Monday, August 15, 2022

What To Do If You Have Carpal Tunnel

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What Is Carpal Tunnel

How to Tell if You Have Carpal Tunnel? | 5 Home Tests for Carpal Tunnel

Carpal tunnel syndrome affects millions of Americans each year, yet experts arent entirely sure what causes it. A combination of lifestyle and genetic factors are likely to blame. However, the risk factors are so diverse that nearly everybody has one or more of them at some point in their lives.

Carpal tunnel syndrome can cause numbness, stiffness, and pain in the fingers and hand. There is no known way to prevent carpal tunnel, but some exercises can reduce your chances of experiencing symptoms.

We spoke with John DiBlasio, MPT, DPT, CSCS, a Vermont-based physical therapist, for exercise suggestions.

Here are three basic moves you can do any time of day. These stretches and exercises are simple and dont require any equipment. You can easily do them at your desk, while waiting in line, or whenever you have a minute or two to spare.

Problems like carpal tunnel are best addressed with stretches done throughout the day, says Dr. DiBlasio. Protect your wrists in just a few minutes a day with these easy movements.

Remember that nursery rhyme from when you were a kid? Turns out its a great stretch for your hands:

  • Start with your fingertips touching and pointing down toward the floor.
  • Spread fingers apart as far you can, then steeple the fingers by separating palms of hands but keeping fingers together.
  • This is as straightforward as it sounds: Shake your hands like youve just washed them and are trying to air dry them.

  • Extend your arm in front of you, palm up.
  • What Actually Happens During Carpal Tunnel Syndrome

    According to Ryan C. Adams, MOT, OTR/L, CLT, hand and upper extremity rehabilitation specialist at Meritus Total Rehab Care, the injury occurs as a result of median nerve compression in the wrist and often results in symptoms that are consistent with numbness and tingling into the thumb, index, middle and sometimes ring fingers. Often these symptoms will also result in decreased grip strength and inability to hold objects without dropping them.

    Typically, this condition is treated conservatively, with bracing and activity modification; however, if symptoms are severe or do not respond well to conservative treatment, carpal tunnel release surgery may be recommended, Adams says.

    Carpal Tunnel Release Surgery

    The goal ofcarpal tunnel surgeryis to de-compress the median nerve. All hand surgeons will advise you that the more advanced or intense your carpal tunnel, the less likelihood surgery will relieve symptoms. In other words,surgery has a higher failure rate with more severe symptoms.

    Carpal tunnel release surgery can be performed using theendoscopic surgerymethod or theopen releasemethod. Each method has itspros and cons,and your doctor will choose which to use. Usually the doctor will specialize in one or the other method.

    Whichever surgical method is used, the success rate of carpal tunnel release surgery is proportional to how severe your symptoms are at the time of surgery.;

    Unfortunately, there are no good statistics to show the association between symptoms severity and surgical success rates. Therefore, ask your surgeon what his/her success rate is relative to having mild, moderate or severe symptoms.

    Also make sure you ask the doctor for an answer that defines success aspatient satisfaction;3 years after surgery.;Why? When combining all levels of severity, the publishedsuccess rate of surgery is 50% patient satisfaction at year 3.;

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    Why Carpal Tunnel Symptoms Arent Resolved After Surgery

    Carpal tunnel surgery can fail and leave you with remaining symptoms for various reasons including:

    Incomplete decompression of the carpal ligament the surgeon did not fully release the pressure from the median nerve, resulting in persistent symptoms.

    Nerve scarring improvements are shown after surgery but symptoms return after the first few months because the median nerve was scarred and tethered to the radial wall of the carpal tunnel.;

    Nerve injury iatrogenic injury to the median nerve or nearby branches may cause worsening or new symptoms to appear immediately after surgery.

    Poor diagnoses patients are often suffering from a condition that exhibits symptoms similar to CTS, such as arthritis, pinched nerve in the neck, or disc degeneration in the cervical spine that can cause irritation of the median nerve. If the nerve problem is being caused by a different issue, carpal tunnel surgery will not resolve all CTS symptoms.

