LEXINGTON, Ky. (Nov. 9, 2011) - The following column appeared in the Lexington Herald-Leader on Sunday, Nov. 6
Carpal Tunnel Syndrome: The Disease You Thought You Knew
By Dr. Brian Rinker
Our hands are amazing. Everything we do in the course of a day, whether at work or play, requires the use of our hands. They are capable of generating tremendous force for gripping, but are also able to perform precise and delicate manipulations. They work so well that we hardly give them a second thought - that is, until something goes wrong with them. When suddenly we can't button a shirt, open a jar or caress a loved one, we realize how much we depend on our hands.
One of the most common conditions affecting the hands is carpal tunnel syndrome. The carpal tunnel is a narrow channel connecting the wrist with the palm. Through this tunnel pass nine tendons and the median nerve. The median nerve is an important nerve which helps move the thumb and provides feeling to the thumb, index, and middle fingers. Carpal tunnel syndrome is caused by increased pressure on the median nerve as it passes through this tunnel.
The carpal tunnel is a natural point of compression for the median nerve. Any condition that causes swelling of the tendons that run with the nerve, such as trauma, pregnancy, or repetitive use, can increase this pressure. However, in most cases the exact cause is unknown. When you hear "carpal tunnel syndrome," you probably think about computer use. But the link between keyboards and carpal tunnel syndrome is not a strong one. In fact, carpal tunnel syndrome occurs just as commonly among manual laborers as office workers.
Early in the course of the disease, the increased pressure on the median nerve is mild, and so are the symptoms. Patients may experience occasional episodes of numbness and tingling in the thumb, index and middle fingers, usually occurring at night when fluid accumulates in the hands. Patients will often describe waking up and shaking the hands to get the feeling back. These episodes are uncomfortable, but hand pain is not a common feature of carpal tunnel syndrome.
Patients with painful hands are much more likely to be suffering from arthritis or tendonitis. As carpal tunnel syndrome progresses, episodes occur more frequently, and restful nights become more rare. Patients will often report difficulty with fine manipulations, such as doing buttons or handling change. Eventually, the fingers will be numb all the time. It is important to seek treatment before this stage, because some of the damage to the nerve can be irreversible, and a full recovery may not be possible.
The treatment of carpal tunnel syndrome does not always include surgery. Many patients with early carpal tunnel syndrome can be treated successfully with splinting, physical therapy, or behavior modification. Patients with more advanced disease may need a surgical procedure to widen the carpal tunnel and take pressure off of the nerve. It is a quick, outpatient procedure, and it can usually be performed with a local anesthetic. After surgery, most patients experience complete relief of their symptoms, straightforward, but, like all hand surgery, should be performed by surgical specialists with training and expertise in surgery of the hand. The amazing hand, the most complex machine that man has the capacity to understand, deserves the attention of a dedicated specialist.
The UK HealthCare Hand Surgery Service specializes in the treatment of carpal tunnel and any other condition of the hand. Call 859-323-8082 to make an appointment with one of our fellowship-trained hand surgeons.
Dr. Brian Rinker is an associate professor of plastic surgery at the University of Kentucky College of Medicine and the Medical Director of UK HealthCare's Hand Surgery Service.