Early treatment is the best fix for carpal tunnel syndrome

Special to the Herald-LeaderNovember 6, 2011 

President Barack Obama greeted shoppers at the Politics and Prose bookstore in northwest Washington on Saturday.

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Our hands are amazing. Almost everything we do in the course of a day requires the use of our hands. They can generate tremendous force for gripping, but they also perform precise and delicate manipulations. They work so well that we hardly give them a second thought — until something goes wrong.

When suddenly we can't button a shirt, open a jar or caress a loved one, we realize how much we rely on our hands.

One of the most common conditions affecting the hands is carpal tunnel syndrome.

The carpal tunnel is a narrow channel connecting the wrist and the palm. Through this tunnel pass nine tendons and the median nerve. The median nerve helps move the thumb and provides feeling to the thumb and the index and middle fingers.

Carpal tunnel syndrome is caused by increased pressure on the median nerve as it passes through this tunnel.

The carpal tunnel is a natural compression point in the median nerve. Any condition that causes swelling of the tendons that run with the nerve — trauma, pregnancy or repetitive use — can increase the pressure. Carpal tunnel syndrome is often linked to computer use. But carpal tunnel syndrome is as common among manual laborers as among office workers.

In most cases, the exact cause is unknown.

Early in the course of the disease, the increased pressure on the median nerve is mild, and so are the symptoms. Patients might experience occasional episodes of numbness and tingling in the thumb and the index and middle fingers, usually at night, when fluid accumulates in the hands. Patients will often describe waking up and shaking the hands to get the feeling back.

As carpal tunnel syndrome progresses, episodes occur more frequently, and restful nights become more rare. Patients will often report difficulty with fine manipulations, such as handling change or buttoning. Eventually, the fingers will be numb all the time. It is important to seek treatment before this stage, because some nerve damage can be irreversible, and a full recovery might not be possible.

Treatment does not always include surgery. Many patients who are treated early can be treated with splinting, physical therapy or behavior modification.

Patients with more advanced disease might need surgery to widen the carpal tunnel and take pressure off the nerve. It is a quick, outpatient procedure, and it can usually be performed with a local anesthetic. After surgery, most patients experience complete relief of their symptoms, but lifting and gripping are restricted for three to four weeks.

The surgery is straightforward, but, as with all hand surgery, it should be performed by surgical specialists with training and expertise in surgery of the hand. The amazing hand, the most complex machine that man has the capacity to understand, deserves no less.

Dr. Brian Rinker is an associate professor of plastic surgery at the University of Kentucky College of Medicine and the medical director of UK HealthCare's Hand Surgery Service.

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