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    Pregnancy and Carpal Tunnel Syndrome

    In some cases, surgery is needed to make the symptoms go away completely. The surgery involves cutting the;ligament;that may be pressing on your median nerve. Youll usually get back the normal use of your wrist and hand within a few weeks to a few months after surgery.

    Doing the hand, wrist, and finger exercises that your doctor tells you to do after surgery is very important. Without exercise, your wrist may get stiff, and you may lose some use of your hand.

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    Traditional Treatments For Carpal Tunnel Syndrome

    More serious cases of carpal tunnel syndrome may require your doctors help.

    Your doctor may recommend corticosteroids to lessen your pain and inflammation. These drugs reduce the amount of swelling and pressure placed on the median nerve. Injections are more effective than oral steroids. This therapy may be particularly effective if your CTS is caused by inflammatory conditions, such as rheumatoid arthritis.

    Your doctor may also recommend surgery to relieve pressure on the nerve. This typically involves making one or two incisions in the area affected and cutting the ligament involved. This will release the nerve and increase the space around the nerve.

    The ligament will eventually grow back, allowing more space for your nerve than there was before. If your CTS is severe, surgery may not clear up your symptoms completely, but it should help you feel better and help prevent any further damage to the nerve.

    Prevention Of Carpal Tunnel Syndrome

    To help prevent carpal tunnel syndrome, you can minimize stress on your hands and wrists. A few tips:

  • Relax your grip whenever possible. If your job involves a keyboard or a cash register, hit the keys as softly as possible. If you write for lengthy periods, use a big pen with a soft grip adapter and free-flowing ink.
  • Take frequent breaks. Stretch and bend your hands and wrists periodically. Do something different for a while, especially if youre using equipment that vibrates.
  • Protect your wrist. Dont bend your wrist all the way up or down. Keep your wrist in a relaxed middle position. Your keyboard should be at elbow height or slightly lower.
  • Improve your posture. If you sit incorrectly, your shoulders can roll forward. This shortens your neck and shoulder muscles and compresses the nerves in your neck. All this pressure will affect your wrists, fingers, and hands.
  • Change your computer mouse. Dont strain your wrist while working with your mouse; make sure its in a comfortable position.
  • Keep your hands warm. If you work in a warm environment, youre less likely to develop hand pain and stiffness. Fingerless gloves will keep your hands and wrists warm.
  • Carpal tunnel syndrome at work is a serious matter. In some settings, it may be necessary to redesign workstations to ensure that the workers wrist is in a natural position during work. Supervisors should also make sure that jobs are rotated among workers whenever possible.

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    Treatment Of Carpal Tunnel Syndrome

    Your health care provider will figure out the best;treatment for you;based on:

    • Your age

    • Your overall health and medical history

    • How bad your wrist is right now

    • How well you tolerate specific medications, procedures, or therapies

    • How bad the disease is expected to get

    • Your opinion or preference

    Treatment may include:

    • Splinting your hand.;This;helps keep your;wrist from moving. It also eases the;compression of the nerves inside the tunnel.

    • Anti-inflammatory medication.;These may be oral or injected into the carpal tunnel space. These;reduce the swelling.

    • Surgery.;This eases compression on the nerves in the carpal tunnel.

    • Worksite changes.;Changing position of your computer keyboard or making other ergonomic changes can help ease symptoms.

    • Exercise.;Stretching and strengthening exercises can be helpful in people whose symptoms have gotten better. These exercises may be supervised by a physical or occupational therapist.

    Why Might I Need Carpal Tunnel Surgery

    How to Determine if You Really Have Carpal Tunnel Syndrome – Dr Mandell, DC

    A diagnosis of carpal tunnel syndrome is about the only reason to have a carpal tunnel surgery. And even then, your doctor will likely want you to try nonsurgical treatments first. These may include over-the-counter pain medicines, physical therapy, changes to the equipment you use at work, wrist splints, or shots of steroids in the wrist to help relieve swelling and pain.

