Carpal Tunnel Syndrome: Common Hand & Wrist Conditions in Columbus & New Albany, OH
By: Dr. AJ Julka
Most people have heard of carpal tunnel syndrome, but not everyone understands how common it is. More than 8 million people each year are diagnosed with the condition.
Learning more about carpal tunnel syndrome, including symptoms to watch for and treatment options, can help you understand your own risk and evaluate treatment options with your doctor.
This condition affects the median nerve, one of the three main nerves involved in hand function and sensation. The median nerve passes from the wrist to the hand through the carpal tunnel, which is a tunnel within your wrist made up of bones and a ligament called the transverse carpal ligament.
Sometimes, thickening of the transverse carpal ligament causes the carpal tunnel to become smaller and compress the median nerve. This compression of the median nerve is carpal tunnel syndrome.
Am I At Risk for Carpal Tunnel?
The transverse carpal ligament thickens as we get older, meaning that aging is a common cause of the condition. Other risk factors include:
- Pregnancy, because fluid gain during pregnancy can compress the median nerve
- Neck problems that involve nerve compression
- Patient factors such as repetitive use during work or hobbies, smoking, diabetes, or higher body mass index.
Although there is higher risk with increased age, many young patients in their 20s, 30s, and 40s can also develop symptoms.
Repetitive work by itself does not result in higher rates of the syndrome. This common misconception may stem from the fact that people who work with their hands — like painters or office workers who use a computer all day — tend to notice symptoms more often and earlier than those who don’t.
Once you have carpal tunnel syndrome, any activity where you use a sustained grip — whether it’s using a sander or driving for long periods of time — increases pressure. So, if you happen to have a job where you use your hands a lot, or if you simply drive a few miles to work, you’ll start noticing symptoms much earlier.
What Does It Feel Like?
The main symptoms of carpal syndrome are numbness, tingling, and pain that primarily affect the thumb, index, and middle fingers. These symptoms may worsen at night, causing you to wake up with a numb, “dead” hand. If you find yourself waking up in the middle of the night to shake your hand awake, you might be experiencing early signs of carpal tunnel syndrome. While the thumb index and long finger are the most common fingers involved its important to realize that some patients can have numbness in their entire hand or even the entire arm.
People with carpal tunnel may also notice dexterity issues with their thumbs and fingers and have trouble completing fine motor tasks.
While numbness is the most common carpal tunnel symptom, some people, particularly patients that are 60 and over, only experience a difficult-to-describe pain in the hand and difficulty with hand use.
Because symptoms can vary, carpal tunnel syndrome can be hard to diagnose without the help of a professional. With the help of a hand and wrist specialist, getting a diagnosis is straightforward.
A hand surgeon will typically take a detailed medical history and perform a complete nerve examination, which may include an evaluation for nerve function, nerve irritability, and any effect nerve compression is having on your hand muscles.
Non-Surgical Treatment Options
Mild cases can often be treated without surgery. Some of the most effective non-surgical treatment options are:
- Wearing a splint (especially at night), which prevents pressure on the median nerve by keeping the wrist in a straight position.
- Cortisone injections to bring down swelling around the nerve, which can be particularly helpful for pregnant women and those in the early stages of the condition.
- Stretching exercises called nerve glides, which can be taught by an occupational therapist.
Surgical Treatment Options
There are 3 main types of surgery used to treat this condition: open carpal tunnel release and endoscopic carpal tunnel release.
- Open carpal tunnel release involves a larger incision of 2-4 inches in size to directly view the transverse carpal ligament and cut it.
- Mini-open carpal tunnel surgery involves a much smaller incision and is performed with the aid of specialized instruments to cut the ligament without cutting as much of the skin.
- Endoscopic carpal tunnel surgery is a minimally invasive version of carpal tunnel release, requiring only a small incision at the base of the hand and leaving almost no visible scarring.
In almost all cases, patients who need surgery should be able to undergo endoscopic carpal tunnel release. People with mild or moderate symptoms are expected to notice near-complete resolution of numbness and tingling within a week or two after surgery.
For more severe patients, it can take up to six months to resolve numbness, although dexterity issues can often improve relatively quickly after surgery.
Every patient’s nerve compression and disease is truly unique. An experienced hand specialist can provide you with the appropriate education about what to expect with your recovery as well as how to choose the appropriate procedure for you.
What can I expect after surgery?
The answer varies based on how your surgery is performed.
In traditional open carpal tunnel release surgery, some patients may have a 2-4 inch incision closed with 10-12 stitches. The larger incisions tend to result in longer times to full recovery and may come with additional restrictions of avoidance of hand use and maintaining a dressing on the hand for 10-14 days.
In mini-open carpal tunnel release, performed for patients with altered anatomy or re-do situations, an incision that is ½ inch in size is made and closed with 1-2 stitches. Patients are allowed to remove dressings at 48 hours after surgery and use their hand lightly the day after surgery.
In patients undergoing endoscopic carpal tunnel release the incision is ¼ inch in size and typically closed with glue. We allow patients to use their hard right away for light activities. Patients remove their dressing the day after surgery, may shower at that time and generally do not have to rebandage the incision. Research studies and our own experience has demonstrated markedly faster recovery times with the endoscopic approach.
Preventing Carpal Tunnel
Unfortunately, there is no surefire way to predict who will develop the syndrome, or to prevent it from happening. The good news is that it can be treated, and catching it early is your best bet for successful management of symptoms.
If you’re having hand or wrist pain, talk to Dr. AJ Julka, hand & wrist specialist at JIS Orthopedics. The sooner you’re diagnosed, the better your outcome is likely to be. You can schedule an appointment today online or by calling 614.221.6331. It’s our goal to help you live without limits!