What are the basics about carpal tunnel syndrome?
I’m sure you’re reading this because you have problems with your hand or fingers. Hence, you’d like to know more about what’s going on. If they’re hurting, or they go numb or tingle (especially at night, and especially your thumb) you probably have carpal tunnel syndrome. Sure, you suspected it. But what is it about carpal tunnel syndrome that you really need to know? Make sure you have this basic information, especially before choosing a carpal tunnel doctor so you can have an intelligent discussion.
The medical condition we know as “carpal tunnel syndrome” is sometimes simply described as “carpal tunnel”. It is so widespread the U.S. Centers for Disease Control (CDC) estimate most people with chronic finger and hand pain (excluding those with arthritis) actually have carpal tunnel. That means the condition affects nearly 20 million Americans, with 250,000 new cases each year.
Carpal tunnel syndrome as a “peripheral entrapment neuropathy”. This means the median nerve, running from the arm to the hand through the wrist, is squeezed or compressed. Because the squeezing happens inside a tight canal called the “carpal tunnel”, the nerve has nowhere to go, and is slowly crushed.
The effects on the median nerve
Among other things, this nerve controls sensations on the palm side of the hand, as well as the thumb and fingers (but not the little finger). The nerve passes through the “carpal tunnel”. The tunnel is a canal formed between the wrist bones and a ligament holding the bones together. Think of it like an archery bow, where the bones form the wooden portion and the ligament is the bowstring. Hence, the “C” shaped canal forms a passageway for the nerve and the tendons of the flexor muscles of the hand.
Like all nerves, the median nerve reacts badly when squeezed. Squeezing produces uncomfortable sensations in order to tell you, “I’m a nerve in trouble”. The idea is for you to take care of the troubled nerve, like removing the pressure on it. But with carpal tunnel pain, that isn’t easy.
Causes of nerve entrapment
The logical question most people ask is, “What causes median nerve entrapment to begin with?” Actually, inflamed tendons cause the entrapment. Doctors do not fully understand the reasons for tendon inflammation, but it has to do with an inability to glide smoothly inside the tendon sheath. As a result, the sheaths try to form a protective cushion and fill with fluid. The resultant swelling greatly increases the tendon’s diameter. And a vicious cycle begins: more swelling causes more injury, and the tendons react with more fluid buildup. The innocent victim is the nerve, which is compressed with everything else inside the carpal tunnel.
Thus, when talking about carpal tunnel, we see fluid retention is the underlying cause. Almost everybody knows fluids tend to accumulate in joints like the wrist, so it’s no wonder carpal tunnel is so common in the population. It’s also no wonder why many pregnant women suffer from this condition. Carpal tunnel pregnancy issues arise because hormonal changes cause fluid imbalances in the body.
All about carpal tunnel symptoms
Research about carpal tunnel shows it usually begins slowly. A quick onset can occur during pregnancy. However, even those symptoms may take 2-3 months to develop fully. Under normal conditions, pain generally starts gradually, over months or years. It may even take months to notice pain at all. But these are the warning signs. Usually, you start feeling sensations like tingling, burning, itching or numbness in the palm of your hand or fingertips. It’s especially bad in the thumb, and some call it carpal tunnel thumb pain. Symptoms usually are bad in the index and middle fingers. In its first stages, your fingers might feel swollen even though they’re not. These sensations can occur in one or both hands simultaneously.
Also at this stage it’s a common to lose sleep: you wake up having to shake out the numbness or tingling in your hands. Simple everyday activities like driving, typing and even holding a phone or umbrella can aggravate the symptoms.
As the median nerve gets more and more compressed and the condition advances, you might also feel a decrease in grip and pinch strength. You might and find it difficult to make a fist pick up small objects like keys or coins. You may feel clumsy buttoning a shirt. In more intense and chronic carpal tunnel cases, the muscles at the base of your thumb begin to waste (or shrink), as indicated by puckering in the skin below your thumb. In the most extreme cases of carpal tunnel, you lose hot and cold sensations on your fingers. Finally, the pain, numbness and tingling become crushing, radiate up your arm, making daily life difficult.
All about carpal tunnel diagnosis
- An early diagnosis of carpal tunnel syndrome is important to prevent permanent damage to the median nerve. For a complete carpal tunnel test, a doctor performs a physical examination of the hands, arms, shoulders and neck. This is important because it can rule out other painful conditions such as arthritis. Doctors often misdiagnose carpal tunnel syndrome as some other condition, like muscle strain.
- When a doctor tells you about carpal tunnel tests which are more comprehensive, they will include detailed examination of the hand and wrist. They look for tenderness, swelling, warmth, and discoloration. The doctor tests finger sensitivity. The doctor also tests muscles at the base of the hand for strength and signs of wasting. Routine lab tests and X-rays can show if you have diabetes, arthritis or fractures causing the symptoms.