    The reasons that a doctor would recommend a carpal tunnel release surgery may include:

    • The nonsurgical interventions for carpal tunnel syndrome dont relieve the pain.
    • The doctor performs an electromyography test of the median nerve and determines that you have carpal tunnel syndrome.
    • The muscles of the hands or wrists are weak and actually getting smaller because of the severe pinching of the median nerve.
    • The symptoms of carpal tunnel syndrome have lasted 6 months or longer with no relief.

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    Dont Overlook Hand Therapy

    Adams says that though hand therapy is a common conservative treatment option, the benefits of this service are often overlooked following surgery. As a result, patients may experience increased pain, hand stiffness and longer recovery times that could have been avoided.

    Following carpal tunnel release surgery, the patient should follow a protocol recommended by their surgeon. Although protocols can be personalized, typically they include splint wear/care, specific exercises, desensitization recommendations, scar management and return to daily activities.

    These important phases of recovery are often misunderstood or neglected, resulting in complications that include pain and increased length of recovery, Adams says.

    According to a 2016 retrospective case study, it was reported that members of the American Society of Surgeons of the Hand revealed that only 12% of surgeons routinely prescribed hand therapy after carpal tunnel release surgery. In that same literature review, it was also determined that patients who had a minimum of one hand therapy visit, had increased function of the hand coupled with a lower risk of palm pain. Therefore, the study determined that hand therapy is essential in providing the best level of care for patients who require carpal tunnel release surgery.

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    Bilateral Acute Carpel Tunnel Syndrome

    Acute carpal tunnel syndrome is typically caused by trauma, says John-Paul H. Rue, MD, orthopedic sports medicine surgeon with Orthopedics and Joint Replacement at Mercy Medical Center in Baltimore, MD.

    Possible Causes of TraumaDr. Rue explains, This trauma could be from a fracture or dislocation, burns, infection , bleeding or from a high-pressure type of injection injury.

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    How Is Carpal Tunnel Syndrome Related Arm Pain Treated

    As soon as pain begins, you should seek out medical care, as the symptoms will only become worse over time without treatment. Initially, something to reduce inflammation is typically recommended. A course of nonsteroidal anti-inflammatory drugs such as Advil or Motrin or a supplement like curcumin may be prescribed.; The affected wrist is typically splinted to restrict movement and aid in resting the nerves and ligaments. In some cases, doctors will discuss injections of corticosteroids to relieve pain. These treatments can provide relief, but they are not a cure.

    If the diagnosis is a result of an inflammatory disease such as rheumatoid arthritis, treatment of the disease may supersede treatment of CTS.

    Read Also: How To Reduce Wrist Pain

    When Its Time To See The Doctor

    How to know if you have carpal tunnel syndrome

    If these home treatments dont ease your pain in one or two weeks, it might be time to see an orthopaedic physician, who specializes in treatment of bones, joints and muscles.

    Your doctor may recommend surgery if theres severe damage to your median nerve or to prevent permanent sensory or functional loss, Dr. Seitz says.

    The surgery involves cutting the band of tissue in the wrist that crosses the median nerve to lessen the pressure.

    Over time, surgery may be the best route to permanent relief, Dr. Seitz says.

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    When To Get Surgery

    “The mistake that people often make is waiting too long to get surgery,” says Dr. Rozental. “I see a lot of people who say that their numbness was gradually worsening and now their hand is completely numb and has been for a year.” If the nerve is compressed long enough, the muscle atrophies and the nerve damage becomes permanent, she says.

    So, if your carpal tunnel symptoms aren’t responding to other treatments, take action quickly.

    The surgery takes 10 minutes under a local anesthetic. Unless you do a job that involves manual labor, you can typically go right back to normal activities, says Dr. Rozental.

    “I tell my patients all the time that a carpal tunnel release done at the right time for the correct diagnosis is very successful,” she says.

