Carpal Tunnel Specialists Near Me

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FAQs:

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome (CTS) is a common neurological disorder that occurs when the median nerve, which runs from your forearm into the palm of the hand, becomes pressed or squeezed at the wrist. You may feel numbness, weakness, and pain in your hand and wrist, and your fingers may become swollen and useless. You might wake up and feel you need to “shake out” your hand or wrist.

The median nerve and the tendons that bend the fingers pass through the carpal tunnel—a narrow, rigid passageway of ligament and bones at the base of the hand. The median nerve provides feeling to the thumb, index, and middle finger, and part of the ring finger (but not the little finger). It also controls some small muscles at the base of the thumb.

Sometimes, thickening from the lining of irritated tendons or other swelling narrows the tunnel and compresses the median nerve. CTS is the most common and widely known of the entrapment neuropathies, in which one of the body's peripheral nerves is pressed on or squeezed.

You can sometimes treat carpal tunnel syndrome at home, but it may take months to heal. Your doctor can recommend treatments. CTS rarely recurs following treatment and home care.

What is Carpal Tunnel Release Surgery?

Carpal tunnel release is a surgery used to treat and potentially heal the painful condition known as carpal tunnel syndrome. Doctors used to think that carpal tunnel syndrome was caused by an overuse injury or a repetitive motion performed by the wrist or hand, often at work. They now know that it's most likely a congenital predisposition (something that runs in families) – some people simply have smaller carpal tunnels than others. Carpal tunnel syndrome can also be caused by injury, such as a sprain or fracture, or repetitive use of a vibrating tool. It's also been linked to pregnancy, diabetes, thyroid disease, and rheumatoid arthritis.

The median nerve and tendons that allow your fingers to move to pass through a narrow passageway in the wrist are called the carpal tunnel. The carpal tunnel is formed by the wrist bones on the bottom and the transverse carpal ligament across the top (or inside) of the wrist. When this part of the body is injured or tight, swelling of the tissues within the tunnel can press on the median nerve. This causes numbness and tingling of the hand, pain, and loss of function if not treated. Symptoms usually start slowly and may get worse over time. They tend to be worse on the thumb side of the hand.

During a carpal tunnel release, a surgeon cuts through the ligament that is pressing down on the carpal tunnel. This makes more room for the median nerve and tendons passing through the tunnel and usually improves pain and function.

Who is More Likely to Develop Carpal Tunnel Syndrome?

Carpal tunnel syndrome usually happens only in adults. You're more likely to develop it if you:

- Are a woman. Women are three times more likely to have carpal tunnel syndrome than men.

- Have a health condition that may affect structures in your wrist.

- Do activities with repeated hand motions.

- Have had a wrist injury.

- Have a close relative who has had carpal tunnel syndromes, such as a parent, brother, or sister.

What Does Carpal Tunnel Pain Feel Like?

You may notice tingling and numbness in the fingers or hand. Usually, the thumb and index, middle, or ring fingers are affected, but not the little finger. You might feel a sensation like an electric shock in these fingers. The sensation may travel from the wrist up the arm.

How Often is Hand Pain Caused by Carpal Tunnel Syndrome?

While carpal tunnel syndrome is a common condition, it has a different set of symptoms from many other sources of hand pain. There are actually several similar conditions that cause hand pain. These include:

1. De Quervain’s tendinosis: A condition where swelling (inflammation) affects the wrist and base of the thumb. In this condition, you will feel pain when you make a fist and simulate shaking someone’s hand.

2. Trigger finger: This condition causes soreness at the base of the finger or thumb. A trigger finger also causes pain, locking (or catching), and stiffness when bending the fingers and thumb.

3. Arthritis: This is a general term for many conditions that cause stiffness and swelling in your joints. Arthritis can impact many joints in your body and ranges from causing small amounts of discomfort to breaking down the joint over time (osteoarthritis is one type of degenerative arthritis).

What Will Happen if Carpal Tunnel Syndrome is Not Treated?

In most patients, carpal tunnel syndrome gets worse over time. If untreated for too long, it can lead to permanent dysfunction of the hand, including loss of sensation in the fingers and weakness. For this reason, it is important to diagnose and treat carpal tunnel syndrome promptly.

Does Carpal Tunnel Syndrome Have a Long Recovery?

Surgery to repair carpal tunnel syndrome does not have a particularly long recovery. The bandage that covers the stitches after surgery can be removed in a few days. The hand can then be used for light activities. Making a fist is encouraged. A full range of finger motion and early symptom relief is usually seen within two weeks after the stitches have been removed. You can usually return to most activities in six weeks. Your return to work depends on factors such as type of work, how much control you have over your work, and workplace equipment.

