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What is Carpal Tunnel?

By Dr. Conrad G. Hamilton




Sports Medicine Recovery Journal

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What Is Carpal Tunnel? Carpal Tunnel Syndrome Causes, Treatment, and Prevention

Carpal tunnel syndrome (CTS) is one of the most common nerve conditions in the United States, currently affecting nearly five million workers around the country.

Unfortunately, with the advent of the “digital age” and the rise of computer usage, a misconception has also risen that carpal tunnel is simply the result of typing and poor mouse ergonomics.

However, a recent study has shown that those who frequently use a computer stand no greater risk of developing carpal tunnel syndrome than less frequent computer users.

Nonetheless, many repetitive stress injuries (RSI) like CTS have been linked to regular computer use. So who is at risk of developing this debilitating nerve disorder?

What Causes Carpal Tunnel?

To better understand carpal tunnel syndrome, we first need to break down the anatomy of the forearm, wrist, and hand.

The “carpal tunnel” is a physical channel in your wrist formed by the carpal bones and a series of connective tissues, vessels, fluids.

The median nerve passes through this tunnel.

At times, these fibers and tissues can cause compression of the median nerve in the wrist.

Over time it is possible for this carpal tunnel to become narrowed, leading to continuous compression of the median nerve and, in some cases, median nerve damage.

Repetitive movements, injury, and other factors may increase the risk of median nerve compression and the consequential development of carpal tunnel syndrome.

Some individuals are more likely to develop carpal tunnel than others.

Occupations with more arduous and repetitive arm, wrist, and hand movements may increase your chances.

Did you know that women are also three times more likely to develop carpal tunnel syndrome than men?

It’s been posited that this increased risk may be due to women having smaller wrists and consequently smaller carpal tunnels than men, creating a greater chance of nerve compression.

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How to Tell If You Have Carpal Tunnel: What to Look For

There are many classic carpal tunnel syndrome symptoms and numerous other potential underlying conditions to rule out before considering treatment.

So, how do you know if you have carpal tunnel?

Loss of grip strength and numbness in the thumb, middle, and index finger are hallmark carpal tunnel syndrome symptoms.

Due to this numbness and decreased strength, it’s common for carpal tunnel sufferers to report accidentally dropping objects.

Some individuals may feel a tingling in the fingers as well as hand and wrist pain.

Because many people either sleep on their wrists or sleep with their wrists in a bent position, it is common for patients to take particular note of carpal tunnel symptoms at night due to this compression.

Other conditions such as tendonitis (specifically DeQuervain's tendonitis and tennis elbow), osteoarthritis of the hand, and hand fractures may also produce many similar carpal tunnel symptoms.

For this reason, it’s important to have a board certified hand and wrist surgeon diagnose your condition and then discuss your carpal tunnel treatment options.

Carpal Tunnel Tests

Before utilizing more sophisticated imaging technology, your doctor will first guide you through a series of tests to diagnose the underlying cause of your wrist or hand pain.

For quite some time now, nerve conduction tests have been considered the “gold standard” of diagnostic carpal tunnel syndrome tests.

Median nerve damage is a classic sign of more advanced carpal tunnel syndrome, and delays to the electrical impulses along the median nerve can signify such damage.

To diagnose this, a carpal tunnel nerve conduction test is designed to measure how long it takes a nerve signal to travel along the nerve and reach a muscle.

Your doctor may choose to use multiple carpal tunnel tests (including the Phalen test, reverse Phalen test, and Tinel’s test) for a more accurate diagnosis.

How to Prevent Carpal Tunnel -- A Smarter Workspace

As we always say, prevention is by far the best sports medicine, and this is certainly the case when it comes to carpal tunnel syndrome.

Carpal tunnel is often a workplace-related condition, and there are many proactive measures employers, industry leaders, and employees can take on the job.

First and foremost, wrist and hand ergonomics should be central to all workplace operations.

For example, in certain industrial and manufacturing settings, it’s crucial to ensure employees have the correct tools for the job and are informed on how to properly use these tools.

Accommodations should be made for dexterity purposes to allow left-handed and right-handed individuals access to proper ergonomic hand tools.

