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Carpal Tunnel Syndrome Identification and Treatment

Dr. Greg Watchmaker, The Milwaukee Hand Center

What exactly is carpal tunnel syndrome? We certainly hear a lot about it and Orthopaedic Hospital of Wisconsin’s Dr. Greg Watchmaker says it is the most common hand problem we treat each year.  Simply stated, carpal tunnel syndrome (CTS) is a pinched nerve (the median nerve) in the palm and wrist area.

How to Identify the Symptoms of Carpal Tunnel Syndrome

The easiest way to identify CTS is to familiarize yourself with its symptoms.  CTS causes numbness in the hand during the day and can awaken you from sleep at night. Observing carefully, you will notice that the numbness involves your thumb, index, and long fingers, but never your small finger. Pain is usually ‘not’ an early problem for sufferers of CTS, but may eventually develop in severe cases.

What Causes Carpal Tunnel Syndrome

There are many misconceptions about carpal tunnel syndrome. One common misunderstanding is that typing or computer work causes the nerve to become pinched. The good news is that scientific studies have shown that keyboard use carries no increase risk for this condition. So key on! In fact, doctors don’t know why most people develop carpal tunnel syndrome; CTS is like arthritis and high blood pressure, which simply becomes more common as we age. We do, however, know that pregnant women and diabetic patients are at greater risk.

Treating Carpal Tunnel

The good news is that carpal tunnel syndrome is very treatable by hand specialists. If you suspect CTS, it’s important to visit a specialist to diagnose and treat the issue before permanent nerve damage is caused.  Early on, wearing a splint on the hand at bedtime helps many patients. A cortisone injection is very effective but also not usually a permanent solution.

For ongoing problems that bother you each day or night, the most reliable and permanent remedy is to make the tunnel slightly larger so that nerve can get its circulation back.

Carpal Tunnel Surgery

So, what do you need to know about carpal tunnel surgery? The good news is that treatments have come a long way in the past 30 years.  The long incisions of the past have been replaced with short incisions which offer a quicker recovery.  The procedure usually only takes 10-15 minutes and involves an inch or so incision in the palm. Using a fiberoptic scope, the procedure can also be performed through an 1/8th” incision though the tunnel doesn’t open quiet as much with this technique. In the past few years, techniques using wires to divide the ligament have also been developed, though most hand specialists are waiting to see the safety and long term outcomes of this method.

The success of carpal tunnel surgery is very age-dependent. Women less than 50 years old report that 99% of their numbness resolves (94% in men). Each decade over 50 sees a slight reduction in the benefit of undergoing carpal tunnel surgery. Even patients in their 90s, however, can still improve their quality of life since awakening with numbness resolves in nearly everyone.

Carpal Tunnel Surgery Recovery Process

No matter the technique, surgery involves only a short time at the hospital and a light hand bandage to go home with. There is no general anesthesia nor overnight stay. A single stitch closes the skin and is removed a week later in the office.

Patients may perform light activities like typing, writing, eating, and dressing independently the day after surgery, however, it may take the patient a few weeks to feel comfortable starting outdoor activities like biking, jogging, and gardening. Full force activities like pull-ups and push-ups can take months to feel comfortable with.

I tell my patients that once they are 2 weeks out from surgery, they may attempt new activities, but should limit themselves to doing only what’s comfortable. Dr. Watchmaker says, “I usually have my patients see a hand therapist one or two visits to learn some home incision line care and exercises.“

If you are living with hand numbness, treatment begins by scheduling a visit with a hand specialist who can confirm that your condition is carpal tunnel syndrome and talk to you about treatments.

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