Carpal Tunnel Syndrome
Carpal tunnel syndrome can seriously diminish your quality of life due to pain, numbness, and tingling that makes normal functions difficult.
Dr. Gregg A. Vagner can help you find relief from carpal tunnel symptoms, starting with conservative techniques and graduating to surgery, if needed.
Seeking treatment for carpal tunnel at his practice serving Austin and Cedar Park, TX, can drastically improve your life...
Carpal tunnel syndrome is a relatively common condition caused by a pinched nerve in the wrist. 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. Dr. Vagner will also 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
Have you recently noticed occasional tingling, numbness, or weakness in your hand? It might even radiate up your forearm to your elbow. If so, you may be experiencing symptoms of carpal tunnel syndrome. Prompt intervention can restore your comfort and keep the condition from progressing and causing further damage.
While the cause of carpal tunnel syndrome may not always be clear, the symptoms are so predictable as to be almost diagnostic.
Tingling, Numbness, and Pain
This sensation is first noticed in the thumb and middle fingers and may be intermittent. It can radiate up the arm as high as the elbow, and the tingling can sometimes feel more like an electric shock. Over time, the numbness can become permanent. The only part of the hand left unaffected is the little finger, which is not innervated by the median nerve.
Weakness in the Hand Muscles
As the condition progresses, the muscles in the hand and forearm can become weaker, making it more difficult to perform normal day-to-day functions. Patients may begin to have problems gripping small objects, such as a fork or pencil.
In time, patients may notice that they are more prone to dropping things and unable to comfortably perform important functions, such as opening doors or gripping the steering wheel.
These symptoms are often more noticeable at night and while participating in certain activities that exacerbate the condition. These might include such actions as holding a phone, newspaper, or steering wheel for long periods at a time. Patients who are noticing these telltale symptoms are encouraged to seek medical help sooner, rather than later. Left untreated, carpal tunnel syndrome can eventually cause muscle atrophy and permanent nerve damage. This can leave patients unable to safely drive or perform normal household or work tasks.
Understanding Carpal Tunnel Syndrome
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.
Gregg A. Vagner, M.D.
Dr. Vagner is a double board-certified orthopedic and hand surgeon who combines the latest research and techniques to treat the hands, wrists, and elbows. His accolades and roles in his field include:
- Distinguished Surgeon of the Year Award - Austin Area Association of Perioperative Medicine
- Clinical Assistant Professor of Surgery in Perioperative Care - Dell Medical School
- Hand Surgery Consultant - University of Texas Athletic Department