What You May Not Know About Carpal Tunnel Syndrome

Carpal tunnel is the leading occupational hazard of the computer age, affecting over five million American workers. However, says Dr. Christopher Koontz, a hand surgeon at SBH Health System, it’s not only a repetitive motion injury, but also one that affects those with diabetes, who have suffered a trauma or have anatomical issues that make them susceptible to compression of the median nerve.

Dr. Koontz recently discussed the issue of carpal tunnel syndrome on SBH Bronx Health Talk. Here is an excerpt from the podcast:

So what exactly is Carpal Tunnel

Carpal Tunnel Syndrome is typically the compression of the median nerve at the wrist. Generally it’s from inflammation or repetitive use. Basically the tissue around the nerve becomes so compressive that the nerve itself becomes less functional and you can end up with nerve damage.

Now I know they talk about typing being a cause of this condition but you can also get it for other reasons as well, right?

Basically anything that will cause inflammation around the nerve itself will cause compression. It can be from changes as you age, where ligaments become stiffer.

What are the common symptoms?

Typical symptoms are going to start with numbness and tingling in the fingers, usually in the thumb, index and middle finger, or in half of the ring finger. You usually start at the fingertips and as time passes it will start to progress more and more down the hand. Once the numbness and tingling occurs, it’ll start being intermittent as time passes and as the nerve dysfunction becomes worse. People will talk about non-stop numbness and tingling that doesn’t ever go away. That will typically progress into a burning pain that people feel at night. They’ll wake up at night and feel like they have to shake out their hands, but they’re not quite sure why. That burning pain will typically be the complaint that drives people to actually come in and seek help. The last thing that you’ll see is going to be muscle weakness and that’s when you really have some nerve damage as opposed to just nerve symptoms. As the nerve becomes more and more compressed and actually starts to die then you start to have muscle weakness and you’ll see the muscles in the hand will start to atrophy or get smaller and that’ll be another sign that things have gotten a little more severe.

So it’s not a condition that you should ignore?

The problem is that people usually wait too long so when they come in they’re already at the point of having irreparable nerve damage. That’s one of the things that I tell people is that having surgery may not make all the symptoms go away, but the important thing is to stop it from progressing because if you go from numbness, burning pain, things like that to actual weakness, that can affect your use of the hand and that could lead to a hand that doesn’t work in the way that you want it to.

Do you end up getting it in one hand or both hands?

It’s typically in both hands. It’s usually one hand will be worse than the other. Often times, people don’t even realize that they have it in the other hand because whichever hand is more symptomatic they think that’s the only one and then when you actually do the testing you’ll see that they have some degree on both sides.

How do you diagnose it?

Clinically, there’s a few tests we can do. While those are pretty reliable obviously we usually use an EMG, which is electromyography. We study the conduction of the nerve and how fast it’s actually moving and conducting a signal.

I assume that surgery is not the first treatment, right?

It depends on what stage you’re at. If you come in with mild carpal tunnel there’s things that we can do to try to alleviate your symptoms such as night time splinting, occupational therapy, dealing with sources of inflammation and also treating the comorbidities so if you have uncontrolled diabetes we treat that and that may alleviate the symptoms. Once you start getting to the moderate and severe levels, you really want to start treating it because if you wait any longer you can get to the level of irreparable nerve damage. Usually I tell people when they’re at the moderate level that’s when we should actually do the surgery because that’s when they will see the best benefit of having the nerve treated.

Are there surgery options?

The surgery that I typically do is an endoscopic carpal tunnel release which means that rather than using the older practice of making a two, two-and-a-half centimeter incision in the palm, now we’re making a smaller incision at the wrist and using a camera to visualize the ligament which needs to be released. The surgery itself, which is done under local sedation, is probably somewhere between five to 15 minutes. If we are able to do it the endoscopic way recovery is actually pretty fast. People can start to use their hand maybe three days after surgery and by the 10th day sutures come out and they’re free to use their hand however they wish.

Is there rehab after that?

Most people don’t need rehab because again it’s a smaller procedure. We’re just releasing a ligament. There’s nothing that needs to heal so people typically don’t develop stiffness. Obviously there are some people who do and we have facilities here that can offer that. We have a certified hand therapist who is well versed in treating carpal tunnel.

Now in general again if you’re getting it because of ergonomic factors is there anything preventively that you can do?

The data is just not reliable enough to say that doing those things differently will definitively help. That being said anecdotally a lot of people do get relief from changes they make in their workplace with different positioning of their wrists and their forearms. If you really spend a lot of time with your wrists kind of flexed that can compress the nerve. So if you’re doing something that would correct that it could help. That’s the idea behind splints, which you wear at night to take your hand out of that position of compressing the nerve to a position of opening up the nerve and taking off that pressure.

Not to change the subject, but I’m guessing you also see a lot of hand injuries due to trauma. How important is physical therapy to returning the patient back to as normal a life as possible?

I think that rehab, especially in trauma, is more important than even the surgery. The surgery is just putting things back together but the patient to heal has to be compliant with the therapy. Those patients typically have a better outcome.