are side effects to consider. In our medical judgement, limited use of NSAIDs as a short term therapy in combination with other conservative treatments above is the primary role of these medications.

Neurontin™ (gabapentin) and Lyrica™ (pregabalin) are nerve pain medications that have been used to treat a variety of chronic nerve pain conditions. There has been some limited success in treating carpal tunnel syndrome with nerve pain medications. One study showed gabapentin had positive effects in doses as low as 100mg per day but 300mg per day worked better. Improvements in both pinch strength and symptom severity were reported with gabapentin.

Oral steroids such as prednisone are often prescribed by primary care providers in an effort to treat symptoms associated with carpal tunnel syndrome pain and symptoms. Many times, a diagnosis has not been established prior to starting these oral steroid medications. We do not recommend taking an oral steroid in this setting due to studies showing limited and short-term relief despite high number of side effects from chronic oral steroid use.

Carpal Tunnel Syndrome Medications

CARPAL TUNNEL INJECTION

Injection therapy for carpal tunnel syndrome is a proven treatment for carpal tunnel syndrome symptoms. Medical research studies show that up to 70% of patients may be able to avoid traditional carpal tunnel surgery. However, many patients are unaware of the option to have this type of carpal tunnel injection treatment. One long term study showed that of all the carpal tunnel patients treated with injection therapy, only a third of patients had a surgery within 5 years of injection.

We provide the most advanced techniques for injection treatment of carpal tunnel in the state. Our physician specialists have years of experience and have provided interventional treatments to thousands of Oklahomans. State-of-the-art high-frequency ultrasound systems allow the visualization of structures smaller than 1 millimeter. Our injection therapies always utilize advanced imaging techniques to improve the safety and outcome of your carpal tunnel syndrome treatment.

 

ENDOSCOPIC CARPAL TUNNEL RELEASE

For the minority of patients that may need to consider surgery due to very severe or serious symptoms of carpal tunnel disease, we work directly with specialty surgeons. This enables us to provide the least invasive surgical approach that enables smaller incisions, less pain, and faster recovery times. The added advantage of having our specialists work with the surgeon enables the opportunity to improved safety for patients with unique carpal tunnel anatomy. For example, patients may rarely have a “bifid” or double nerve anatomy that could predispose to problems if your surgeon is unaware. In order to reduce risks during surgical carpal tunnel release, our specialists can help your surgeon identify this and plan carpal tunnel treatment accordingly.

 

TRADITIONAL OPEN RELEASE

In the U.S. alone, it is estimated that 250,000 traditional carpal tunnel release surgeries are performed every year. This makes it the second most common musculoskeletal surgery with spine surgery being number one. Many of those undergoing surgery may not be aware of the options discussed above.

When an open carpal tunnel release surgical procedure is performed, an incision is made near the base of the palm of the hand. This allow a surgeon to see the structure that is cut which is known as the transverse carpal ligament. After completing the cutting of the ligament, the wound is sewn together with stitches. Most of the time, patients are discharged the same day from the surgical facility. The stitches are removed at 1 to 2 weeks later during a follow up appointment with your surgeon.

Return to work after traditional carpal tunnel release surgery can take up to 6 to 8 weeks. To return to normal use of the hand, you may need several months following this type of open surgery. Unfortunately, if there are any complications with your carpal tunnel surgery, you may need longer times for recovery. In addition, some patients with jobs requiring heavy use of their hands may never be able to resume pre-carpal tunnel workloads.

Due to the challenges of traditional carpal tunnel release surgery, many patients seek non-surgical or minimally invasive treatment options. We recommend exploring all of your treatment options. You should work with a specialty physician group capable of providing the full scope of care for carpal tunnel syndrome.

CONCLUSION

If you have any symptoms of carpal tunnel syndrome, a specialist familiar with evaluation, diagnosis, and treatment can help. The Oklahoma pain management  specialists at Elite Pain & Health have the experience to get you a complete assessment of your condition. We are experience in initial evaluations, ultrasound examination, EMG/NCV studies, and advanced injection techniques. Our specialty physicians provide a full range of care through minimally invasive and endoscopic surgical referral. Our orthopedic surgery colleagues also provide traditional carpal tunnel release procedures for those requiring this form of treatment. Contact our Oklahoma based interventional specialists today for a complete evaluation of your carpal tunnel symptoms.

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