Speaking of Health – Carpal Tunnel

By Gilda Morales, ANP, DC

Today’s column deals with a common condition that many people think they have, and which is becoming more common with the overuse of texting and computer work—carpal tunnel.

Among the most common complaints, patients will report that their hands fall asleep or that things slip from their fingers without noticing, such as loss of grip, dropping things, and numbness and tingling.  The symptoms come and go and are related to certain activities such as driving long distances, repetitive activities such as hammering, crocheting, or painting.

There are specific symptoms that occur at night, that usually awaken the patient, such as numbness and tingling in the wrists or hands that are relieved by shaking the hands and wrists.  Although both hands may be affected in carpal tunnel, usually it is the dominant hand that is affected more severely.  The sensory symptoms are usually accompanied by an aching on the inside of the wrist, which can refer to both the palm and fingers or up the inside of the forearm.

There are several risk factors for developing carpal tunnel, including increasing age, female sex, large frame or obesity, square-shaped wrist, and being short.  There are also several medical conditions that contribute to the risk of developing carpal tunnel such as diabetes, thyroid disease, rheumatoid arthritis, recent menopause, dialysis, and pregnancy.

Diagnosis of carpal tunnel is primarily made through clinical symptoms and a diagnostic testing, EMG and NCV (electromyography and nerve conduction velocity testing), which can evaluate the severity of nerve damage.  Treatment is progressive, beginning with the least invasive, such as physical therapy, and bracing of the affected wrist at night for at least one month.  Medications, including NSAIDs such as ibuprofen and naproxen, and gabapentin for nerve pain, have shown to give some relief, albeit temporarily.  Corticosteroid injections into the wrist may also be quite effective and should be considered before surgery.

Surgery is the last treatment option and consists of decompressing the carpal tunnel, a band-like structure that pushes against the nerves of the wrist, causing the pain, numbness and tingling.  Unfortunately, the success rate is realistically around 60% and many have to undergo a repeat surgery when symptoms return.

LEAVE A REPLY

Please enter your comment!
Please enter your name here