Last summer, Anna Lea Matysek of Sarasota, Florida, and her husband Jim set to work sprucing up their property. Some of the hardscaping that had been installed two decades prior had sunk into the soft, Gulf Coast soil, and it was time to break up that old concrete and elevate the flower beds. “We excavated these giant concrete pieces and then filled the trenches with rock and laid the pieces back down so that they’re now at surface level again,” Matysek says. The job took about two weeks and involved “a lot of digging, moving pieces of concrete and shoveling rocks.” By the end of the project, the property looked great, but Matysek was suffering from a classic case of carpal tunnel syndrome.
The National Institute of Neurological Disorders and Stroke reports 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.”
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When this area sustains an injury or chronic use results in a narrowing of the tunnel, that can produce the tell-tale symptoms of carpal tunnel syndrome, which include “pain, numbness and tingling in the thumb, index finger and middle finger, and sometimes part of the ring finger,” says Dr. Hisham Awan, an orthopedic surgeon and director of the OSU Hand and Upper Extremity Center at the Ohio State University Wexner Medical Center. “A lot of patients will feel like they have symptoms in their whole hand,” and some people experience symptoms in the forearms, too.
Although no one’s absolutely certain what causes carpal tunnel syndrome, Awan says the common notion that typing or repetitive office-based work causes CTS is a misconception. “Nothing has been proven that computer work causes carpal tunnel syndrome. It probably has mostly to do with genetics — we know that some people, because of their anatomy, are more prone to getting carpal tunnel syndrome.” (Resources from the U.S. National Library of Medicine note that studies have not proven that typing, using a mouse, playing a musical instrument or sports cause CTS “but these activities may cause tendinitis or bursistis in the hand, which can narrow the carpal tunnel and lead to symptoms.”) The NINDS reports that diabetes and rheumatoid arthritis may elevate risk for developing CTS and that fluid retention during pregnancy or menopause can contribute to the development of CTS or exacerbate symptoms. Women are three times more likely than men to develop CTS.
Although office work isn’t likely to be the source, your occupation can be a risk factor, Awan says. “There are a few professions that have been proven to be at higher risk of getting carpal tunnel syndrome. People who have a lot of vibration on their hands, such as someone who works as a pile driver or a truck driver, are at higher risk.” People in occupations that involve a lot of repetitive flexion of the wrist are also more likely to get CTS.
In Matysek’s case, the cause was clear — all that breaking up of concrete and using her hands and wrists as levers to shovel heavy loads of rock put a strain on the ligaments in her wrist that led to inflammation, swelling and ultimately nerve impingement that announced itself through tingling and numbness in her hands.
Most people with CTS are advised to start out with nonsurgical approaches to treatment such as wearing wrist splints at night, says Dr. Benjamin J. Jacobs, a hand surgeon with Rebound Orthopedics and Neurosurgery in Vancouver, Washington and public education committee chair for the American Society for Surgery of the Hand. “Most people will make use of splints for nighttime use. They’re a little less obtrusive to your life at night and also the posture that many of us take at night is to have our wrists in a very flexed position. The splints tend to keep the wrists in a more neutral posture,” and slightly extended, which “decreases the pressure on the nerve in the carpal canal.” This can alleviate tingling and numbness in the hands at night, which can also help the patient sleep better.
Other nonsurgical approaches include steroid medications injected into the carpal tunnel, but these typically only provide temporary relief. Awan notes that physical therapy may also be used for some cases of CTS.
Matysek’s doctor recommended that she begin treatment with splints. “I wore the braces on my wrists day and night for at least a month, maybe more.” After that first month, she wore them only at night. Within about six months, the tingling and numbness had subsided and Matysek, an avid swimmer, was able to ditch the splints, which she’d worn even in the pool to keep from flexing her wrists too much while swimming. “I knew I needed to keep [my wrists] as stationary as possible, but it is not pleasant to swim in those things,” she laughs.
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By December, Matysek’s case of carpal tunnel syndrome had largely resolved itself, but that’s not the case for all people who have it. In cases where the condition is disruptive to the patient’s life and the symptoms haven’t resolved with nonsurgical treatment, it may be time to consider surgery. Jacobs says the ideal candidate is someone who’s had “acute or fairly acute onset of carpal tunnel syndrome because they’re more likely to get better quicker as opposed to someone who’s had long term changes or maybe even muscle loss.” Rapid onset of symptoms — such as what Matysek experienced — means that recovery may be more complete with surgery than if the patient has muddled along with progressively worse symptoms for years. Nevertheless, “even people who’ve had long-standing carpal tunnel syndrome can get some significant improvement,” from surgery, Jacobs says, so it’s worth talking to your doctor about your options if a chronic case of CTS is negatively impacting your life.
Surgery for CTS involves cutting the carpal ligament to provide more space for the medial nerve. “For most surgeons, the actual cutting time is usually around 10 minutes, and the total surgery time is probably 30 to 45 minutes.” There’s prep time and some recovery for the patient as well, so the entire time commitment is usually a few hours.
Traditionally, open carpal tunnel release surgery involved local anesthesia and a 2-inch incision in the wrist. These days, endoscopic surgery techniques are also used, which may result in faster recovery and less discomfort after the surgery. Endoscopic surgery involves one or two very small incisions and smaller cuts to the carpal ligament to release the pressure on the nerve. “We’ve come a long way with hand surgery, so we’re doing a lot more with no anesthesia or no sedation,” Awan says. The patient will receive a numbing injection to block pain and sensation during the surgery, but “the patient can stay completely awake for the surgery, and then they don’t have to have any risks of anesthesia with their surgery.”
Awan says most patients need just a light bandage and typically can use their hand the same day. Full recovery varies depending on how severe the case of carpal tunnel was and how the area heals, but most people are able to get significant relief from symptoms within a few weeks after surgery. “We ask manual laborers to take a month off work, but for people who do desk work, I’ve had some go off to work the same day, right after surgery. I’ve had surgeons operating the next day after surgery,” he says.
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Although risks of carpal tunnel surgery are few, “any time you do surgery, there are risks like bleeding and infection,” Awan says. There’s also risk of nerve damage if the nerve is injured during the procedure. Jacobs notes that in rare cases, “some people have persistent pain for a period of time, but almost always that goes away” within a few days or months.
Lastly, some people may not get full release of the ligament, and the surgery may not resolve symptoms as much as hoped. In extreme cases, surgery could exacerbate the problem. “The internet is full of anecdotes about people getting worse after a carpal tunnel release, but that’s not very common,” Jacobs says. “The main times people don’t get better is if they wait too long and the nerve has some irreversible damage where it won’t wake back up again. But the surgery is still worthwhile in these cases because you’re preventing them from getting worse.”
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When Is Surgery the Answer for Carpal Tunnel Syndrome? originally appeared on usnews.com
