by Sucharu Prakash, MD
Chris Prakash, MD
The “carpal” in carpal tunnel refers to the small bones in the hand and wrist, and the “tunnel” refers to the narrow passageway in the wrist where the median nerve travels. The median nerve controls sensation and movement in the first three fingers of the hand. When this nerve is pinched, we can experience numbness, tingling, weakness or pain in the hand. This is called carpal tunnel syndrome.
We often see people who have had surgery for carpal tunnel, and wonder what caused it, and what can be done to prevent it. It’s a common belief that frequent typing can lead to carpal tunnel syndrome. But this is not true. A 2001 study found that even heavy computer use — up to seven hours a day, did not make people more likely to develop carpal tunnel syndrome. So you cannot blame your job for getting carpal tunnel syndrome!
Any condition that causes swelling or inflammation in the carpal tunnel area can result in carpal tunnel syndrome. Symptoms may be present in one or both hands. Women are three times more likely than men to get carpal tunnel syndrome. Certain conditions such as diabetes, hypothyroidism, gout and rheumatoid arthritis can also increase the risk. Pregnant women are more prone to get this syndrome as well.
Initially, the symptoms of carpal tunnel syndrome can be mild and come and go. As the condition worsens, symptoms may become constant, and pain may even radiate up the arm all the way to the shoulder. Over time, if untreated, carpal tunnel syndrome can cause muscle atrophy (wasting), especially the small muscles around the thumb.
Careful examination by the doctor will often yield the diagnosis. Your doctor may do the “Tinel test” which involves tapping on the median nerve to see if it causes tingling in the fingers, or the “Phalen test”, in which the doctor will have you press the backs of your hands together for a minute to see if this causes numbness or tingling. To confirm the diagnosis, a nerve conduction study or electromyography may be needed to assess the electric activity in the nerve.
Surgery for carpal tunnel is usually used as a last resort. Initial management is usually conservative and involves resting the hand and wrist and wearing a brace to limit movement. Night use is important to prevent the wrist from curling during sleep, which can make your symptoms flare up. Non-steroidal anti-inflammatory drugs such as ibuprofen can also be helpful in reducing pain.
Sometimes, injection of corticosteroid can temporarily reduce inflammation around the median nerve and ease your symptoms. Injection of a local anesthetic such as lidocaine can also relieve symptoms.
If surgery is needed, it’s typically done on an outpatient basis under local anesthesia. The goal of surgery is to relieve pressure on the nerve, and is achieved by cutting the ligament overlying the top of the carpal tunnel. Sometimes the procedure is done endoscopically (using a tiny camera). You may need to wear a wrist brace for a few weeks while you heal, but will still be able to use your hands. Pain and weakness usually resolve within two months after surgery, but it may take six months to a year to recover completely.
Once carpal tunnel symptoms subside, it is important to do stretching and strengthening exercises, and a physical therapist may come in handy. These exercises are important to prevent the return of symptoms.
This information is strictly an opinion of Dr Prakash, and is not intended to replace the advice of your doctor. Dr Chris Prakash is a contributing columnist, and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology. He lives in Paris, TX with his wife and two children, and can be reached at 9037850031, or Sucharu.prakash@usoncology.com
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