- Doctors who suspect carpal tunnel syndrome will use some simple tests to mimic symptoms. These are provocative tests. They include the Phalen, Durkan and Tinel tests. In past decades a diagnosis using EMG tests confirmed carpal tunnel syndrome. It required using thin electrode needles inserted into the hand and wrist, followed by tiny electric shocks to determine the speed with which the nerves react. This test was costly, uncomfortable and painful. It also gave too many “false positive” results over 50% of the time. As a result, in recent years the EMG test has fallen out of favor with most doctors. Finally, magnetic resonance imaging (MRI) can show the anatomy of the wrist. But it is useless for diagnosing carpal tunnel syndrome.
Who gets carpal tunnel?
Carpal tunnel syndrome usually occurs in adults. You are much more likely to get it if a close family member has it. Doctors do not completely understand this genetic link but it is a real relationship nonetheless. Women are three times more likely to develop carpal tunnel because a woman’s wrist may be smaller than a man’s. Generally, symptoms in the dominant hand appear first, and it has the most intense pain. Metabolic conditions like diabetes place the person at higher risk for carpal tunnel syndrome, probably because diabetes makes nerves more susceptible to compression.
Workers in single industry are not the only ones who get carpal tunnel. However, it’s more common in those who work on an assembly line (manufacturing, finishing, cleaning, sewing, food packing, etc.). Also, those who use vibration equipment on the job (jackhammers, drills, saws, etc.) or do a lot of forceful hand movements (hairdressers, dental hygienists, etc.) are at high risk. The general rule is if you make multiple forceful hand movements for more than 6 hours per day, the risks are greater — and you need to take precautions now.
The CDC estimates carpal tunnel affects 3 of every 10,000 workers to the degree they lose time from work. Half of these people miss more than 10 days of work. The CDC estimates the average lifetime cost of carpal tunnel syndrome (including medical bills and lost time on the job is $33,000 for each injured worker.
About carpal tunnel prevention
In an ideal world, you would take care of hand or finger symptoms as soon as they appear. But most people don’t do that, mostly because they don’t recognize the problem early enough to intervene. But if you already know you’re are stressing your hands, preventing carpal tunnel syndrome starts with “avoidance”.
Avoiding carpal tunnel:
The National Institutes of Health and the American Academy of Orthopedic Surgeons recommend several things you can do avoid getting carpal tunnel in the first place. You can begin by recognizing the highest risk factors, like typing, keyboarding, using power tools, or generally making forceful and repetitive hand movements. Take measures to reduce any hand-associated workloads, like taking shortcuts or eve resting periodically. Use hand rests when you can. Using warm and well-fitting gloves as cushions is crucial. Also, pay attention to the position of each hand while it works and types. For instance, too much bending for a long time can cause carpal tunnel keyboarding stresses you might not even be aware of. At the workstation, adjust the chair, keyboard, mouse and monitor height. Be conscious of posture and all hand positions.
Rest for carpal tunnel:
When you recognize you already have symptoms then you can prevent them from worsening. Rest Is the key. Find ways to rest your hands as much as possible because it’s one of the best things you can do to prevent hand injury. Rest your hands as often as you can: most periods of rest only need 10 seconds every 10 minutes. Let your hands dangle, shake them out, and then do some brief finger stretching and wrist wringing. This increased blood flow and decreases inflammation.
About carpal tunnel treatments
If you have very bad symptoms of carpal tunnels syndrome then you must take steps to keep the condition from worsening. Take serious and immediate action now to prevent life from becoming miserable. Treatment falls into broad categories; non-surgical remedies and surgery. I will review these in detail below.
Don’t overstress your hands:
Overall, begin by removing or avoiding the activity causing hand stresses in the first place. Almost everybody has to use their hands, no matter the occupation, so this can be tricky. But you can try to find ways to take shortcuts, and rest and stretch each hand frequently. For instance, since many people complain of carpal tunnel mouse pain, then find ways to use the mouse without straining your fingers and hand.
2. Use a night brace or splint:
If symptoms are more bothersome, wear a good carpal tunnel brace at night. When we sleep we unconsciously bend our wrists (“hyper-flexing” or “hyper-extending”). This increases pressure inside the wrist joint, especially in the carpal tunnel space. Of course, more pressure is not good for the nerve, and in the morning you may wake up with a hurting or tingly hand and fingers. A carpal tunnel brace at night will keep the hand from over-bending while you sleep.
3. Try limited use anti-inflammatory drugs:
These drugs include NSAIDS, like Advil, Tylenol, and Motrin. Take them to relieve pain only when pain is unbearable. They reduce swelling around the nerve which eases the pressure and irritation on it. However, all NSAIDS are toxic and taking them for more than a few weeks can cause kidney and liver damage, and can increase the risk of heart attack and stroke; thus, use them sparingly, and not on a long term basis.
4. Do stretching exercises:
You should stretch your fingers often, especially if you do a lot of manual work. There are a number of finger, hand, and wrist exercises you can do. They take only a couple minutes but can make a huge difference. Therapists suggest about 4 minutes of exercises for every 20 minutes of keyboarding to avoid reduce symptoms of carpal tunnel syndrome.
