By: Shilo Urban
By: Courtney Dabney
Have you ever felt a tingling sensation in some of your fingers after typing a few too many emails? Do you find yourself shaking and flicking your hand in the air trying to get feeling back in your fingers when this happens? If the answer is yes to both of these questions, you may suffer from carpal tunnel syndrome.
If you could look through the skin on the palm side of your hand and wrist, you would see a whitish yellow nerve about the diameter of a very thin pencil running right down the middle. This nerve carries impulses to the muscles that move your thumb and first three fingers. (If the symptoms occur in the pinky finger the diagnosis is not carpal tunnel syndrome.) It is called the median nerve because it courses in between two other main nerves. The median nerve runs through a tunnel formed by some curve-shaped bones in the wrist and hand called carpal bones. If the nerve begins to swell within the carpal tunnel, pressure increases and causes the nerve to malfunction. When that happens, it feels like electricity, pain and numbness are running through your hand and wrist.
When I was in kindergarten, I was often instructed to sit with my legs crossed. If I did that long enough, my feet would start to tingle. These sensations are called paresthesias, and they result from prolonged compression to one of the nerves in our arms or legs. My Uncle Dave used to refer to this as having 7-Up in his foot. These symptoms are the same kinds of sensations patients feel when they have carpal tunnel syndrome.
Doing anything with our hands repetitively, such as writing, typing or texting, will cause an overuse of the median nerve and swelling. That is why carpal tunnel syndrome is part of a group of disorders classified as overuse syndromes.
Some of the tests we use to diagnose carpal tunnel are Phalen's test, Tinel's test and the flick test. All involve bending or tapping the wrist in an attempt to increase the pressure in the carpal tunnel. If the symptoms of carpal tunnel syndrome increase or occur during these maneuvers, the result is considered positive. Sometimes we order a nerve conduction study to verify the diagnosis, but usually this expensive test is unnecessary.
There are lots of good treatment options for carpal tunnel besides surgery. The most effective treatment is to determine what overuse actions the patient is doing and adjust accordingly. A good example is texting less for those who text often enough to get carpal tunnel. Another is adding ergonomic devices to a keyboard.
One of the best treatments is a night carpal tunnel splint that looks like a Velcro-secured bowler’s splint. This device keeps the hand cocked back rather than curled in. A lot of us sleep with our hands curled in and underneath us, and this positioning contributes to carpal tunnel syndrome. I have found that this device is effective in most cases of carpal tunnel.
In my 13 years of medical practice, I have performed injections into the wrists of patients suffering from carpal tunnel syndrome only a few times. Although it is effective, for long-term relief it must be combined with decreasing the offending activity causing overuse.
Surgery is reserved only for cases that have been ongoing for a long period time and are not responding to conservative treatments. That being said, the surgical option for carpal tunnel syndrome is very effective and safe. Surgeons now use arthroscopic techniques that cause very limited scar size and allow for a quick recovery. The surgeon's job is to release some of the tissue overlying the carpal tunnel, diminishing the pressure.
Hopefully, you won’t find yourself with this overuse disorder. If you do, you can take advantage of some of these conservative treatment options.
By: Shilo Urban
By: Courtney Dabney