What is the Success Rate for Carpal Tunnel Syndrome Surgery?

Surgery for carpal tunnel syndrome has a very high success rate of over 90%. Many symptoms are relieved quickly after treatment, including a tingling sensation in the hands and waking up at night. Numbness may take longer to be relieved, even up to three months. Surgery won’t help if carpal tunnel syndrome is the wrong diagnosis.

When the carpal tunnel syndrome has become severe, relief may not be complete. There may be some pain in the palm around the incisions that can last up to a few months. Other after-surgery pain may not be related to carpal tunnel syndrome. Patients who complain of pain or whose symptoms remain unchanged after surgery either had severe carpal tunnel syndrome, had a nerve that was not completely released during surgery, or did not really have carpal tunnel syndrome. Only a small percentage of patients do not gain substantial relief from symptoms.

Is Carpal Tunnel Syndrome Permanent?

No, carpal tunnel syndrome does not have to be a permanent condition. There are a number of treatment options that those diagnosed with this syndrome can use to help relieve any pain they are currently experiencing. This is good news for those who have been recently diagnosed, as well as those who have been living with CTS for a long time. Those who have only a mild case of CTS are encouraged to wear a hand and wrist splint when they are sleeping at night, as this allows the hand to rest, which helps relieve any symptoms.

Those who have more severe cases of carpal tunnel syndrome may benefit from having their doctor give them steroid injections, which give them relief from their discomfort and/or pain. If these two treatment options do not work, then the next step is getting surgery. Carpal tunnel surgery is done under a local anesthetic and only takes anywhere between 10 and 15 minutes to complete the surgery. Those undergoing surgery are able to resume their regular activities within a couple of days.

Does Carpal Tunnel Go Away?

Once carpal tunnel pain becomes apparent, it is unlikely to resolve on its own without taking any action. However, this does not necessarily mean surgery is the only option at Interventional Orthopedics of Atlanta. In early or mild cases of carpal tunnel syndrome, Dr. Williams often recommends conservative treatments first, including physical therapy, splints, stretching, and behavioral modification. While Dr. Williams fully understands the desire to avoid more invasive treatments, it is important for patients to understand that when left untreated, carpal tunnel syndrome can become worse and lead to permanent nerve damage and other complications.

How Long is Carpal Tunnel Surgery?

Generally speaking, this is a short procedure, which is why the surgery rarely takes more than 15 minutes. However, with the preparation, setting up anesthesia (if needed), and everything else that follows, it’s not uncommon for a patient to spend as much as 45 minutes in the operating room.

What is Carpal Tunnel Surgery Recovery Time?

The standard recovery time after carpal tunnel surgery is anywhere from 2 to 6 weeks. However, it might take a full year for your hands to completely recover sensation and for you to regain your old strength. With some post-surgery stretches, you may be able to slightly facilitate the healing process.

What is Carpal Tunnel?

The carpal tunnel is a narrow canal or tube in the wrist. Similarly to a tunnel, you could travel through by car, this part of the wrist allows the median nerve and tendons to connect the hand and forearm. The parts of this tunnel include:

Carpal bones: These bones make up the bottom and sides of the tunnel. They are formed in a semi-circle.

Ligament: The top of the tunnel, the ligament is a strong tissue that holds the tunnel together.

Inside the tunnel are the median nerve and tendons.

Median nerve: This nerve provides feeling to most of the fingers in the hand (except the little finger). It also adds strength to the base of the thumb and index finger.

Tendons: Rope-like structures, tendons connect muscles in the forearm to the bones in the hand. They allow the fingers and thumb to bend.

Anatomy of the Carpal Tunnel

The carpal tunnel is a narrow passageway in the wrist, about an inch wide. The floor and sides of the tunnel are formed by small wrist bones called carpal bones.

The roof of the tunnel is a strong band of connective tissue called the transverse carpal ligament. Because these boundaries are very rigid, the carpal tunnel has little capacity to stretch or increase in size.

The median nerve is one of the main nerves in the hand. It originates as a group of nerve roots in the neck; these roots then come together to form a single nerve in the arm.

The median nerve travels down the upper arm, across the elbow, and into the forearm, then passes through the carpal tunnel at the wrist on its way to the hand and fingers. It separates into several smaller nerves along the way, particularly once it reaches the palm. These nerves allow for feeling in the thumb, index finger, middle finger, and half of the ring finger (the thumb side).