5. Avoid supplements:
Don’t waste time and money on supplements for carpal tunnel. There is no evidence any of them have an effect. This is especially true for vitamin B6 or B12. They do not help carpal tunnel syndrome at all, yet some people claim beneficial results – probably a placebo. Vitamin B6 (plus Biotin and Riboflavin) will take a long time to have any effect on the body, if any. But if you insist on dosing yourself, do not take more than 100 milligrams of vitamin B6 daily; it can make you sick and cause other problems.
About carpal tunnel non-surgical remedies
When carpal tunnel syndrome has advanced enough where you need a remedy to eliminate the condition, there are multiple non-surgical therapies publicized to be the best. The FDA has approved only two to relieve symptoms:
If you’re considering steroid (cortisone) injections as a non-operative option for carpal tunnel, then consider it carefully. New research shows these popular steroid shots (which cost about $500 each) don’t help most carpal tunnel patients in the long-term. A steroid injection can help some patients with carpal tunnel syndrome in the short term, but most patients end up having carpal tunnel surgery. According to Dr. Isam Atroshi, one year after diagnosis of carpal tunnel syndrome, 81% of patients opted for surgery. Finally, doctors must use steroid shots sparingly. You should have no more than three injections per lifetime due to the potentially heavy side effects. These include weight gain, kidney malfunction, nerve damage, joint damage and osteoporosis. This is why experts say doctors should first recommend braces and massage therapy before considering cortisone shots.
Myofascial release massage therapy:
Also carpal tunnel symptoms worsen, myofascial release massage is an excellent remedy. This is an ancient technique which still works today. Usually a therapist will work the tissues of the wrist and forearm using a kneading motion. Doing so breaks up the adhesions formed between tissues, and also drains fluid buildup in the wrist joint. The result is removal of pressure from the median nerve. Apply the therapy once a day for approximately 4 weeks. This gives the tissues enough time to heal, and drain fluid themselves – as they would naturally do.
About carpal tunnel Surgery
Carpal tunnel surgery aims at cutting the ligament over the wrist joint to allow the carpal tunnel additional space to snap open and relieve pressure on the nerve. This pressure is so high, when doctors pierce the carpal tunnel, fluid often squirts out of the wrist joint.
The surgery can either be “open release” or “endoscopic”. Open release carpal tunnel surgery means the surgeon creates a 2-3 inch slit on the palm. The surgeon cuts the ligament, the sutures the skin. A significant palm scar results.
Endoscopic surgery simply means a surgeon uses an endoscope in order to see inside the carpal tunnel rather than opening the skin over the carpal tunnel completely. The surgery uses a thin, flexible tube containing a camera guided through a small incision in the wrist or through both the wrist and palm. The surgeon can cut the ligament without having to make large incisions – or creating a long scar.
Generally, you can go home the same day. But carpal tunnel surgery recovery can be long. Every patient will require 3-12 months of rehabilitation and physiotherapy. In most cases alleviation of symptoms is almost immediate following surgery. However, in many patients it takes several months and up to a year. In other patients, the symptoms subside only a little or not at all. Also, symptoms can disappear for months and then return. That’s because surgery doesn’t address the underlying problem, which is tendon inflammation: swelling can return as fluid builds up again.
Every patient must avoid heavy use of the hand for a few weeks. Returning to work depends on several factors. If you heal fast, had dominant hand surgery, use a lot of hand movements on the job, and commit to rehabilitation, these will all factor into recovery time.
Learning about carpal tunnel syndrome is a process you MUST start if you’re serious about curing your symptoms. Be your own healthcare advocate because no one will take better care of you than you!
Two 15 minute Carpal Rx treatments
for 30 days cures symptoms in
97% of carpal tunnel patients.
15 years ago my wife was waking up during the wee hours screaming from carpal tunnel pain.
I’m not exaggerating. She’d literally scream from pain shooting up through her wrist to her shoulder. Poor girl, she still shudders when she thinks about it.
Being a physiologist, I’m skilled in a physical therapy technique called myofascial release. It’s a type of massage with an excellent track record for completely curing carpal tunnel symptoms.
So I’d massage her arm until the pain subsided and we could both go back to sleep. But her pain was so severe that she insisted on wanting surgery. It was so bad that she was afraid to go sleep at night.
I was dead-set against surgery because I knew myofascial release was a much better option. I made a bargain with her. Give me 30 days to cure her symptoms using massage and if it didn’t work – I’d go along with the surgery.
She agreed and I got busy in the lab. I hodgepodged together the first Carpal Rx prototype. Using it before bed for 15 minutes, she was able to sleep through the night by the 2nd day.
Carpal Rx, born out of love and compassion.
Dr. Z invented Carpal Rx to cure his wife’s symptoms so she didn’t have to undergo surgery.
He invites your questions.
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