Getting Relief for Carpal Tunnel
Sonia didn't like the idea of surgery for the pain she was feeling in her wrist, and neither did her doctor. But, in this case, they agreed, it was a wise course.
Carpal tunnel syndrome is one of the most common reasons for surgery in the United States, and it is usually undertaken for severe symptoms that have lasted six months or longer. Like any surgery, it's not to be taken lightly, but the majority of patients have a full recovery and are satisfied with the outcome.
Sonia's symptoms started gradually with occasional burning or tingling feelings in the palm of her right hand, often when she was driving or holding the phone. When the symptoms became more frequent and painful, keeping her awake at night, she saw her doctor.
Carpal tunnel syndrome occurs because of compression of the median nerve as it passes through a narrow passage (the carpal tunnel) in the wrist. This is the main nerve that provides sensation to the thumb, index finger, middle finger and the middle-finger side of the ring finger. And it also has motor functions, controlling muscles that move the thumb, explained Dr. Sanjay Shah, General Surgeon, MMH Surgical Group.
When pressure is placed on this nerve, it results in the symptoms that Sonia experienced-numbness, tingling and pain. In some cases, these eventually extend up the arm to the shoulder (on the palm side). And in advanced stages, the person may develop weakness in the hand, affecting the grasp and sometimes resulting in frequent dropping of objects.
“The space in the carpal tunnel is limited (about the size of a thumb), and pressure can occur from anything that reduces the space even more, including injury, arthritis, hormonal changes, inflammation or fluid retention due to pregnancy or other causes. Some individuals simply have smaller wrists, and women are three times more likely than men to develop carpal tunnel syndrome,” Dr. Shah explained.
Keeping the wrist bent for a prolonged period-such as when typing or playing the guitar-can narrow the tunnel and increase pressure on the nerve. Some persons sleep with the wrist flexed, and symptoms often occur for the first time during the night.
Early Treatment Is Crucial
There are other reasons for pain in the hand or wrist, and tests are usually needed to diagnose carpal tunnel syndrome. In any case, treatment should begin as soon as possible, under the care of a doctor.
If there is an underlying medical condition such as diabetes or hypothyroidism contributing to the problem, then these should be treated first. Inflammation in the wrist should be treated with ice packs and rest from any activity that might have caused or aggravated the problem.
One of the earliest treatments usually is splinting of the wrist to keep it straight and relieve pressure on the nerve. Splints may be used only during sleep or as long as 24 hours a day, if needed.
Non-steroidal anti-inflammatory drugs can treat the inflammation; diuretics can help relieve fluid retention. Once the symptoms have abated somewhat, stretching and strengthening exercises may be recommended, under the supervision of a physical or occupational therapist.
If the symptoms are related to work or recreational activities, changes should be made to reduce the stress-by changing tools or techniques, paying more attention to form or taking more frequent rest breaks. Special ergonomic keyboards may be helpful for persons who spend long hours at a computer.
When mild problems are detected early, these measures may be all that's needed. Except for the diuretics, they're similar to what might be used to treat tendinitis or other soft tissue injuries.
When symptoms are severe and persist for six months or longer, however, there is a danger that the nerve can become permanently damaged or that muscles in the hand may atrophy to the point that normal function may be difficult or impossible to recover.
At this point, the question of surgical versus non-surgical treatment becomes crucial. The American Academy of Neurology recommends non-invasive treatment first. But one study found that 60 to 70 percent of patients treated conservatively still had symptoms after 18 months.
Among conservative options, splinting is the most popular, and about 80 percent of patients report that splints are effective. The greatest benefit, however, probably comes if this treatment is started within the first three months.
Surgery, known as carpal tunnel release, involves severing a band of ligament around the wrist to relieve the pressure. This can be done as traditional "open release" surgery (with a two-inch incision) or through an endoscopic procedure with small surgical tools inserted through two small incisions. Recovery is quicker with endoscopic surgery, but either procedure can be performed on an outpatient basis under local anesthesia,” said Dr. Shah.
Surgery usually results in relief of symptoms caused by compression of the median nerve. About 70 percent of patients report that they are either satisfied or very satisfied with the results.
However, recovery from surgery may take several weeks to several months, and there is a risk of infection, nerve damage, stiffness and pain at the scar. Patients usually need physical therapy to restore strength to the wrist, which may be affected by the cutting of the ligament.
Surgery is never an easy option, and timing is crucial. If problems are detected early and changes are made in lifestyle and work routine, disability from carpal tunnel syndrome can be prevented. When symptoms are severe and persistent, as they were in Sonia's case, prompt surgical intervention may be
For more information or an appointment regarding Carpal Tunnel and treatments, please call MMH Surgical Group at 315-769-4656 and ask for one of the Board Certified General Surgeons: Dr. Shah, Dr. Jose Mejia or Dr. Rosalind Mariano. Additionally, Dr. Bedros Bakirtzian, Board Certified Orthopedic Surgeon treats Carpal Tunnel issues; he can be contacted at 315-769-9908, located at Seaway Orthopedics.