Myth: The Only Way To Relieve Carpal Tunnel Pain Is Surgery
Once carpal tunnel syndrome has been diagnosed, surgery is not the only tool to relieve the pain. There are several nonsurgical treatment options that can bring relief for individuals who want to postpone or avoid surgery:
- Resting the wrist by avoiding repetitive motion or heavy use
- Wearing a wrist brace
If theres a severe case of carpal tunnel syndrome that involves muscle wasting or potentially permanent damage to the median nerve, then surgery is advised as soon as possible.
Severe Stage Carpal Tunnel
In thesevere stage numbness or pain is constant, with no respite during the day or night. And it’s almost intolerable. It can be so bad that patients often tell me,I want to cut my hand off.
Some describe the numbness as crushing thats ever-present and relentless, even at night. If the main symptom is pain, people describe it as “cruel” or “punishing” and it’s always relentless.
Eventually patients lose the feelings of hot and cold sensations in their fingers and hand. Also, the muscular bump at the base of the thumb noticeably flattens out, and the skin over the muscle wrinkles. Thats because the thumb muscle has degenerated. This begins the final, irreversible stage of carpal tunnel syndrome.
Carpal Tunnel And Arthritisgo Hand In Hand
The factor we need to pay attention to in a context of getting or avoiding Arthritis, is the part of the dynamic where muscles get tight, and stay tight.
When a muscle is tight, the tendons that connect muscle to bone get pulled on. So whatever the tendon connects to gets pulled on.
So if your forearm muscles connect to the forearm, and the hand and fingers. If your forearm muscles are tight, they pull your hand bones into your forearm bones. This compresses your wrist joint and finger joints.
Muscles get tight and stay tight, and in fact that tightness becomes the new ‘normal’. So even when you sleeping and theoretically ‘relaxing’, your wrist and/or your finger joints are getting compressed.
When you are using your hands during the day, every time you move your hands and fingers, those compressed joints then grind on each other.
The tighter your muscles, the more pressure the bones grind on each other with.
Point being, the same factors that cause Carpal Tunnel Syndrome can also cause arthritis in hands and fingers.
What Is The 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 . 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.
What Is Bilateral Carpal Tunnel Syndrome
Most people who havenumbness, tingling, weakness or painin one hand eventually see the same problems happen in their other hand. Carpal tunnel syndrome behaves this way most of the time. This isbilateral carpal tunnel syndromeand it’s a huge problem for employers and workers.
Studies show that if you feel these symptoms in one hand, there’s more than80% probabilitythey will appear in the other handwithin 6 months. Fewer people have symptoms begin in both hands at the same. But it’s still considered bilateral carpal tunnel syndrome.
For at least two decades doctors recognized that carpal tunnel syndrome will almost always happen in both hands. This is wherepreventative measureshelp a lot. They can reduce the chances of developing bilateral carpal tunnel syndrome when it appears on the first hand.
However, most people dont take preventative measures or even the slightest precautions. As a result, the other hand ultimately suffers as well.
The Reason You Get Carpal Tunnel From Guitar Playing
The reason you feel unpleasantsymptoms of carpal tunnel from guitar playing is the result of the median nerves compression. The compression produces neuropathy, which is when the nerves signals between the fingers and brain are scrambled.
This signal scrambling results in motor problems like weakness or limited hand movement. It also results in a variety of sensory problems. For example a feathery touch might feel like a stab or burn.
The most common neuropathy sensations caused by carpal tunnel syndrome usually include hand or finger:
Where Is This Tunnel
Take a look at the palm of your hand. Under the skin at your wrist is the tunnel we’re talking about. Nine tendons and one nerve pass through this tunnel from the forearm to the hand. The bottom and sides of the carpal tunnel are formed by wrist bones, and the top of the tunnel is covered by a strong band of connective tissue called a ligament.
The tendons that run through the tunnel connect muscles to bones and help you use your hand and bend your fingers and thumb. The nerve that passes through the carpal tunnel to reach the hand is the median nerve.
