February 23, 2010 in Features

Carpal tunnel treatments have uneven results

Peter H. Gott, M.D.
 

To contact Dr. Gott

Readers may write to Dr. Gott c/o United Media, 200 Madison Ave., Fourth Floor, New York, NY 10016.

On the Web: www. AskDrGottMD.com.

DEAR DR. GOTT: I am a 64-year-old female with carpal-tunnel syndrome in my right hand. I wear a wrist splint when I go to bed. For many years, it hasn’t been too much of a nuisance, but over the past few months, about once every seven to 10 days, I have an episode of painful numbness that takes more than a half-hour to go away. The incidents happen at night while I am sleeping. I have to get out of bed and try to shake the numbness away. I have also tried running hot water from the faucet over my hands, but it still takes a long time to subside.

I do have numbness in my hand during the day, but it is not as intense. It occurs when I apply my makeup, style my hair, write, drive and a few times it has happened while playing tennis. Is there anything short of surgery that can be done?

DEAR READER: Carpal tunnel syndrome is a common condition of the hands and wrist. It is commonly thought to be caused by using a computer keyboard for extended periods of time, repeatedly; however, it actually has many causes.

The condition involves the median nerve that runs though the carpal tunnel. This tunnel protects the nerve and the nine tendons that allow us to move our fingers. Problems arise when the nerve becomes compressed, causing tingling or numbness of the fingers (excluding the little finger) or hand, a sense of weakness causing a tendency to drop objects, and pain extending from the wrist up the arm into the shoulder – typically on the palm side of the forearm, or from the wrist down into the fingers.

The nerve itself is known as a mixed nerve because it provides both sensory and motor functions. The sensory portion of the nerve is responsible for providing sensation to the thumb, index and middle fingers and the middle-finger side of the ring finger.

Causes of pressure on the medial nerve include specific health conditions such as rheumatoid arthritis, diabetes, pregnancy-related fluid retention, thyroid disorders and menopause, repetitive flexing and extending of the hand and wrist tendons, wrist injuries that cause swelling, and having a narrower-than- average carpal tunnel. Risk factors include overuse or strain from certain tasks such as from the use of power tools or heavy assembly-line work, having a family history of CTS, having certain health conditions and being female, because women are three times more likely to develop the condition. While computer work is commonly considered a cause and risk factor, scientific evidence is not definitive on this point.

Those with mild symptoms may need only to take frequent breaks to rest their hands and/or apply cold packs to reduce occasional swelling. As symptoms increase or if these techniques fail to provide relief, wrist splinting such as you have used is an appropriate next step. Nonsteroidal anti-inflammatory drugs may offer relief by reducing swelling and pain. A final option is corticosteroid injections directly into the wrist to decrease inflammation. If the CTS is caused by an underlying health condition, treating that condition may result in lessened CTS symptoms.

The last resort is surgery, which does not work for everyone; however, about 70 percent of those who have undergone the carpal-tunnel-release procedure say they are completely or very satisfied with their results. Some may experience residual pain, numbness or weakness.

Speak with your physician regarding further treatment options, or request a referral to a specialist who can better help you.


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