More and more patients come to me convinced they know the nature of their medical condition. It’s not surprising because people nowadays “google” everything and sometimes find out more than they need to know.
Just yesterday, I saw a patient who swore she had Carpal Tunnel Syndrome because she felt pain and tingling in one of her hands. She went on to say that she “googled” it and sure enough, she was sure it had to be her problem.
In some ways a self-diagnosis is helpful to me as an orthopedic surgeon because it quickly spells out some of the problems a patient may be having. On the other hand, patients are not experts and sometimes mistake a simple condition for one that is much worse. It’s always best to consult your doctor before your imagination gets the best of you.
I have to say, in this particular instance, the patient’s symptoms appeared to be carpal tunnel syndrome. However, because there may be other conditions that mimic carpal tunnel, such as a pinched nerve in your neck, it is important to have imaging tests, such as MRI or X-ray to know for sure.
Carpal tunnel syndrome is a fairly common ailment that affects many people whose work or hobbies are hand-intensive. Repetitive computer use is usually what people assume causes carpal tunnel but scientific evidence for this association isn’t definitive.
Research suggests that carpal tunnel syndrome may result from strain in jobs that require repetitive, forceful, and awkward motions of your hands and wrists. Examples might be using power tools, such as chain saws or jackhammers, or where you must constantly use your hands to pinch or grip while working.
There may be other things that put you at risk for carpal tunnel in addition to repetitive hand movements. Women are three times as likely as men to develop carpal tunnel syndrome, according to the National Institute of Neurological Disorders and Stroke.[i] Also, the shape of your wrist, an inherited trait, may make you more susceptible.
What exactly is carpal tunnel syndrome?
You know it causes pain, tingling, and other problems in your hand but may not know the reasons why. The median nerve travels from your forearm to your hand through a narrow, tunnel-like structure in the wrist (carpal) bones. A strong band of connective tissue called the transverse carpal ligament covers the top of the tunnel.
The median nerve controls the feeling in the palm side of the thumb, index finger, and long fingers as well as the muscles around the base of the thumb. When swelling or anything else makes the tunnel smaller, pressure builds up causing pain and numbness.
In most cases the condition starts gradually with a subtle ache in your wrist, hand or forearm. Your thumb and index, middle or ring fingers (but not your little finger) may feel tingly when you are holding a steering wheel, phone or newspaper first thing in the morning. Eventually the numbness becomes constant and the pain radiates from your wrist to your shoulder. You may also experience a sense of weakness in your hands and have a tendency to drop things.
What if you think you have carpal tunnel syndrome?
When patients come to me with typical symptoms of carpal tunnel, the first thing I do is discuss their medical history. This is because there are many factors that contribute to the development of carpal tunnel syndrome. I’ve mentioned hand use and genetics, but hormonal changes related to pregnancy can play a role as well as age. Older people are more likely to suffer from carpal tunnel and those with medical conditions such as diabetes, rheumatoid arthritis, and thyroid gland imbalance seem to be at a higher risk.
Of course a thorough examination of your hand is necessary to check for weakness in the muscles around your thumb. This includes bending and holding your wrists to determine numbness or tingling along with applying pressure on the median nerve.
Diagnostic tests are usually recommended such as:
- Electromyogram – measures the tiny electrical discharges produced in muscles. By inserting a thin needle electrode into the selected muscle, electrical activity is recorded when you contract and relax the muscle.
- Nerve conduction study – two electrodes are taped to your skin and a small shock passes through the median nerve to see if impulses are slowed while in the carpal tunnel.
Without some form of treatment, carpal tunnel will progressively get worse. That’s why you should consult your doctor as soon as you experience any of the symptoms mentioned here. Once diagnosed, you and your doctor can discuss the types of treatment available and what might be best in your situation. The sooner you start treatment, the better your chances of preventing long-term damage to the nerve.
Home Care – If possible, stop activities that cause numbness and pain and rest your wrist often. Use ice once or twice an hour for 10 to 15 minutes each time. Try wearing a wrist splint at night to keep your wrist in a neutral position to relieve pressure to the median nerve. The splint should be snug but not tight. Aspirin or other over-the-counter anti-inflammatory drugs (NSAIDS), such as Ibuprofen and naproxen may help relieve symptoms temporarily. However, if your symptoms do not improve after 1 to 2 weeks of home care you may need another form of treatment.
Nonsurgical Therapy – Most of the time, people find relief by implementing nonsurgical methods especially if you’ve had only mild to moderate symptoms for less than 10 months. Other than wrist splinting and OTC pain relievers, doctors may inject your carpal tunnel with a corticosteroid, such as cortisone. This helps decrease inflammation thereby relieving pressure on the median nerve.
Surgery – When pain or numbness persists longer than 6 months, surgery may be recommended as a last resort. Surgery is sometimes done using an endoscope, which is a tiny camera attached to a device that allows the doctor to see inside your carpal tunnel. Sometimes, a larger incision is required in the palm of your hand to release the nerve.
There is no way anyone can really prevent carpal tunnel syndrome, but taking the necessary precautions can help protect your hands from repetitive use. If you are in a job that requires you use your hands, reduce the force needed to perform the task and relax your grip. Take frequent breaks, stretch and bend your wrist and hands periodically. If you use a keyboard, keep it at elbow height or slightly lower.
If you think you have symptoms of carpal tunnel, you could be right! Try a few of the home care therapies first, but if you do not find relief within a week or so, see your doctor. The longer you wait, the worse it gets. Don’t let that happen to you!