It’s pretty tight inside the carpal tunnel. In fact, there’s barely enough room for the tendons and the nerve to pass through it. If anything takes up extra room in the canal, the median nerve gets pinched, which causes numbness and tingling in the area of the hand where the nerve spreads out. Swelling can happen when someone does the same thing over and over, like typing. This swelling can pinch the nerve.
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Differences Between Carpal Tunnel And Arthritis
While several forms of arthritis and carpal tunnel syndrome can all cause hand and wrist pain, there are certain features of each disease that distinguish the two. Carpal tunnel syndrome pain is primarily the result of nerve compression, while arthritis is swelling and inflammation of the joint itself.
How Can Carpal Tunnel Syndrome Be Prevented
At the workplace, workers can do on-the-job conditioning, perform stretching exercises, take frequent rest breaks, and use correct posture and wrist position. Wearing fingerless gloves can help keep hands warm and flexible. Workstations, tools and tool handles, and tasks can be redesigned to enable the workers wrist to maintain a natural position during work. Jobs can be rotated among workers. Employers can develop programs in ergonomics, the process of adapting workplace conditions and job demands to the capabilities of workers. However, research has not conclusively shown that these workplace changes prevent the occurrence of carpal tunnel syndrome.
Do I Have Carpal Tunnel Or Something Else
Carpal tunnel syndrome is a common term that we hear from family and friends when we complain of numbness or pain in the wrist. Its the one condition that seems the most likely cause because its quite well known. However, just because carpal tunnel syndrome is well-known does not mean it is the only condition that causes wrist pain and numbness.
It is important to understand the symptoms of other common conditions that relate to the hand and wrist, as well as carpal tunnel syndrome, to rule out other possibilities.
In this article, we will cover common conditions that cause numbing, tingling, pain, or numbness in the fingers and wrists as well as what you should do if you believe you have one of these conditions.
Carpal Tunnel Syndrome
Carpal tunnel syndrome happens when pressure is applied to your median nerve by the carpal bones. When swelling happens in your wrist, the carpal tunnel constricts the median nerve causing symptoms to appear. These symptoms could be radiating pain from the forearm to the shoulder, numbness, burning, or tingling starting at the thumb, pinky, or felt within the forearm.
The symptoms of carpal tunnel syndrome typically start slow and are felt mostly at night. This is due to sleeping positions that cause restriction within the wrists. How to tell is if you feel the need to shake your wrist to regain feeling. As the condition worsens, you will begin to feel symptoms during the day while driving, typing, or talking on the phone.
Do Not Have Surgery Performed On Both Hands At The Same Time
If you do decide to go forward with surgery, definitely do not do both hands at the same time unless you have a close to fulltime caregiver that you have an intimate personal connection with and that you trust with personal hygiene and intimate daily care for several weeks. Life can be complicated without the use of either hand.
Using a hand that has been operated on for Carpal Tunnel Release Surgery before it has completely healed can result in serious potential complications and generation of scar tissue. The formation of scar tissue can actually make Carpal Tunnel worse after surgery than it was before the surgical procedure at the base of the hand. Soft tissue healing takes six weeks minimum and can take up to 8 weeks or even 12 weeks if there are complications with bacterial infection.
The temptation to use your hand for some essential task when a caregiver is not immediately available is too high for most people to resist. The probability that you will be put in a situation where you must use your hand for a task that puts too much force on the injured tissue before the healing is complete is high, even if you think you will have the full-time attention of a caregiver. This is why we strongly recommend that you do not have a surgical procedure for Carpal Tunnel Release performed on both hands at the same time.
Some people are excited about the idea that you can minimize downtime by having both hands done at the same time.
Carpal Tunnel Syndrome Surgery
If your CTS is getting worse and other treatments have not worked, the GP might refer you to a specialist to discuss surgery.
Surgery usually cures CTS. You and your specialist will decide together if it’s the right treatment for you.
An injection numbs your wrist so you do not feel pain and a small cut is made in your hand. The carpal tunnel inside your wrist is cut so it no longer puts pressure on the nerve.
The operation takes around 20 minutes and you do not have to stay in hospital overnight.
