Advancing Orthopaedic Medicine Through Research
The doctors and researchers in our Center for Orthopaedic Research and Translational Science at the Milton S. Hershey Medical Center are committed to advancing our field through scientific discovery and education. As the only academic medical center in central Pennsylvania, Hershey Medical Center is a national leader in research, in partnership with Penn State College of Medicine, and on the leading edge of new treatment options, including clinical trials.
When To Consider Surgery
If these home treatments dont ease your pain in one or two weeks, it might be time to see an orthopedic physician, who specializes in the treatment of bones, joints and muscles. More intensive treatments might be suggested and your healthcare provider may also look for other conditions that can be affected by carpal tunnel syndrome.
A recent study on which Dr. Seitz worked found that patients with carpal tunnel syndrome who may also have amyloidosis, a protein disorder, could be at risk for congestive heart failure. In this case, a biopsy can be performed during carpal tunnel surgery to test for amyloidosis.
Your healthcare provider may recommend surgery if theres severe damage to your median nerve or to prevent permanent sensory or functional loss, Dr. Seitz says.
Surgery for carpal tunnel syndrome involves cutting the ligament at the base of your palm that covers the carpal tunnel. This procedure increases the size of the carpel tunnel, taking pressure off both your median nerve and your tendons.
Over time, surgery may be the best route to permanent relief, Dr. Seitz says.
What Is The Carpal Tunnel
The carpal tunnel is a narrow canal or tube in the wrist. Similarly to a tunnel you could travel through by car, this part of the wrist allows the median nerve and tendons to connect the hand and forearm. The parts of this tunnel include:
- Carpal bones: These bones make up the bottom and sides of the tunnel. They are formed in a semi-circle.
- Ligament: The top of the tunnel, the ligament is a strong tissue that holds the tunnel together.
Inside the tunnel are the median nerve and tendons.
- Median nerve: This nerve provides feeling to most of the fingers in the hand . It also adds strength to the base of the thumb and index finger.
- Tendons: Rope-like structures, tendons connect muscles in the forearm to the bones in the hand. They allow the fingers and thumb to bend.
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Can Carpal Tunnel Syndrome Be Prevented Or Avoided
You can take steps to prevent carpal tunnel syndrome. The following actions may help to prevent it:
- Lose weight if youre overweight.
- Get treatment for any disease you have that may cause carpal tunnel syndrome.
- If you do the same tasks over and over with your hands, try not to bend, extend, or twist your hands for long periods of time.
- Dont work with your arms too close or too far from your body.
- Dont rest your wrists on hard surfaces for long periods of time.
- Switch hands during work tasks.
- Make sure the tools you use arent too big for your hands.
- Take regular breaks from repeated hand movements to give your hands and wrists time to rest.
- If you use a keyboard a lot, adjust the height of your chair so that your forearms are level with your keyboard, and you dont have to flex your wrists to type.
Many products you can buy, such as wrist rests for a computer keyboard, are supposed to ease symptoms of carpal tunnel syndrome. No one has proven that these products really prevent wrist problems. Some people may have less pain and numbness after using these products, but other people may have increased pain and numbness.
How Often Is Hand Pain Caused By Carpal Tunnel Syndrome
While carpal tunnel syndrome is a common condition, it has a different set of symptoms from many other sources of hand pain. There are actually several similar conditions that cause hand pain. These include:
- De Quervains tendinosis: A condition where swelling affects the wrist and base of the thumb. In this condition, you will feel pain when you make a fist and simulate shaking someones hand.
- Trigger finger: This condition causes soreness at the base of the finger or thumb. Trigger finger also causes pain, locking and stiffness when bending the fingers and thumb.
- Arthritis: This is a general term for many conditions that cause stiffness and swelling in your joints. Arthritis can impact many joints in your body and ranges from causing small amounts of discomfort to breaking down the joint over time .
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Could Your Job Be To Blame
It’s a common belief that frequent typing can lead to carpal tunnel syndrome. But it’s actually three times more common among assembly line workers than it is among data-entry personnel — and frequent use of vibrating hand tools increases the risk. In contrast, one study found that even heavy computer use — up to seven hours a day — did not make people more likely to develop carpal tunnel syndrome.
Carpal Tunnel Is It Causing Your Shoulder Pain
Carpal tunnel syndrome is a common but potentially debilitating condition of the wrist and hand. It can detrimentally impact the use of the entire arm, as well as the shoulder.
Excessive demands on the hands and wrists makes this is a very common issue. In fact, 1 out of every 20 people in the United States have Carpal Tunnel.
While surgery is often performed to correct the issue, it is not necessary.
Physical therapy and similar treatments have been found to be effective in alleviating the symptoms associated with the condition.
In this comprehensive guide, you will learn about carpal tunnel syndrome. If you have shoulder pain, limited use of your arm, or complications with your wrists and/or hands, continue to learn more.
The pain you feel today will be the strength that you feel tomorrow Unknown
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Carpal Tunnel Syndrome Causes
Physical conditions like inflammatory arthritis and the fluid retention related to pregnancy can cause carpal tunnel syndrome. However, most cases are the result of repetitive stress injury, nerve damage, or anatomical anomalies.
For example, it is not unusual for people who work in the textile and fabric finishing industry to suffer from this condition. According to a 2018 CDC report, nearly 45% of all textile and fabric industry workers report carpal tunnel syndrome. Nearly 40% of all slaughterhouse workers report it as well.
