Know the symptoms and be proactive to avoid further nerve damage.
By Joseph Woodward, MD
EvergreenHealth Hand Surgery
Do you experience numbness in your hands at night or with repetitive activity?
Do you find yourself dropping things, or notice cramps in your hands and forearms?
These symptoms may be associated with compressive neuropathy – or nerve compression.
A common form of this is carpal tunnel syndrome (CTS).
CTS presents with varying symptoms, such as pain, numbness and tingling in the hand and arm. One of the main nerves of the arm–the median nerve–becomes compressed in the wrist.
The carpal tunnel consists of bone on three sides and a thick ligament over the top, or “roof.”
In this tunnel are the nine tendons that bend or flex our fingers, the thumb and the median nerve, which gives sensation to the thumb, the index, the middle, and half the ring finger.
Symptoms of CTS can include numbness or tingling that most often occurs in the thumb, index, middle and ring fingers.
These symptoms usually occur at night, but may also be noticed while driving or during other similar activities.
Cramping and feelings of weakness and the tendency to drop things may also develop.
Certain repetitive and vibratory activities also predispose to developing symptoms.
There are several risk factors for CTS, including hereditary anatomy, repetitive hand use, prolonged flexed position of the wrist and pregnancy. Many health conditions also contribute, such as diabetes, thyroid disease, rheumatoid arthritis and osteoarthritis with associated swelling of the flexor tendons. Most cases of CTS combine some or all of these factors. Women and the elderly are also at higher risk.
CTS is often diagnosed by your history and symptoms alone. A hand surgery specialist will also perform an exam to note weakness and will attempt to re-create the symptoms.
Sometimes, specialized nerve conduction studies are ordered to confirm the diagnosis.
Mild cases can be treated with conservative measures such as a wrist splint at night or avoiding certain activities that tend to worsen symptoms.
However, once symptoms progress to a certain point, relieving the pressure on the nerve through a surgical procedure–carpal tunnel release–can be necessary.
The amount of improvement expected after surgery is directly related to how severe and longstanding the compression is, so early diagnosis is important.
Irreparable harm can occur if the process goes on too long, requiring complex reconstructive surgery if not treated in a timely fashion.
Carpal tunnel release surgery is an outpatient procedure performed endoscopically with a small incision at the wrist, or through an open incision in the palm.
Recovery is generally a few weeks with minor restrictions.
Some tenderness can persist for a few months, but usually does not impede function.
Most patients feel significant improvement in their symptoms.
This can occur overnight or take several months depending on the severity of the nerve compression.
Recurrent CTS can occur, but is rare.
If you have these symptoms frequently, ask your doctor about them, or see a hand specialist for an evaluation.
Dr. Joseph Woodward is a hand surgeon at EvergreenHealth Hand Surgery, part of the EvergreenHealth Neuroscience, Spine & Orthopedic Institute. He specializes in minimally invasive and endoscopic hand and wrist surgery, treatment of compressive neuropathies including endoscopic carpal tunnel release, treatment of Dupuytren's disease, hand trauma, wrist arthroscopy, hand and wrist arthritis, tendonopathies, trigger finger and work injuries
Call 425.899.4810 for an appointment with Dr. Woodward.