It can take a month after the operation to get back to normal activities.
Carpal Tunnel Syndrome: Its Not What You Think
October 18, 2018
Orthopedic Hand Surgeon Michael Vender, M.D., on staff at Northwest Community Healthcare , has been in practice for over 30 years and annually performs about 125 carpal tunnel surgeries, mainly at the NCH Day Surgery Center. Below, he answers common questions about carpal tunnel syndrome, including misconceptions, symptoms and treatment.
What is carpal tunnel syndrome?
Its an abnormality of the median nerve at the wrist level caused by pressure on the nerve.
How can I combat carpal tunnel syndrome when I spend hours a day on my computer?
This is a common misconception. You dont get carpal tunnel syndrome from computers, laptops and tablets. Thats an old wives tale. You just happen to notice the symptoms while youre on the computer, and you associate those symptoms with that particular activity. Thats not really the cause.
What is another common misconception people have about carpal tunnel syndrome?
People think its a bad condition to have and that treatment isnt effective. In most cases where carpal tunnel syndrome surgery doesnt work, its because of a misdiagnosis. If you have pain from arthritis and you call it carpal tunnel syndrome and you do surgery, of course its not going to work.
Why do certain people develop it?
About half of the cases of carpal tunnel syndrome have no cause or known risk factors for developing this . The other half may have a risk factor.
The most common are:
What are the symptoms of carpal tunnel syndrome?
What Other Conditions Can Cause Similar Symptoms
Several of them. One, which doctors call de Quervain tenosynovitis, causes problems with the tendons that control your thumb. It hurts to turn your wrist, make a fist, or try to grasp an object. Your doctor can do some simple tests to tell whether you have this condition or carpal tunnel.
Other health problems that may seem like carpal tunnel syndrome include:
Can Carpal Tunnel Syndrome Be Prevented Or Avoided
You can take steps to prevent carpal tunnel syndrome. The following actions may help to prevent it:
- Lose weight if youre overweight.
- Get treatment for any disease you have that may cause carpal tunnel syndrome.
- If you do the same tasks over and over with your hands, try not to bend, extend, or twist your hands for long periods of time.
- Dont work with your arms too close or too far from your body.
- Dont rest your wrists on hard surfaces for long periods of time.
- Switch hands during work tasks.
- Make sure the tools you use arent too big for your hands.
- Take regular breaks from repeated hand movements to give your hands and wrists time to rest.
- If you use a keyboard a lot, adjust the height of your chair so that your forearms are level with your keyboard, and you dont have to flex your wrists to type.
Many products you can buy, such as wrist rests for a computer keyboard, are supposed to ease symptoms of carpal tunnel syndrome. No one has proven that these products really prevent wrist problems. Some people may have less pain and numbness after using these products, but other people may have increased pain and numbness.
Worst Jobs For Carpal Tunnel Sufferers:
Today, researchers are still learning about the causes of Carpal Tunnel Syndrome. Though not all studies have linked particular professions to carpal tunnel syndrome, others have found a correlation between the condition and specific jobs. It is noted that the average person spends 70% of their time working in their chosen profession; and if that profession involves certain repetitive, strenuous hand motions like using vibrating machinery; that means a lot of time is been spent in putting stress on the hands and the wrist. Let us now talk about some of the worst jobs for Carpal tunnel sufferers.
Mechanic:
Making use of Rachet, Screwdriver, power tools etc in a mechanics job can actually worsen the condition in Carpal tunnel syndrome. So this is not at all a fit job for you if you are a carpal tunnel sufferer.
Professional Gardener:
Hand weeding, power tools when used while gardening can impact your wrists and hand pain in Carpal tunnel.
Garment Worker, Sewer, Tailor:
Grasping and tugging fabric, pulling etc can cause more of hand and wrist pain if you are a carpal tunnel sufferer. So, this is listed under worst jobs for carpal tunnel syndrome.
Clerk and Secretary:
One more profession that is absolutely not for carpal tunnel sufferers is a job of clerk or secretary. This is because these jobs involve a lot of keyboarding, using mouse, filing etc that are not suitable for the condition.
