Carpal Tunnel Syndrome

What is carpal tunnel syndrome??

According to the National Institute of Neurological Disorders and Stroke Carpal tunnel syndrome (CTS) occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist.  The carpal tunnel—a narrow, rigid passageway of ligament and bones at the base of the hand—houses the median nerve and the tendons that bend the fingers.  The median nerve provides feeling to the palm side of the thumb and to the index, middle, and part of the ring fingers (although 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 causes the median nerve to be compressed.  The result may be numbness, weakness, or sometimes pain in the hand and wrist, or occasionally in the forearm and arm.  CTS is the most common and widely known of the entrapment neuropathies, in which one of the body’s peripheral nerves is pressed upon.

Symptoms usually start gradually, with frequent burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers. Some carpal tunnel sufferers say their fingers feel useless and swollen, even though little or no swelling is apparent. The symptoms often first appear in one or both hands during the night, since many people sleep with flexed wrists. A person with carpal tunnel syndrome may wake up feeling the need to “shake out” the hand or wrist. As symptoms worsen, people might feel tingling during the day. Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In chronic and/or untreated cases, the muscles at the base of the thumb may waste away. Some people are unable to tell between hot and cold by touch.

The National Institute of Health and National Institute of Neurological Disorders and Stroke has done a great job of describing and detailing CTS, FOR MORE INFORMATION, in a concise and easy to follow format, please visit:

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Carpal-Tunnel-Syndrome-Fact-Sheet#3049_6

Do I have Carpal Tunnel Syndrome?

Dr. David Eisenhauer, Hand and Upper Extremity Orthopedic Surgeon, asks his patients a few general questions:

  1. Do you have numbness or tingling in your hand?
  2. If you do have numbness/tingling, is it painful?
  3. Do you have pain or numbness at night time?
  4. What fingers are affected; the thumb, index, middle and ring, or any combination thereof?
  5. Are the symptoms constant, or do they come and go?
  6. Is the hand weak or clumsy?
  7. Do you have any other medical conditions such as diabetes, hypothyroidism or an autoimmune process going on?

“If I get a ‘YES’ answer to all or most of these questions, then there is a high likelihood that the patient does have carpal tunnel syndrome.” Says Dr. Eisenhauer

Please follow the link below to TAKE THE CARPAL TUNNEL TEST. This is a more formal, computer based test for the diagnosis of CTS: http://www.carpal-tunnel.net/diagnosing/questionnaire/43

Are there Non-surgical treatment options for Carpal Tunnel Syndrome?

Not all patients diagnosed with carpal tunnel syndrome need surgery, here are some “Home treatments” according to Dr. William Seitz at the Cleveland Clinic:
While carpel tunnel syndrome can be uncomfortable or painful, you can treat it at home. The first step to take is to stop the activity that is causing the compression.

“Think about the activities that you think may be causing numbness and pain in your wrist and try to stop or reduce them,” Dr. Seitz says. “You can resume the activity when your symptoms improve.”

Here are five ways you can treat your carpal tunnel syndrome at home:

  • Ice your wrist or soak it in an ice bath for 10 minutes to 15 minutes once or twice an hour.
  • Relieve nighttime pain by gently shaking your hand and wrist or hanging your hand over the side of the bed.
  • Buy a wrist splint at the drugstore to keep your hand properly aligned. It may help to wear the splint at night to keep you from flexing or overextending your wrist while you sleep.
  • Take a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen or naproxen to relieve pain. Take NSAIDs with food and after consulting your primary care physician to make sure there are no medical reasons — such as interaction with other medicines you may be taking — to avoid these pain relievers.

  • Immerse your hand in warm water — with a temperature between 92 and 100 degrees — and gently move or flex your hand and wrist. Do this three to four times a day.

Dr. Eisenhauer offers an additional in-office treatment recommendation, particularly for those patients with mild to moderate carpal tunnel syndrome:

  • “Strong evidence from our American Academy of Orthopedic Surgeons supports the use of corticosteroid injections in the office.”

Or, if you need to really, REALLY immerse yourself in literature, please see the link below to the AAOS CURRENT PRACTICE GUIDELINES for Carpal Tunnel Syndrome. Just be careful, as you may develop carpal tunnel, if you don’t already have it, after reading this 986-page synopsis for Orthopedic Surgeons! (the first 13 pages outline the guidelines)
MANAGEMENT OF CARPAL TUNNEL SYNDROME EVIDENCE-BASED CLINICAL PRACTICE GUIDELINE Adopted by the American Academy of Orthopedic Surgeons Board of Directors

February 29, 2016

https://www.aaos.org/uploadedFiles/PreProduction/…and…/CTS%20CPG_2.29.16.pdf

For additional information regarding Carpal Tunnel Syndrome, or to be seen on-line by a Hand Surgeon, please visit Carpal Tunnel Concierge at  http://www.carpaltunnelconcierge.com or see our “Pricing” tab here at MoonlightOrtho.com and click on the Carpal Tunnel Concierge tab to get started!
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