Helping Hands Heal since 2005
From Dr. Z - Carpal tunnel syndrome specialist
Most people who suspect they have carpal tunnel syndrome also have a lot of questions. This article will answer those questions simply and directly. They include:
You can always call Dr. Zannakis (CarpalRx's Medical Director) for questions, advice & recommendations. It's FREE! Call 800-450-6118.
Carpal tunnel syndrome is a neurological disorder. It affects about 5 million Americans and is also responsible for over 230,000 surgeries each year.
It affects a major nerve in the arm and hand called the median nerve. Carpal tunnel syndrome is when this nerve becomes injured and starts to malfunction (see "Causes" below).
Carpal tunnel syndrome produces a distinct pattern of symptoms in the hand and fingers (see "Symptoms" below).
The primary sings or symptoms of carpal tunnel syndrome are unusual feelings in your hand and fingers. Symptoms are confined to the palm-side of the hand and sometimes the forearm. They never affect your little finger.
In the beginning of the disorder, these feelings are intermittent. This is why most people dismiss the symptoms as "overtired hands".
As carpal tunnel progresses, the symptoms are more constant and more intense. This is when most patients start to take serious notice of the problem.
Note that you can have any one or combination of these symptoms. These include:
The exact cause of carpal tunnel syndrome is not clear to scientists. At its source, the tendons inside your wrist joint (flexor tendons) become irritated. The irritation leads to swelling inside a narrow passageway in your wrist joint called the carpal tunnel (hence the name of the disorder).
This carpal tunnel passageway is tightly packed with the tendons as well as the median nerve. This is a main nerve of the hand that carries sensations like pain and touch.
Now this already tightly-packed passageway has to contend with swollen tendons. But there’s no room for anything to “give” or expand. As a result, the swollen tendons push against the median nerve and crush it.
It's that crushed median nerve that gives you all signs and symptoms of carpal tunnel syndrome.
Scientists now have over three decades of data about who gets carpal tunnel syndrome and when. That means you can be placed at higher risk if you:
The two major ways to diagnose carpal tunnel syndrome are using provocative tests and electrodiagnostic tests.
Provocative tests are simple, in-office tests your doctor can perform. The purpose is to see if they can elicit symptoms of carpal tunnel syndrome (or make symptoms more intense). In fact, you can do these tests on yourself, and at home, and get similar accuracy. The description of the tests below are if you wish to perform them on yourself.
Usually, having two or more of these tests give positive results confirms carpal tunnel syndrome.
While holding your fingers straight, flex your wrist gently and as far as possible. Using your other hand to push it down a bit more is fine. Hold this position for 1 minute.
Do the symptoms you have get worse or are they more intense? If they are, it's positive for carpal tunnel syndrome.
With your hand straight, use an opposite finger to tap over your wrist area crease. Tap vigorously, and tap left to right and back again.
Do the symptoms you have get worse or are they more intense? If they are, it's positive for carpal tunnel syndrome.
Holding your fingers straight, use your opposite thumb to apply firm pressure to your hand. Press the thumb firmly, in the "valley" at the base of your palm.
Hold this for 30 seconds. Do the symptoms you have get worse or are they more intense? If they are, it's positive for carpal tunnel syndrome.
You doctor will order electrodiagnostic tests if your provocative tests are positive for carpal tunnel. However, by themselves, the electrodiagnostic tests are not more accurate than the provocative tests. In other words, they are used to "confirm" the provocative tests.
Electrodiagnostic tests are performed under the supervision of your carpal tunnel doctor. They require specialized electronic equipment and special training for the technologist.
The electrodiagnostics tests are usually performed in 2 parts: the nerve conduction test and the electromyographic test (or EMG).
This test determines if your median nerve is functioning properly. It measures the speed of electrical signals travelling down your median nerve. An unhealthy nerve produces slower signals. Slower signals can mean you have carpal tunnel syndrome.
The technologist applies several tape electrodes to your palm. Then they use an electrical stimulator (like a large pen) to send signals down the median nerve. The electrodes in your palm pick up the signals for analysis.
These tests are not painful. However, some patients may feel "static electric" shocks on their skin surface.
This is like the nerve conduction test. It determines the health of your median nerve and thumb muscles.
The test requires needles inserted into your thumb muscles. Other electrodes are applied to the skin along your arm. The needles detect the electrical signals travelling down the median nerve from the surface electrodes. Any delay in the signal means you might have carpal tunnel syndrome.