Painter:
Dental Hygienist:
Transcriptionist and Computer Programmers:
Hair Dresser:
Can You Tell Which Condition You Have
Joint swelling in arthritis may also cause compression of the nerves in the hand or wrist, which can then cause numbness, tingling, and pain. Your doctor will perform a few specific tests to pinpoint the problem.
- Reduced muscle mass in the fleshy part of the hand at the base of the thumb
- A positive Tinel’s Sign, or a burning or tingling sensation when the median nerve is tapped lightly
- A positive Phalen’s sign, a test that assesses for pain when your arms are held vertically and your wrists are flexed 90 degrees for 60 seconds
- Weakness or poor dexterity with pinching movements
- Pain that is worse at night or wakes your from your sleep
- Asymmetric patterns of joint involvement
- Swelling of other joints outside of the hands and wrists
- Systemic involvement with inflammatory arthritis, including fevers, malaise, or rash
- Antibodies or inflammatory markers present in blood testing
- Pain that goes away after a few hours in the morning
Reduce Or Quit Tobacco Use
Nicotine is an addictive chemical in tobacco products. It also constricts arteries and reduces blood flow in the body. If the blood flow in the hand is reduced, the nerves can be more sensitive to injury. Stopping tobacco use may reduce the risk of CTS symptoms and is good for your overall health. Consider talking to your primary care physician about quitting.
How Common Is Carpal Tunnel From Guitar Playing
Guitar players are at very high risk for this condition. In fact, most doctors will tell you that a high proportion of their carpal tunnel patients are guitar players.
Unfortunately, nobody has the exact statistic because good clinical surveys are still lacking.But overall musculoskeletal disorders occur in 26-93% of musicians. Thats very high by any measure.
In one study of guitar players , the average rate of all “overuse disorders” was 75%. That was further broken down as occurring in:
- 82.1% of flamenco guitarists
From experience, I’m very familiar with this issue. So when guitar players ask me what to do, I always advise the same thing…
If you treat early, youll probability beat it.
But if you wait, it will almost certainly worsen.
And thats when its hardest to treat.
Take Caution With Use Of Nsaids
Non-steroidal anti-inflammatory drugs are oral medications used to reduce pain and inflammation. Examples are ibuprofen and naproxen, which can be purchased over-the-counter. Some patients can have short-term relief of CTS symptoms with these medications. However, most research studies do not recommend using NSAIDs for CTS treatment, especially long-term. Use of NSAIDs is associated with increased risk of gastrointestinal bleeding, kidney disease, and heart attack. These risks increase in patients with certain medical problems and when used long-term or at higher doses.
Surgeons Often Face Conflicts Of Interest
It is difficult to think of any medical advantage to the patient in doing the surgical procedure on both hands other than saving downtime.
While most surgeons are quite altruistic, some are insensitive to the patients plight post-carpal tunnel surgery.
From a Surgeons point of view, it saves time and increases revenue generated per operation by doing both hands at the same time. It seems more efficient to the Surgeon.
Generally, surgeons are altruistic and follow the Hippocratic Oath closely. Most surgeons endeavor to do the best for the patient despite potential conflicts of interest.
However, it is also true that a lot of patients never come back to have surgery on the second hand, once they know what they went through with surgery on the first hand.
So, the Surgeon can make sure that he has the opportunity to perform the procedure on both hands by doing them both at the same time. Again, advantage Surgeon not patient.
Surgeons often have conflicts of interest where what is in the patients best interest is not necessarily in the Surgeons best interest. Again, we have found surgeons usually error on the side of what is in the patients best interest when confronted with such situations.
How Do You Get Carpal Tunnel Syndrome
Carpal tunnel syndrome, caused by a pinched nerve in your wrist, is a hand and arm condition that results in uncomfortable symptoms like numbness, tingling, and even pain. Its a repetitive use injury with a number of contributing factors, and in this blog the orthopedic surgeons at Mirza Orthopedics will demystify this common hand condition.