    What Is The Success Rate For Carpal Tunnel Syndrome Surgery

    Surgery for carpal tunnel syndrome has a very high success rate of over 90%. Many symptoms are relieved quickly after treatment, including tingling sensation in the hands and waking up at night. Numbness may take longer to be relieved, even up to three months. Surgery wont help if carpal tunnel syndrome is the wrong diagnosis.

    When the carpal tunnel syndrome has become severe, relief may not be complete. There may be some pain in the palm around the incisions that can last up to a few months. Other after-surgery pain may not be related to carpal tunnel syndrome. Patients who complain of pain or whose symptoms remain unchanged after surgery either had severe carpal tunnel syndrome, had a nerve that was not completely released during surgery, or did not really have carpal tunnel syndrome. Only a small percentage of patients do not gain substantial relief from symptoms.

    Last reviewed by a Cleveland Clinic medical professional on 10/22/2019.

    References

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    What Are The Potential Causes Of Cts

    How can I check myself for carpal tunnel syndrome?

    The;National Institute of Neurological Disorders and Stroke reports that CTS may be caused by wrist injuries, overactive pituitary gland, hypothyroidism,;and arthritis. They also claim that repeated flexing or bending of the wrist, pregnancy,;and menopause could contribute to CTS.

    The;Arthritis Research UK ;has claimed that occupations involving typing, repetitive wrist movements and usage of vibrating tools may lead to an onset of CTS.

    The;Mayo Clinic;has also claimed that the usage of vibrating tools or other occupations that require prolonged and repetitive flexing of the wrist may contribute to the development of CTS.

    These claims concerning occupation and CTS make sense. There are many occupations that do require the same wrist and finger motion on a day-to-day basis. A number of the same people who occupy these positions have been known to experience CTS.

    However, a positive association between CTS and specific occupations is anything but certain.

    In reading a number of pamphlets and studies concerning CTS there seems to be an assumed belief about occupations that involve repetitive wrist and finger movements must contribute in some way to the development of CTS. Yet, data supporting this notion has proven to be elusive.

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    How Can I Prevent Carpal Tunnel Syndrome

    You can prevent carpal tunnel syndrome by making lifestyle changes that reduce your risk factors for developing it.

    Treating conditions such as diabetes, high blood pressure, and arthritis reduces your risk for developing carpal tunnel syndrome.

    Paying careful attention to hand posture and avoiding activities that overextend your wrist are also important strategies for reducing symptoms. Physical therapy exercises may be helpful as well.

    What Are The Symptoms

    Carpal tunnel syndrome can cause tingling, numbness, weakness, or pain in the fingers or hand. Some people may have pain in their arm between their hand and their elbow.

    Symptoms most often occur in the thumb, index finger, middle finger, and half of the ring finger. If you have problems with your other fingers but your little finger is fine, this may be a sign that you have carpal tunnel syndrome. A different nerve gives feeling to the little finger.

    You may first notice symptoms at night. You may be able to get relief by shaking your hand.

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    What Happens After Carpal Tunnel Surgery

    Your wrist will likely be in a heavy bandage or a splint for 1 to 2 weeks. Doctors usually schedule another appointment to remove the bandage or splint. During this time, you may be encouraged to move your fingers to help prevent stiffness.

    Youll probably have pain in your hand and wrist after surgery. Its usually controlled with pain medicines taken by mouth. The surgeon may also have you keep the affected hand elevated while sleeping at night to help decrease swelling.

    Once the splint is removed, you will likely begin a physical therapy program. The physical therapist will teach you motion exercises to improve the movement of your wrist and hand. These exercises will speed healing and strengthen the area. You may still need to sometimes use a splint or brace for a month or so after surgery.

    The recovery period can take anywhere from a few days to a few months. In the meantime, you may need to adjust job duties or even take time off from work while you heal. Your doctor will talk to you about activity restrictions you should follow after surgery.

    Let your doctor know about any of the following:

    • Fever
    • Redness, swelling, bleeding, or other drainage from the incision
    • Increased pain around the incision

    These problems may need to be treated. Talk to your doctor about what you should expect and what problems mean you need to see your doctor right away.

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