Carpal Tunnel Syndrome
Carpal tunnel syndrome is a relatively common condition caused by a pinched nerve in the wrist. As a result, you could experience numbness and tingling in your hand and arm. This can make both work and recreation difficult and painful, and it can greatly affect your overall quality of life. Following a clinical diagnosis and full evaluation of your hands and wrists, Gregg A. Vagner, M.D. in Austin, TX, can recommend the proper carpal tunnel treatment plan. He will usually begin with a steroid shot or bracing. However, if these methods do not help you experience relief, he may recommend open or closed surgery. After surgery, Dr. Vagner will provide thorough monitoring and follow-up treatment.
What Is Carpal Tunnel Syndrome?
The carpal tunnel runs along the underside of your wrist. It encases the median nerve, which gives sensation to your palm, thumb, and all of your fingers, except your little finger. Carpal tunnel syndrome occurs when the median nerve is pinched. There are a number of factors that can contribute to nerve compression, including:
- Wrist fracture
- Heredity, causing a naturally narrow carpal tunnel
- Hormonal changes due to pregnancy
- Rheumatoid arthritis, thyroid imbalance, diabetes, and other health conditions
What Daily Activities Can Contribute to the Condition?
Since overuse is one of the most common causes of carpal tunnel syndrome, it is important to be aware of activities that could trigger the condition. Some of these include:
- Typing on the computer
- Improper positioning of the wrists when using a computer mouse
- Prolonged exposure to vibrations from power or hand tools
- Playing the piano
- Any activity that requires repeated movement and overextension of the wrist
In some cases, doctors are not sure why certain patients develop carpal tunnel syndrome.
Since overuse is one of the most common causes of carpal tunnel syndrome, it is important to be aware of activities that could trigger the condition.
The Symptoms of Carpal Tunnel Syndrome
Tingling and numbness are the most common symptoms of carpal tunnel syndrome. You may also experience weakness in your hand or arm. Sometimes, discomfort can radiate along your forearm and up to your elbow. Because the median nerve does not connect to your little finger, it is not affected. Nevertheless, the condition can dramatically impact the movement and function of your other fingers. These sensations are more likely to be pronounced at night or when you are engaged in certain activities, such as driving or holding the phone. You may also become clumsier, frequently dropping things due to weakness in your hand.
Diagnosing Carpal Tunnel Syndrome
To diagnose carpal tunnel syndrome, Dr. Vagner will conduct a full evaluation of your hands and wrists. This involves testing the strength of your hand muscles and assessing the feeling in your fingers. He will also bend the wrist and gently tap on the nerve to determine which factors trigger your symptoms. In addition to a physical examination, Dr. Vagner may also:
- Take x-rays: To eliminate other possible issues, such as a wrist fracture or arthritis, x-rays may be taken.
- Recommend an ultrasound or MRI (magnetic resonance imaging): These diagnostic tools help Dr. Vagner assess the median nerve for signs of compression.
- Review the history of your symptoms: Dr. Vagner will talk with you in depth about your symptoms. This will help him establish when the pain began and determine which activities trigger the condition.
- Perform an electromyogram: During this procedure, gentle electrical stimulations will be sent down your median nerve from various points higher on your arm. Dr. Vagner will then measure how long it takes for the stimuli to reach your hand and fingers. A slow reaction time will typically indicate carpal tunnel syndrome.
- Recommend a nerve conduction study: Another variation of electromyogram, a nerve conduction study involves taping two electrodes to the skin. A slight shock is then sent through the median nerve to determine if the impulses are slowed.
Carpal Tunnel Treatment Options
Following your diagnosis, Dr. Vagner will determine the most effective course of treatment. Typically, he will begin with conservative methods, such as bracing and cortisone injections. These treatments can help to reduce swelling, inflammation, and discomfort.
If they do not prove effective, Dr. Vagner will usually recommend surgery. During this process, he will make an incision in the ligament that is pressing down on your median nerve. As you recover, the ligament will usually heal with more room for this nerve. Dr. Vagner offers two types of carpal tunnel surgery: endoscopic and open.
- Endoscopic carpal tunnel surgery: During this minimally invasive procedure, Dr. Vagner will create tiny incisions in the hand or wrist. Next, a small optical tube (endoscope) will be inserted through the incisions to access your nerve and cut the ligament. This treatment typically involves a very fast recovery.
- Open carpal tunnel surgery: This type of procedure requires a larger incision, usually placed across your palm. Once the area is accessed, Dr. Vagner cuts the ligament to free the problematic nerve. Open surgery may be the best option if you have larger hands. This method requires a longer recovery period compared to endoscopic carpal tunnel release.
Both endoscopic and open surgical techniques are designed to achieve similar goals. During your initial consultation with Dr. Vagner, he will help you determine which treatment option will most effectively meet your needs.
Recovery after Carpal Tunnel Surgery
Immediately following your carpal tunnel release, it is beneficial to raise your hand above your heart and move your fingers. This will help alleviate swelling and prevent stiffness. As with any surgical procedure, patients can expect some degree of discomfort and inflammation. These side effects can be mitigated with prescription medications and over-the-counter pain relievers.
Grip and pinch strength is typically regained approximately two to three months after your procedure. In severe cases, however, this could take up to one year.
Depending on you specific case, you may need to wear a wrist brace or splint for several weeks. During this time, you can still use your hand for light activities, such as light lifting, driving, and self-care. You may need to take time off of work or switch to lighter job duties while you are recovering. Dr. Vagner will talk with you in detail about your restrictions.
As aforementioned, endoscopic surgery requires less recovery time. If you had open carpal tunnel surgery, you will need to wear dressings over the incision for two days. After this time, you should only need an adhesive bandage. In about 10 days, Dr. Vagner will remove your stitches. You should avoid heavy lifting for about two weeks. Once you have made a full recovery, you can experience completely restored strength and range of motion.
Preventing Carpal Tunnel Syndrome
Currently, there are no established methods to prevent the development of carpal tunnel syndrome. However, wrist and hand strain can be significantly reduced by following a few guidelines:
- Take breaks often: Alternate tasks whenever possible to prevent prolonged repetitive motion. Periodically, gently stretch the hands and wrists.
- Improve your posture: Incorrect posture can roll the shoulders forward. As a result, the neck and shoulder muscles are shortened, compressing nerves in the process. This can cause a domino effect of issues, eventually affecting your hands, wrists, and fingers.
- Pay attention to form: When working at a computer, try keeping the wrists in a middle position rather than bending them all the way up or down. In addition, your keyboard should be at elbow height or slightly lower.
- Relax your grip: When writing for prolonged periods of time, use a large pen with free-flowing ink. You can even add a soft grip adapter if desired.
- Reduce force: When typing, hit the keys softly. Excessive force can exacerbate carpal tunnel syndrome.
- Invest in a comfortable computer mouse: If your current mouse strains your wrist, switch to a more comfortable, ergonomic option.
- Keep your hands warm: You are more likely to develop stiffness and pain in a cold environment. If you are unable to control the temperature in your office space, invest in a pair of fingerless gloves to keep the wrists and hands warm.
If you are suffering from the symptoms of carpal tunnel syndrome, contact Dr. Vagner’s office to schedule a consultation. Dr. Vagner will review your symptoms and conduct an analysis of your wrist to determine the best approach.
"I am committed to using experience, along with the latest techniques and technologies, to help my patients achieve the full function, mobility, and comfort in their hand, wrist, and arm that they experienced prior to their injury."Dr. Gregg Vagner