Carpal Tunnel Syndrome Risk Factors
You might have a higher risk of getting carpal tunnel syndrome if you:
- Are a woman. Women are three times more likely than men to get it. This might be because they tend to have smaller carpal tunnels.
- Have a family member with small carpal tunnels
- Have a job in which you make the same motions with your arm, hand, or wrist over and over, such as an assembly line worker, sewer or knitter, baker, cashier, hairstylist, or musician
- Fracture or dislocate your wrist
Coldness And Colour Change
The hands may feel subjectively cold , but as with many of the symptoms described here measurement of the hand temperature usually does not reveal dramatic coldness. There have been studies of thermography as an aid to diagnosis in CTS which suggest that there are slight changes in temperature but this has not taken off as a diagnostic method . Marked coldness of the fingertips combined with colour change is sometimes a clue to the presence of Raynaud’s disease, which is essentially a disorder of the small blood vessels. As with trigger finger, there may be an association between Raynaud’s and carpal tunnel syndrome .
Getting A Diagnosis And Treatment
If you have pain, numbness, or tingling anywhere along your arm, wrist, hand, or fingers, Dr. Fitzmaurice first conducts a detailed examination and takes imaging studies to determine whether you have carpal tunnel syndrome, cubital tunnel syndrome, or both. To prevent further damage to your median or ulnar nerves, he may recommend:
- Stretching exercises
What To Expect After Surgery
There may be some swelling and stiffness right after surgery, which can be relieved by elevating your hand over your heart and moving your fingers frequently. 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.
Surgery For Carpal Tunnel Syndrome
If surgery is needed, it’s typically done on an outpatient basis under local anesthesia . The ligament overlying the top of the carpal tunnel is cut to relieve pressure. The healed ligament will allow more space in the carpal tunnel. Sometimes the procedure is done endoscopically, using a tiny camera inserted through a very small incision to guide the procedure.
Who Is At Risk For Carpal Tunnel Syndrome
People at risk for carpal tunnel syndrome are those who do activities or jobs that involve repetitive finger use. Motions that can place people at risk of developing carpal tunnel syndrome include:
- High-force .
- Extreme wrist motions.
- Vibration.
Many other factors can also contribute to the development of carpal tunnel syndrome. These factors can include:
- Heredity .
- Pregnancy.
- Amyloid deposits .
Carpal tunnel syndrome is also more common in women than in men.
Myth: Endoscopic Approach Is Riskier Than Open Approach
In the past, many patients were concerned or advised against the endoscopic approach for fear of higher risk for complications such as nerve damage.
However, current research shows that theres no statistically significant added risk of complications from the endoscopic approach. A large systemic review of 28 studies that compared open and endoscopic approach for carpal tunnel release found that:
- Both approaches were equally effective in relieving symptoms and improving function and had similarly low rates of major complications
- The endoscopic approach was better in restoring grip strength, allowed patients to return to work faster , and was safer in terms of minor complications
Individuals who suspect they may have carpal tunnel syndromeor have been diagnosed but have questions about their treatmentshould see their physician to formulate a successful treatment plan.
See Diagnosing Carpal Tunnel Syndrome
Myth: Any Hand Pain Or Tingling Is A Sign Of Carpal Tunnel Syndrome Especially If You Use A Computer All Day
At the first sign of pain, numbness, or tingling in the hand or wrist, people may assume its a sign of carpal tunnel syndromeespecially if they sit at a computer for most of the day. Just as with any repetitive motion thats done for long periods of time, typing on a keyboard or using a computer mouse all day can cause aches and stiffness in the hands and wrists. But this isnt necessarily carpal tunnel syndrome.
See Is My Hand and Wrist Pain Caused by Carpal Tunnel Syndrome or Something Else?
Carpal tunnel syndrome has specific symptoms that set it apart from other conditions that can cause pain and numbness in the hand. For example, carpal tunnel syndrome typically causes tingling and numbness in the thumb, index, and middle fingers, but not the ring or pinky fingers. Also, the pain of carpal tunnel syndrome is usually worse at night.
See Distinctive Carpal Tunnel Syndrome Symptoms
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