The EMG test is a bit painful because of the needles in your hand. Most patients also feel electric shocks or burning during the test.
The time it takes for carpal tunnel syndrome to progress. While the timeline is different for everybody, it's typical to see symptoms go from mild to severe in about 6-9 months.
The progression is usually slow and almost unnoticeable. If left untreated, the probability of carpal tunnel syndrome advancing from mild to severe (in that 6 month period) is about 66%. That means there's a mere 34% chance symptoms will not progress.
The rate that symptoms worsen also varies. For instance, some see symptoms go from barely noticeable to severe in just a couple months. But in others it might take 2 or more years. Symptoms may also linger in a mild form for a long time (usually up to a year) and then worsen suddenly. Or symptoms could intensify steadily.
If symptoms start in one hand, then
88% of the time they'll also appear in the opposite hand. Doctors call this bilateral carpal tunnel syndrome. Symptoms on the opposite hand can start simultaneously. But normally they appear within 6 months of each other.
For most people, carpal tunnel syndrome starts almost without notice. You may feel some tingling at your fingertips when typing. Or it may tingle if you tap your wrist or hand. Numbness at night comes and goes.
Want to know how severe your carpal tunnel really is?
Take this 60 second Quiz designed by Dr. Z.
But as carpal tunnel advances, it gets progressively more unpleasant. Numbness and tingling usually intensify. If pain was just annoying before, it gets far worse in just weeks. This is when life becomes miserable.
The primary stages of carpal tunnel syndrome are:
Nature's most healing remedy is rest. Tissues heal naturally during rest. The healing needed from carpal tunnel syndrome is no different.
Therefore, the most basic way to treat carpal tunnel syndrome is with rest. That means:
Rest breaks: Rest your hands periodically while you work. And stretch (more of this below). Also, don't perform the exact same activity that caused the tendon stresses to begin with.
Modify: Modify the activity that caused the stress, like changing the position of your hand or grip. Don't perform a repetitive stress activity, like constant keyboarding, especially without takeing frequent breaks.
Posture: Make sure your sitting posture is proper for your job. Many office workers using a computer keyboard and mouse have extremely poor sitting posture. This causes unbalanced upper body forces to transmit to the shoulders, arms, and hands. Effectively, your hand never gets a rest from mechanical stress, and carpal tunnel can result.
While not the best option, the most popular way patients treat carpal tunnel syndrome is by using over-the-counter pain medications. In particular, medicines called non-steroidal anti-inflammatory drugs or NSAIDs are the most familiar.
In fact, the most common ones are probably in your medicine chest right now. These are Tylenol (acetaminophen), Aleve (naproxen), Motrin (ibuprofen), and Advil (ibuprofen).
NSAIDs relieve pain by reducing inflammation. While they're safer to use than steroids, they're not completely safe.
The most common steroid used for carpal tunnel pain relief is cortisone. Cortisone can be taken by injection (steroid shot) or in the form of a pill (oral). However, the pill form usually doesn't help with carpal tunnel symptoms, especially pain.
That’s why most patients choose steroid shots for carpal tunnel. But steroid shots are only a temporary fix for this disorder. In other words, they're not intended for long-term pain management.
Bracing your hand is one of the most effective treatmentys for carpal tunnel, especially in the mild stage. Bracing at night (nocturnal bracing) keeps your wrist joint from hyper-bending. This prevents even more tissue problems inside your wrist, and is a great carpal tunnel fighter.
Caution #1: Make sure you use a certified carpal tunnel brace because a generic pharmacy brace will do more harm. You can tell if it's NOT a certified carpal tunnel brace by looking at the palm surface of the brace. It if has a metal spine (as pictured) then it's not a certified carpal tunnel brace. That metal spine will push into your carpal tunnel and irritate tissues even more.
Caution #2: If you have carpal tunnel syndrome, NEVER brace your hand while working during the daytime. Your wrist's interior is already damaged. Therefore, working with your hand while wearing a brace causes you to subconsciously "fight" the brace. Why make your hand do additional work and add even more stress to your joint?
It sounds so simple and basic, but stretching exercises are some of the best remedies for carpal tunnel syndrome. Stretching exercises lubricate your tendons and help remove restrictions. This creates a healthier tendon that won't swell and cause carpal tunnel syndrome.
The best stretching exercises are not complicated or time consuming. The most effective ones (4 core exercises) only take 30 seconds to complete. That means whatever you're doing, stop every 30-60 minutes and do these quick exercises.