The median nerve also controls the muscles around the base of the thumb.

The nine tendons that bend the fingers and thumb also travel through the carpal tunnel with the nerve. These tendons are called flexor tendons because they flex the fingers and thumb.

What Causes Carpal Tunnel

Most cases of carpal tunnel syndrome are caused by a combination of factors. Studies show that women and older people are more likely to develop the condition.

Other risk factors for carpal tunnel syndrome include:

1. Heredity. This is likely an important factor. The carpal tunnel may be naturally smaller in some people, or there may be anatomic differences that change the amount of space for the nerve — and these traits can run in families.

2. Repetitive hand use. Repeating the same hand and wrist motions or activities over a prolonged period of time may aggravate the tendons in the wrist, causing swelling that puts pressure on the nerve.

3. Hand and wrist position. Doing activities that involve extreme flexion or extension of the hand and wrist for a prolonged period of time can increase pressure on the nerve.

4. Pregnancy. Hormonal changes during pregnancy can cause swelling that results in pressure on the nerve.

5. Health conditions. Diabetes, rheumatoid arthritis, and thyroid gland imbalance are conditions that are associated with carpal tunnel syndrome.

The Warning Signs of Carpal Tunnel Syndrome

Symptoms of carpal tunnel syndrome may include:

1. Numbness, tingling, burning, and pain — primarily in the thumb and index, middle, and ring fingers. This often wakes people up at night.

2. Occasional shock-like sensations that radiate to the thumb and index, middle, and ring fingers

3. Pain or tingling that may travel up the forearm toward the shoulder

4. Weakness and clumsiness in the hand — this may make it difficult to perform fine movements such as buttoning your clothes

5. Dropping things — due to weakness, numbness, or a loss of proprioception (awareness of where your hand is in space)

In most cases, the symptoms of carpal tunnel syndrome begin gradually, without a specific injury. Many patients find that their symptoms come and go at first. However, as the condition worsens, symptoms may occur more frequently or may persist for longer periods of time.

Nighttime symptoms are very common. Because many people sleep with their wrists bent, symptoms may awaken you from sleep. During the day, symptoms often occur when holding something for a prolonged period of time with the wrist bent forward or backward, such as when using a phone, driving, or reading a book.

Many patients find that moving or shaking their hands helps relieve their symptoms.

How Carpal Tunnel Syndrome is Diagnosed

Early diagnosis and treatment are important to avoid permanent damage to the median nerve.

1. Physical exam. Your doctor will examine your hands, arms, shoulders, and neck to determine if your complaints are related to daily activities or to an underlying disorder and to rule out other conditions that mimic carpal tunnel syndrome. Your wrist will be checked for tenderness, swelling, warmth, and discoloration. Your fingers will be tested for sensation, along with muscles at the base of the hand for strength and signs of atrophy.

2. Routine laboratory tests and X-rays can reveal fractures, arthritis, and nerve-damaging diseases such as diabetes.

3. Specific wrist tests may produce the symptoms of CTS.

- In the Tinel test, the doctor taps on or presses on the median nerve in your wrist. The test is positive when tingling in the fingers or a resultant shock-like sensation occurs.

- The Phalen, or wrist-flexion, test involves having you hold your forearms upright by pointing the fingers down and pressing the backs of the hands together. If you have CTS, you should feel tingling or increasing numbness in your fingers within 1 minute. Your doctor may also ask you to try to make a movement that brings on symptoms.

4. Electrodiagnostic tests may help confirm the diagnosis of CTSs.

A nerve conduction study measures how quickly impulses are transmitted along a nerve. Electrodes are placed on your hand and wrist and a small electric shock is applied and the speed with which nerves transmit impulses is measured. In electromyography, a fine needle is inserted into a muscle, and electrical activity is viewed on a screen to determine the severity of damage to the median nerve.

5. Diagnostic imaging also can help diagnose CTS or show problems.

Ultrasound imaging can show an abnormal size of the median nerve.

Magnetic resonance imaging (MRI) can show the anatomy of the wrist but to date has not been especially useful in diagnosing carpal tunnel syndrome.

How to Treat Carpal Tunnel

Treatments for carpal tunnel syndrome should begin as early as possible, under a doctor's direction.  Underlying causes such as diabetes or arthritis should be treated first.

Non-surgical treatments

1. Splinting.  Initial treatment is usually a splint worn at night.

2. Avoiding daytime activities that may provoke symptoms.  If you have slight discomfort you may wish to take frequent breaks from tasks, to rest your hand.  If the wrist is red, warm, and swollen, applying cool packs can help.

