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Let’s Talk About Carpal Tunnel Syndrome

There are a lot of misconceptions about carpal tunnel syndrome. Thanks to a lot of very well publicized theories many people think that it comes from typing. Yes, there’s a high association of typing and carpal tunnel, but there’s also a high association of typing in 21st century America. I would say that typing and carpal tunnel is most often an association and not a causation. Typing generally does not cause carpal tunnel, but it can somewhat aggravate it.

 

So What is it?

Nerves can be compressed all the way from the central nervous system to the finger tips, but by far the most common place is at the wrist in the carpal tunnel.

Carpal tunnel syndrome is the compression of the median nerve at the wrist. The median nerve gives sensation to your thumb, index, middle, and half of your ring finger as well as strength to the base of the thumb. What happens with carpal tunnel syndrome is you have increased pressure across the nerve at the wrist where it passes under a stout ligament called the transverse carpal ligament. That pressure prevents blood flow and oxygen from getting to the nerve. The nerve then gets irritated and causes the numbness, pain, and tingling that people have.

People often notice symptoms at night. This is because we have the tendency flex our wrist and our elbows while we sleep.  When we flex our wrists it increases the pressure on the nerve.  This prevents oxygen from reaching the nerve, creating irritation.  When the nerve is irritated it causes someone with carpal tunnel syndrome to have numbness, tingling, and pain in their hand.  This is also why, when you wake up with your hands numb and shake them out oxygen is once again able to get to the nerve and the feeling slowly comes back.

Similarly, we also hear people complain about their hands going numb during the day when they are driving or talking on a cell phone.

 

Treatment

There’s been a bit of a change in the last couple years in terms of treatment recommendations for carpal tunnel syndrome. For mild symptoms, we usually recommend night time bracing with neutral braces to keep the wrists from flexing. That will help keep pressure off the nerve and can be effective with mild carpal tunnel syndrome.

Recently, joint guidelines were issued by the American Academy of Orthopaedics, The American Society for Surgery of the Hand, and the Ameican College of Surgeons stating that the evidence is convincing that people with carpal tunnel syndrome do better with a surgical release compared to all other therapies including injections, bracing, therapy or any other kind of intervention.

The surgery itself is a relatively simple procedure. We make a small incision in the palm and release the ligament that sits over the top of the nerve.  The release takes pressure off that nerve and allows easier flow of oxygen to the nerve. The patient then gets closed with stitches and keeps a dressing on it for 3- 5 days. They can start moving their fingers immediately after surgery. I see people back after 2 weeks to get the stitches out. Often, by the first follow up visit and even the night of surgery patients find that the numbness and tingling that was keeping them up at night is gone which is incredible! It’s a simple but life changing procedure for patients. It’s actually one of my favorite procedures to perform because despite its simplicity, it has such a significant and often immediate impact on the quality of life of my patients.

By Dr. James Wilkerson

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