Being pregnant, pounding fenceposts, snowmobiling, typing, riding a dirt bike, video gaming, and having arthritis. What do all these things have in common? They can all be associated with carpal tunnel syndrome, or CTS. And that list is not exhaustive.
While it was once thought that carpal tunnel syndrome was only caused by repetitive motion, mainly from typing, we now know that many things, including other health conditions and genetics, can contribute to the development of this painful condition of the wrist and hand.
Dr. Benjamin Garner, an orthopedic surgeon with East Falls Orthopaedics specializing in hand and wrist conditions, has seen plenty of patients with CTS. The painful condition occurs when the median nerve that runs from the forearm to the palm of the hand, becomes pressed or squeezed at the wrist.
Usually, their symptoms have progressed gradually, beginning with mild tingling or numbness in the fingers or hand. Often, they experience weakness in the hand and increasing pain in the wrist. Dr. Garner helps people at all stages of CTS.
Mild and conservative treatment
“Some cases are really mild, and I always offer non-surgical treatments first,” he says. “Splints are the go-to. Nothing special; you can find them at a drug store or department store. They just need to keep the wrist straight, and they especially need to be worn at night.”
Why at night? Because, says Dr. Garner, “sleeping people tend to curl their hands and wrists, and curling puts pressure on the median nerve.” When the median nerve is already pinched and irritated, curling the wrists at night causes a person to experience pain, numbness, and tingling. During the day, these same symptoms make it difficult to do everyday tasks or even impossible to do work.
For some people, CTS is temporary. As Dr. Garner explains, “A farmer can get carpal tunnel from pounding fenceposts for a week. Someone who rides a snowmobile during the winter can get it, so can motorcycle riders. NSAIDs [like ibuprofen], splints, and rest can sometimes relieve temporary symptoms.
“For pregnant women who get gestational carpal tunnel, the symptoms sometimes resolve two to three months after the baby is born.”
What about those office workers and gamers, the people who get CTS from hours of mousing and typing every day?
“The most conservative treatment is to try an ergonomic keyboard and mouse, which helps keep the hands and wrists in a more natural, straight position, reducing the pressure on the median nerve,” says Dr. Garner. “Again, using splints as needed can also provide relief.”
When surgery is necessary
When necessary, surgery at EIRMC is available to fix chronic CTS. Dr. Garner uses simple indicators to decide whether it is time for that.
“The ‘rule of thumb’ is to evaluate the muscle at the base of the thumb. If there is no atrophy of that muscle, and if the fingers feel normal most of the time, then there’s no particular reason to rush to surgery,” he explains. “But, it’s time for surgery if its bothersome on a daily and nightly basis—more days bothered than not, more nights than not.”
Open release surgery, the kind Dr. Garner practices, is one of the most common surgical procedures done in the United States. It usually takes less than half an hour for the actual procedure, and the patient goes home the same day.
During the surgery, “I ‘release’ (cut) the transverse carpal ligament on the palm side of the hand, which relieves pressure on the median nerve in the wrist,” describes Dr. Garner. “Afterward, the incision is stitched up, and we apply a bulky, soft dressing. No brace or cast is required.
“The first week after surgery is crucial, and patients need to keep the palm clean and dry. Stitches come out in about two weeks. After that, the patient can resume activity ‘as tolerated,’ which is hugely variable. Some people are back to work in a couple days, for others it can be some weeks. In general, recovery is about two weeks, or when the skin heals.”
The success rate for CTS surgery is high, especially when the patient sought treatment early enough to avoid long-term nerve damage. And that’s Dr. Garner’s best piece of advice: “Don’t wait. Get help if there’s tingling or numbness in your hand or fingers that keeps coming back.”
To schedule an evaluation with Dr. Garner, visit East Falls Orthopaedics or call (208) 535-4580.
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