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Carpal Tunnel Syndrome

Robert S. Leak, MD

Written By: Robert S. Leak, MD

Do you ever wake up with numb or tingling fingers? Do you shake your hand to make it go away? How about painful or swollen and stiff fingers? If so, you may be suffering from carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is a very common disorder becoming more prevalent in our high-tech world of computers, ipods, and mp3 players. It can affect anyone – young, old, typists, non-typists, athletes, non-athletes – but even more common is patients who are pregnant, diabetic, or who have rheumatoid arthritis.

CTS is caused by too much pressure on a nerve as it enters your hand, characterized by numbness and tingling in the fingertips. The digits that are commonly involved are the thumb, index finger, and middle finger. While it is often worse at night and tends to cause multiple nighttime awakenings, CTS symptoms can occur at any time during the day, particularly with increasing activities. Repetitive activities, in fact, have often been implicated in CTS.

As the disease progresses, the sensory changes in the hand will become worse, with difficulty in performing daily tasks such as doing a button, tying a shoe, or sorting the coins in a pocket. The hand will gradually become weak, with loss of grip strength.

A diagnosis can generally be made in the office by a physician following a few simple examination maneuvers. The diagnosis will often be further confirmed by a nerve conduction and electrical diagnostic study.

The treatment of CTS generally depends on the severity of the symptoms and exam findings. In mild cases, wearing a wrist splint at night will often alleviate symptoms and allow for a good night’s rest. In moderate cases, taking an anti-inflammatory medicine will help, and often times, a steroid injection can be quite beneficial.

If conservative treatment is unsuccessful, a consideration of surgical intervention is warranted. Surgery performed on the appropriate patient has a very high success rate – greater than 95 percent of patients with an accurate diagnosis will experience full recovery. The surgery can be done as an outpatient with a local anesthetic. A small incision can be used that will lead to minimal post-operative scarring. The risks for surgery are minimal, and the recovery time is very quick. Many patients can return to work the next week, although labor intense jobs may require up to six weeks of recovery.

As always, prevention is the best treatment. Take appropriate steps to avoid repetitive activities at work or at home to prevent the onset of symptoms. If you are going to be at your computer or desk for a long period, use correct posture with a comfortable chair at the right height. Be sure your keyboard is at the right level for you, with a wrist pad on which to rest your wrists. Ask your boss for an ergonomic assessment if you are concerned. If symptoms occur, early diagnosis and treatment by your physician will get you back to a normal lifestyle.