With only 2-4 weeks from starting these exercises (depending on your carpal tunnel's severity) symptoms usually resolve completely.
<<<Doctor performs myofascial release massage
Doctors and therapists agree that a specific type of massage called myofascial release is best to treat carpal tunnel syndrome. That's because of how it's performed and what it does to tendons below the skin.
Its twisting and kneading motion breaks up restrictioons on tendons. As inflammation lessens, carpal tunnel symptoms disppear permanently
Normally, after a regimen of about 4 weeks of twice daily myofascial massage will fully resolve even severe symptoms. The downside of myofascial massage is that you cannot do it on yourself. A therapist (or a helper) needs to perform the circular, kneading motions required.
<<<CarpalRx performs the identical therapy
Myofascial release massage for carpal tunnel can be performed automatically using the CarpalRx device. The CarpalRx is patented, FDA cleared, and validated by clinical studies.
Best of all, the CarpalRx does not require visiting a trained therapist or doctor every day to get the same therapy.
The proprietary mechanism inside each CarpalRx kneads your skin, which breaks up restrictions below. Use it morning and evenings for 30 days. You have a 97% probability that pain, numbness, tingling, burning, shooting electric shocks, and weakness will be gone forever.
In fact, it's guaranteed to work or your money back!
Definitely not!
Here's what you need to know about carpal tunnel surgery including your chances for remission of symptoms.
In general, your doctor will use one of two surgical methods, depending on which he/she has the most experience. Anyone considering surgery should sit down with their doctor and discuss the various pros and cons of carpal tunnel release surgery.
The aim of all carpal tunnel surgery (called "carpal tunnel release surgery") it to release the median nerve from being trapped by swollen tendons. To relieve the pressure, the surgeon must cut a ligament which holds your wrist bones together. When cut, the bones snap apart, providing more "breathing room" for the median nerve.
The two methods are
open
carpal tunnel release surgery
and
endoscopic carpal tunnel release surgery.
These are detailed below.
The open technique is is the most common type of carpal tunnel surgery. The doctor makes a 2-3 inch long incision in your lower palm. This lets the surgeon clearly identify the ligament in order to cut it.
The big advantage of this technique is that the surgeon can clearly see the ligament and other important structures. This way, the surgeon can avoid damaging the median nerve, blood vessel, and other structures.
The disadvantage of the open technique is that it results in more postsurgical pain and longer recovery time. Also, more aftercare is required due to the larger incision. There is also a larger scar remaining after surgery.
Endoscopic carpal tunnel release surgery also aims to cut the ligament in order to relieve pressure on the median nerve. But instead of using a long incision on the palm, the doctor uses an endoscope to look inside the wrist joint.
The doctor makes one tiny incision in your palm for the endoscope, which also contains the scalpel. Sometimes two holes are used; one for the endoscope and a another one for the scalpel. These are called the single portal and double portal endoscopic methods, respectively.
The big advantage of endoscopic carpal tunnel release surgery is the use of a smaller incision (or incisions). That means less trauma to your hand. It results in much less post-surgical pain, less complicated aftercare, and a faster recovery time.
The disadvantage of this technique is the greater chance the doctor can accidentally cut or damage an important structure. That's because of a more narrow field of view offered by the endoscope.
As described above, non-surgical remedies include:
If you have MILD symptoms, then any of the above should be beneficial. Use night bracing, stretching or massage each day/night for 3-4 weeks.
If you have MODERATE symptoms, then yo need more aggressive therapy. That means daily application of myofascial release massage. You also must wear a night brace and do the stretching exercises at least three times daily. Do all this for about 30 days.
If you have SEVERE symptoms, you will need the most aggressive therapy. This will require twice daily application of myofascial release massage. Wear a night brace and do the stretching exercises every hour, especially whne using your hands a lot. It may require 30-60 days to see good results.
You can always call Dr. Zannakis (CarpalRx's Medical Director) for questions, advice & recommendations. It's FREE! Call 800-450-6118.
Carpal tunnel syndrome is not a disorder to take lightly. But since symptoms creep up slowly, many people don't recognize the the disorder until it has taken a firm hold. Determining you have this condition early is the BEST thing you can do, because mild symptoms are easily treated. But even if symptoms are moderate or severe, it's never too late to begin an earnest and aggressive therapy regimen to eliminate symptoms for good.
