Carpal tunnel doesn’t happen just to people who type a lot. Here’s how it’s treated.
If you’ve heard the term “carpal tunnel syndrome,” the first image that probably comes to mind is clerical workers, typing at a keyboard all day.
Certainly, people who use computers for work are vulnerable to this common problem, but many people might have carpal tunnel syndrome without realizing why they’re feeling these symptoms. Doug Weikert, M.D., a hand surgeon with Vanderbilt Orthopaedics, explains his patients’ problems and what brings relief:
What is the carpal tunnel?
The small bones in the wrist are called the carpal bones. In the wrist, there’s a small round “tunnel” formed of bone and ligament. This opening is only about the size of a quarter, but nine tendons and a nerve pass through it, connecting the forearm to the hand. That’s a lot of tissue squeezed through a small, fairly inflexible space.
What is carpal tunnel syndrome?
Carpal tunnel syndrome happens when there is too much pressure on the median nerve that passes through the carpal tunnel.
What are symptoms of carpal tunnel syndrome?
Numbness and tingling are symptoms. “People come in because they can’t sleep at night – their hands wake them up,” Weikert said. “Or they have numbness in their fingers when they drive or put on their makeup, comb their hair — functional activities that we do every day that are hindered by numbing, tingling, clumsiness, weakness.”
What causes carpal tunnel syndrome?
There’s some controversy over the cause, Weikert said, partly because workers compensation policies involving treatment of carpal tunnel syndrome vary by state.
“Doing any sort of activity over and over and over again certainly plays a part in repetitive trauma to the tendons and nerves,” Weikert said. That repetitive motion might be typing at a keyboard, but it could also be from working with hand tools, playing a musical instrument or styling hair all day. Sometimes, just positioning the wrist in a bent position – maybe during sleep – can put more pressure on the nerve. With increased pressure, blood flow decreases, the nerve doesn’t get enough oxygen and a tingling sensation results.
People in middle age are more susceptible to this condition than their younger counterparts just because of the increased wear and tear on joints, tendons and nerves that occurs over time.
“Very few people under age 30 have carpal tunnel syndrome,” Weikert said, “except women in the third trimester of pregnancy.” The swelling and increased blood volume that come with pregnancy can make the tight conditions in the carpal tunnel worse.
Weikert added, “We look to see if patients with symptoms have diabetes, a thyroid problem, any sudden weight gain or medical conditions.” Congestive heart failure, for example, in which fluid can build up in the body, can contribute to carpal tunnel syndrome. So can scar tissue from an old wrist injury.
But many of Weikert’s patients have none of these factors. “It’s not one specific thing. It’s just the nature of what our hands do for us, day in and day out, for five or six decades.”
How is carpal tunnel syndrome treated?
There are conservative (non-surgical) and surgical strategies for treating carpal tunnel syndrome. Patients can ease the pressure on the medial nerve in several ways:
- Wearing a splint on the wrist at night.
- Using warm water soaks and/or applying heat, to encourage the carpal tunnel to relax and expand so blood flow will increase. Icing won’t help.
- Having a vitamin B6 supplement, which is good for nerve health.
- Getting steroid shots.
Sometimes workers compensation policies require the steroid shots, Weikert said; policies vary from state to state. These injections can provide some relief, Weikert said, but they’re not a cure. The injections can help predict how well a patient will respond to surgery if that becomes necessary.
If surgery is recommended, patients should ask how many carpal tunnel surgeries a doctor has performed, and with what technique. Weikert, for example, does this surgery for hundreds of patients every year. At Vanderbilt, it’s done on an outpatient basis, meaning there is no overnight hospital stay. The operation uses local anesthesia and IV sedation.
Surgery for carpal tunnel syndrome involves cutting the transverse carpal ligament, a leathery piece of tissue that forms part of the tunnel’s circumference. When the ligament is snipped, it expands the width of the tunnel. Over time, the ends of the severed ligament heal together, but they create a thinner band than before, so the carpal tunnel is permanently widened.
Sometimes this surgery is done through an incision in the palm (“open” surgery). Sometimes it’s done endoscopically, with tiny tubes equipped with a camera and cutting tools threaded into the wrist, allowing the doctor a view on a large monitor.
Most patients only need a soft dressing around the wrist after surgery – no splint or cast. The day after surgery they can return to many normal activities, like driving.
If you are dealing with an injury, facing surgery or coping with chronic pain, Vanderbilt Orthopaedics offers a full spectrum of care. Our specialists work with you from evaluation and “prehab” through physical therapy and, if needed, surgery. We’ll help you get back to doing the things you love, pain-free. To make an appointment, call 615-936-7846.
Douglas Weikert, M.D., is associate professor of orthopaedic surgery and rehabilitation at the Vanderbilt Orthopaedic Institute.