Workspaces and tools should allow the hands and wrists to be in a neutral position during operational tasks.

Ergonomic hand stretches should also be used before and after repetitive physical activities.

Carpal Tunnel Treatment -- A Conservative Approach

While carpal tunnel release surgery is commonly used to treat carpal tunnel syndrome, there are plenty of nonsurgical options to choose from.

Carpal tunnel treatments without surgery range from simply avoiding trigger activities to cortisone injections.

Once your specific condition has been properly diagnosed by our hand and wrist surgeons, we will design a plan of action for you.

Avoidance of trigger activities is the first step in conservative treatment, but this isn’t always possible or preferential for many patients.

For more active individuals, avoiding the hobbies they love is simply not an option.

Many sufferers choose to utilize the latest injections for carpal tunnel syndrome when basic anti-inflammatory medications aren't enough to manage carpal tunnel symptoms.

Both cortisone injections and carpal tunnel steroid injections have been shown to reduce swelling in connective tissues.

It’s important to remember that these injections are short-term solutions, and patients will need to return for treatment regularly to minimize hand and wrist pain.

Wrist immobilizers and splints can be used to reinforce the hands and wrists during activity and at night.

These carpal tunnel splints are designed to support the connective tissues of the forearm, wrist, and hand to minimize median nerve compression and provide nerve pain relief.

Unfortunately, with severe carpal tunnel syndrome, surgery may be necessary.

Carpal Tunnel Physical Therapy

Many patients with less severe carpal tunnel syndrome symptoms may greatly benefit from hand and wrist exercises designed to decrease compression of the median nerve.

Studies have shown yoga to be an effective carpal tunnel treatment, with yoga exercises for carpal tunnel increasing flexibility and range of motion in the hand and wrist, decreasing median nerve pressure.

Unfortunately, carpal tunnel exercises and stretches aren’t right for everyone, and physical therapy exercises are best when paired with other carpal tunnel treatments.

For those with severe carpal tunnel, physical therapy may do little to address hand and wrist pain, and carpal tunnel release surgery may be the best option.

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What Is Carpal Tunnel Release Surgery?

Carpal tunnel release surgery is a common hand and wrist surgery.

In fact, per a recent report, more than 500,000 carpal tunnel surgeries are performed every year.

If the aforementioned conservative care treatment options have failed to relieve your carpal tunnel syndrome symptoms, your doctor may recommend one of two surgeries to decrease compression of the median nerve.

Open carpal tunnel surgery and endoscopic carpal tunnel surgery are the two main corrective surgeries used today.

While both surgeries are typically performed as outpatient procedures, open carpal tunnel surgery is more invasive than endoscopic carpal tunnel surgery.

During open carpal tunnel surgery, the surgeon will make a small incision along the wrist and use this opening to clip the carpal ligament and expand the carpal tunnel.

During endoscopic carpal tunnel surgery, the surgeon makes a small incision or multiple incisions.

Then, a small camera is used to assess the carpal tunnel.

Next, portions of the carpal ligament are trimmed through the aforementioned openings, to expand the carpal tunnel.

Your surgeon may recommend endoscopic surgery or open carpal surgery, depending on your symptoms and lifestyle.

What Is the Recovery Time for Carpal Tunnel Release Surgery?

Your recovery timetable will depend on many factors.

As mentioned previously, open carpal tunnel release surgery is more invasive than endoscopic carpal tunnel release and will thus require a longer recovery time.

Regardless of the procedure your doctor recommends, general soreness and swelling around the incision is to be expected after the procedure.

You may be instructed to wear a splint to immobilize and support the hand and wrist during recovery.

Hand swelling, wrist swelling, and soreness can last up to a month, although these symptoms may subside sooner with less invasive surgeries.

Patients with more physically demanding occupations may not be able to return to work for about a month.

However, individuals with less strenuous jobs may return to the workplace within a few days.

A full carpal tunnel surgery recovery may take multiple months.

Remember, we update our Sports Medicine Oregon blog monthly, so be sure to tune in often to stay up to date on the latest sports medicine news and views!