3. Over-the-counter drugs.  In special circumstances, various medications can ease the pain and swelling associated with carpal tunnel syndrome. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and other nonprescription pain relievers, may provide some short-term relief from discomfort but haven't been shown to treat CTS.

4. Prescription medicines.  Corticosteroids (such as prednisone) or the drug lidocaine can be injected directly into your wrist or taken by mouth (in the case of prednisone) to relieve pressure on the median nerve if you have mild or intermittent symptoms. (Check first with your doctor if you have diabetes or may be predisposed to it, as prolonged use of corticosteroids can make it difficult to regulate insulin levels.)

5. Exercise. Ask your doctor about hand exercises that might help with pain.

6. Alternative therapies. Yoga has been shown to reduce pain and improve grip strength among those with CTS. Other alternative therapies, such as acupuncture and chiropractic care, have benefited some people with CTS but their effectiveness remains unproved.

7. Vocational or occupational therapy. You may need to learn new ways to perform certain tasks or job skills that will not complicate or worsen your CTS.

Surgery

1. Carpal tunnel release is one of the most common surgical procedures in the United States. It may be recommended when non-surgical treatments are ineffective or if the disorder has become severe. Carpal tunnel surgery involves cutting a ligament to relieve the pressure on the nerve. Surgery is usually done under local or regional anesthesia (involving some sedation) and does not require an overnight hospital stay. Many people require surgery on both hands.

2. Open-release surgery is the traditional procedure used to correct carpal tunnel syndrome. It consists of making an incision up to 2 inches in your wrist and then cutting the carpal ligament to enlarge the carpal tunnel. The procedure is generally done under local anesthesia on an outpatient basis unless there are unusual medical conditions.

3. Endoscopic surgery may allow somewhat faster functional recovery and less postoperative discomfort than traditional open-release surgery but it may also have a higher risk of complications and the need for additional surgery. The surgeon makes one or two incisions (about ½ inch each) in your wrist and palm, inserts a camera attached to a tube, observes the nerve, ligament, and tendons on a monitor, and cuts the carpal ligament (the tissue that holds joints together) with a small knife that is inserted through the tube. Following the surgery, the ligaments usually grow back together and allow more space than before. Your symptoms may be relieved immediately after surgery, but full recovery can take months. You may have infections, nerve damage, stiffness, and pain at the scar. Almost always there is a decrease in grip strength, which improves over time. You may need to modify work activity for several weeks following surgery or need to adjust job duties or even change jobs after recovery from surgery.   

Recurrence of carpal tunnel syndrome following treatment is rare. Less than half of individuals report their hand(s) feeling completely normal following surgery. Some residual numbness or weakness is common.

Risk Factors of Carpal Tunnel Syndrome

A number of factors have been associated with carpal tunnel syndrome. Although they may not directly cause carpal tunnel syndrome, they may increase the risk of irritation or damage to the median nerve. These include:

1. Anatomic factors. A wrist fracture or dislocation, or arthritis that deforms the small bones in the wrist, can alter the space within the carpal tunnel and put pressure on the median nerve. People who have smaller carpal tunnels may be more likely to have carpal tunnel syndrome.

2. Sex. Carpal tunnel syndrome is generally more common in women. This may be because the carpal tunnel area is relatively smaller in women than in men. Women who have carpal tunnel syndrome may also have smaller carpal tunnels than women who don't have the condition.

3. Nerve-damaging conditions. Some chronic illnesses, such as diabetes, increase the risk of nerve damage, including damage to the median nerve.

Inflammatory conditions. Rheumatoid arthritis and other conditions that have an inflammatory component can affect the lining around the tendons in the wrist and put pressure on the median nerve.

4. Medications. Some studies have shown a link between carpal tunnel syndrome and the use of anastrozole (Arimidex), a drug used to treat breast cancer.

5. Obesity. Being obese is a risk factor for carpal tunnel syndrome.

6. Body fluid changes. Fluid retention may increase the pressure within the carpal tunnel, irritating the median nerve. This is common during pregnancy and menopause. Carpal tunnel syndrome associated with pregnancy generally gets better on its own after pregnancy.

7. Other medical conditions. Certain conditions, such as menopause, thyroid disorders, kidney failure, and lymphedema, may increase the chances of carpal tunnel syndrome.

8. Workplace factors. Working with vibrating tools or on an assembly line that requires prolonged or repetitive flexing of the wrist may create harmful pressure on the median nerve or worsen existing nerve damage, especially if the work is done in a cold environment.

