Wrist Pain (Adobe Stock)

Doctor, I have carpal tunnel syndrome. Can you help me?

Sure, of course. What symptoms have you been having?

Well, my hand and wrist hurt a lot. And I work on a computer all day long.

Hmmm. I see. It sounds like you definitely have some issues, but your symptoms are not consistent with carpal tunnel syndrome.

This conversation or ones like it play out in my office almost once per clinic. Patients will come to me convinced that they have carpal tunnel syndrome, only to feel disappointed in their incorrect diagnosis.

Carpal tunnel syndrome gets a lot of attention because it is so common. It also has been pegged as directly related to computer use. And so, a lot of office workers just assume that carpal tunnel syndrome is the cause of their pain.

 

Carpal tunnel syndrome symptoms

The diagnosis of carpal tunnel syndrome is not always so cut and dry. Carpal tunnel syndrome is a constellation of symptoms that arise from compression of one of the nerves that supplies sensation and motor function to parts of the hand called the “median nerve.”

When the syndrome first starts, most patients notice a tingling sensation in their fingers. The tingling tends to occur while holding the phone, driving, and at night. The sensation is similar to your fingers falling asleep. The typical fingers involved are the thumb, index, middle, and a portion of the ring finger. The pinky finger is usually not involved, so one of the questions I first ask patients when they come to my office complaining of carpal tunnel syndrome is, “Do you notice any symptoms in your pinky finger?” If the answer is yes, then almost certainly they have something other than carpal tunnel syndrome.

Sometimes, patients will say they shake or wring their hands to get rid of the symptoms. This is also very typical. With time, the tingling will turn to more pronounced burning and pain.

When the carpal tunnel progresses, symptoms tend to occur more often and more prevalently. It can wake the patient up at night. Weakness in the hand can also start with a loss of pinch strength. Sometimes, a patient will complain of dropping objects.

 

Where does it come from?

Most cases of carpal tunnel syndrome, despite widespread belief to the contrary, do not have an identifiable cause. And no, it is not caused by using a computer. Practically everybody in the developed world uses a computer; it would be dramatically obvious at this point if carpal tunnel syndrome was caused by computers!

However, there are a few associated risk factors. These include diabetes, obesity, thyroid disease, pregnancy, kidney disease, and alcoholism. Sometimes, a repetitive vibratory activity in the workplace (i.e., jackhammer or chainsaw operator) has also been associated with carpal tunnel syndrome.

Carpal Tunnel Syndrome (256 x 256 px)
Photo under CC license, “Blausen gallery 2014”

Although the exact cause is most of the time unidentified, what occurs in the body is almost always the same every single time. The carpal tunnel is a tight and enclosed space that we all have in our wrists. It contains many structures, but the one most pertinent to this discussion is the median nerve. When a patient has carpal tunnel, the nerve is squished inside the carpal tunnel between the bones of your wrist on one side and a thick ligament on the other side. Imagine trying to squeeze a whole bunch of leftover hot dogs from your July 4th barbecue in a Tupperware container and barely getting the lid closed. Now imagine one of those hot dogs is your median nerve and you will get the idea of what is going on in carpal tunnel syndrome.

 

What can be done for it?

The first step when you have the symptoms mentioned above is to see your physician. This can either be your primary care doctor or a hand specialist. After a thorough exam, he or she may first start by ordering a nerve conduction study to confirm and quantify the diagnosis.

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Depending on the severity of the carpal tunnel, there are several treatments that can be helpful. The first (and easiest) is to wear a brace.

There are many over the counter products that are marketed towards carpal tunnel sufferers. These include sleeves, supports, creams, and bracelets. Searching for “carpal tunnel” on Amazon.com will bring up a laundry list of these products. However, the only proven wearable device for carpal tunnel syndrome is a wrist brace that prevents the wrist from bending. Because when the wrist bends, there is even less room in the carpal tunnel for the median nerve. So keeping the wrist straight in a brace can really help!

People have also tried vitamins and anti-inflammatory medication without any real improvement. Oral steroids can help temporarily but the effect is short-lived.

A steroid injection can be a helpful treatment option when the brace is not helping. This is an injection of steroids (or cortisone) directly into the carpal tunnel. But like oral steroids, in most patients, the injection will wear off within 1 year. An injection is a safe treatment for basically any patient, even diabetics, as long as they are counseled on monitoring their glucose levels after injection. It can even be an excellent choice for the expectant mother who is suffering from new onset carpal tunnel syndrome.

Finally, when all else fails, surgery can provide long-lasting relief. There are different variations, but the surgery essentially accomplishes one thing: Dividing the carpal tunnel ligament. To use the hot-dog packed Tupperware analogy from earlier, the surgery would be akin to taking the lid off of the Tupperware.

By performing this release, the compression on the median nerve is relieved and the symptoms tend to improve. The amount of nerve recovery can depend on the severity of the carpal tunnel syndrome.

More severe diseases can have persistent symptoms even after surgery. Therefore, the patient expectations need to be tempered for this outcome.

After a carpal tunnel release surgery, it is important for the patient to perform exercises on moving the fingers and wrist as soon as possible in order to speed recovery. Elevation of the operated hand after surgery can also help control post-operative swelling. This can be done by using a few pillows to prop up the hand above the level of the heart or by wearing a device designed to elevate the hand (such as the Wing Sling). Anti-inflammatory medication such as ibuprofen can also be helpful.

The good thing about carpal tunnel syndrome is that it can be easily treated when caught early enough. But when symptoms have drawn on for months and years, then the chance of a full recovery is not assured. This is not a diagnosis to ignore.


 

Mark E. Elzik, MD
Dr. Mark Elzik is an accomplished and technically skilled orthopaedic surgeon subspecializing in the field of hand, wrist, elbow, and microvascular surgery. Dr. Elzik is a Duke University graduate with Distinction where he received his bachelor’s degree. He went on to medical school at the University of North Carolina-Chapel Hill where he again graduated with Distinction. He was inducted into the coveted Alpha Omega Alpha medical honor society early on in his third year of medical school, which is an honor held by only the top 1% of medical students. He pursued the field of Orthopaedic Surgery at the University of California Los Angeles where he completed his residency. Having a particular interest in hand surgery, Dr. Elzik further pursued sub-specialty training and completed a fellowship at the prestigious Philadelphia Hand Center under the direction of world-renowned hand surgeon Dr. A. Lee Osterman. Dr. Elzik has published multiple medical articles and given numerous lectures at national meetings. He serves patients throughout Orange County and operates at Mission Hospital in Mission Viejo and Laguna Beach, California.

1 COMMENT

  1. Chinese meditation balls are very good for getting rid of carpal tunnel syndrome and for preventing it for computer users. Very cheap, non-invasive. We showed our to a GP friend and he got rid of his problem from playing the cello. He is now recommending them to patients with similar needs.

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