However, the scientific evidence is conflicting and these factors haven't been established as direct causes of carpal tunnel syndrome.

Several studies have evaluated whether there is an association between computer use and carpal tunnel syndrome. Some evidence suggests that it is mouse use and not the use of a keyboard, that may be the problem. However, there has not been enough quality and consistent evidence to support extensive computer use as a risk factor for carpal tunnel syndrome, although it may cause a different form of hand pain.

How to Prevent Carpal Tunnel

There are no proven strategies to prevent carpal tunnel syndrome, but you can minimize stress on the hands and wrists with these methods:

1. Reduce your force and relax your grip. If your work involves a cash register or keyboard, for instance, hit the keys softly. For prolonged handwriting, use a big pen with an oversized, soft grip adapter and free-flowing ink.

2. Take short, frequent breaks. Gently stretch and bend hands and wrists periodically. Alternate tasks when possible. This is especially important if you use equipment that vibrates or that requires you to exert a great amount of force. Even a few minutes each hour can make a difference.

3. Watch your form. Avoid bending your wrist all the way up or down. A relaxed middle position is best. Keep your keyboard at elbow height or slightly lower.

4. Improve your posture. Incorrect posture rolls shoulders forward, shortening the neck and shoulder muscles and compressing nerves in the neck. This can affect the wrists, fingers, and hands, and can cause neck pain.

5. Change your computer mouse. Make sure that your computer mouse is comfortable and doesn't strain your wrist.

6. Keep your hands warm. You're more likely to develop hand pain and stiffness if you work in a cold environment. If you can't control the temperature at work, put on fingerless gloves that keep the hands and wrists warm.

What Happens During Carpal Tunnel Surgery

Carpal tunnel release is usually an outpatient procedure, which means that you can go home the same day as the surgery if all goes well. There are 2 types of carpal tunnel release surgery. The traditional method is the open release, in which the surgeon cuts open the wrist to do the surgery.

The other method is endoscopic carpal tunnel release, in which a thin, flexible tube that contains a camera is put into the wrist through a tiny incision (cut). The camera guides the doctor as the surgery is done with thin tools put into the wrist through another small cut.

In either case, here is the general sequence of events in a carpal tunnel release surgery:

1. You will usually be asked to remove your clothing, or at least your shirt, and put on a hospital gown.

2. Typically, local anesthetic is used for this procedure to numb the hand and wrist.

3. In an open-release surgery, the surgeon cuts about a 2-inch incision on the wrist. Then he or she uses common surgical instruments to cut the carpal ligament and enlarge the carpal tunnel.

4. In an endoscopic carpal tunnel release, the doctor makes 2, half-inch incisions. One is on the wrist, and one is on the palm. Then he or she inserts a camera attached to a narrow tube into one incision. The camera guides your doctor as he or she inserts the instruments and cuts the carpal ligament through the other incision.

5. The surgeon will stitch up the incision or incisions.

6. Your hand and wrist will be placed in a splint or bandaged heavily to keep you from moving your wrist.

Once the surgery is done, you'll be monitored for a short time and then allowed to go home. Only in rare cases or complication is an overnight stay needed for a carpal tunnel release surgery.

What Happens After Carpal Tunnel Surgery

Your wrist will likely be in a heavy bandage or a splint for 1 to 2 weeks. Doctors usually schedule another appointment to remove the bandage or splint. During this time, you may be encouraged to move your fingers to help prevent stiffness.

You'll probably have pain in your hand and wrist after surgery. It's usually controlled with pain medicines taken by mouth. The surgeon may also have you keep the affected hand elevated while sleeping at night to help decrease swelling.

Once the splint is removed, you will likely begin a physical therapy program. The physical therapist will teach you motion exercises to improve the movement of your wrist and hand. These exercises will speed healing and strengthen the area. You may still need to sometimes use a splint or brace for a month or so after surgery.

The recovery period can take anywhere from a few days to a few months. In the meantime, you may need to adjust job duties or even take time off from work while you heal. Your doctor will talk to you about activity restrictions you should follow after surgery.

Let your doctor know about any of the following:

- Fever

- Redness, swelling, bleeding, or other drainage from the incision

- Increased pain around the incision

These problems may need to be treated. Talk to your doctor about what you should expect and what problems mean you need to see your doctor right away.

Sources:

NIH

OrthoInfo

Mayo Clinic

Cleveland Clinic

Brain and Spine

IOA

Johns Hopkins

MedlinePlus

OINJ

 

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