We often hear of carpal tunnel syndrome among office workers who sit behind computers all day. When office work is the culprit, carpal tunnel syndrome can usually be traced to the patients position in front of the computer. The position of the persons hands relative to keyboard and mouse, along with chair height and distance to monitor, all play a role.
Fortunately, carpal tunnel syndrome is very treatable. A typical case can be addressed with anti-inflammatory medication, a wrist brace, physical therapy, and lifestyle changes. Only in the most serious cases is more aggressive treatment required.
Make a point to visit us at our clinic if you are suffering from chronic pain that you think could be related to carpal tunnel syndrome. Our highly experienced team of pain doctors are here to help you feel better.
What Is The Treatment For Carpal Tunnel Syndrome
Treatments for carpal tunnel syndrome include:
- Avoiding activities that may provoke symptoms
- Resting the hand and wrist
- Wrist splints to keep hands in a neutral position
- Over-the-counter pain medications such as nonsteroidal anti-inflammatory drugs , including aspirin and ibuprofen for short-term pain relief
- Steroid shots or pills for inflammation and swelling
- Injections of the anesthetic lidocaine
- Yoga, to reduce pain and improve grip strength
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Diagnosis Of Carpal Tunnel Syndrome
The diagnosis of carpal tunnel syndrome is clinical and based on a persons symptoms, history, and physical exam findings. Patients may be recommended to have a nerve test performed by a neurologist which can help determine the severity of the nerve compression and rule out other potential causes of nerve symptoms, including nerve compression at the neck and diabetic neuropathy.
Where Carpal Tunnel Pain Hurts The Most
Exactly where carpal tunnel pain hurts the most varies from person to person. That’s because everybody experiencessymptoms of carpal tunnel syndromea little differently.
In general, pain is usually themajorsymptom, followed by numbness and tingling . The pain can be on any finger except the little finger. It can also include the entire palm of the hand and even the wrist. Sometimes pain shoots from the fingers, through the hand and up the arm.
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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.
Where Pain Ismost Intense
Carpal tunnel syndrome is a progressive and painful neurological condition. And it’s very common, affecting at least five million Americans.
The condition occurs as a result of straining or stressing your hand and fingers. When you perform repetitive, rapid and forceful hand movements for a long time , wrist flexor tendons tend to react badly.
Over time and a lot of stress, the tendons becomeinflamedand start to show signs of swelling. Thats when problems really go downhill.
The tendons swell inside the wrist joint in a tight space called the carpal tunnel. It’s a narrow, crowded passageway through which your hand’s tendons and themedian nervepass.
Unfortunately, the swellingpusheson the median nerve which is nearby. With enough time, the swelling slowly crushes the nerve. The crushed nerve is what produces all of the sensations of carpal tunnel syndrome – especially pain. You feel the pain in the fingers, hand or wrist. Along with pain, other carpal tunnel symptoms include:
- electric shock sensations
Usually, the place where carpal tunnel pain hurts the most is thepalm of the hand,the thumb,and first finger. It’s common for the fingertips or the thumb’s base to hurt more .
Carpal tunnel pain can be constant or intermittent. The pain is unusual in that it hurts even when you’re not using your hand. In fact, most often the pain is worse when you’re resting or even trying to sleep. This distinguishes carpal tunnel syndrome fromwrist tendonitispain.
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Treatment: Rest And Immobilization
Underlying causes such as diabetes or arthritis will need treatment. Then your doctor may advise resting the hand and wrist and wearing a brace to limit movement. Night use is important to prevent the wrist from curling during sleep, which can make symptoms flare up. Non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen, along with cold compresses, may reduce pain.
Health Issues That May Cause Carpal Tunnel Problems
There are several unique health conditions that may lead to the onset of problems with the carpal tunnel region. These are as follows:
- Those that experience issues with the tendons in the wrist, such as swelling, inflammation, and other types of irritation are at a high risk for developing carpal tunnel problems.
- Changes with the hormones or the unique metabolic balance of the body such as pregnancy and/or issues with the thyroid could result in CTS.
- Injuries that directly impact the wrist like sprains, dislocations, and even fractures may place immense pressure on the carpal tunnel and cause hand, arm, and shoulder problems.
- Retaining fluid in the body due to other conditions, such as pregnancy, diabetes, and issues with the endocrine system may increase the pressure in the carpal tunnel.
- Arthritis and/or degenerative disorders in the body are known to cause carpal tunnel problems.
- In addition to the health issues that may lead to CTS, certain types of medications such as steroids may also result in severe pressure in the carpal tunnel in the wrist.
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Can Yoga Ease Carpal Tunnel
There’s strong evidence that yoga can reduce pain and improve grip strength. In one small study, participants who did an eight-week yoga regimen of 11 postures designed to strengthen, stretch, and balance the joints of the upper body had better outcomes than participants who wore wrist splints and participants who were given no treatment at all.
Confidence In Treatment Through Education
We developed a special joint replacement education website just for patients undergoing joint arthroplasty. The website takes you step by step through the joint replacement process. From things to consider before choosing surgery to recovery after surgery, youll find the information you need to help you feel confident in your decision to undergo joint replacement.
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How To Relieve Carpal Tunnel Pain
For most people, it doesn’t matter where carpal tunnel pain is as long as they can treat it. But it may surprise you that treating the pain symptoms is only slightly helpful. But treating thecauseof the pain is far more effective and lasting. In other words:
If you treatonly the painit will come back. But if you treat thecause of the painit will eliminate symptoms forever.
Therefore, where carpal tunnelpainis your main symptom, there are 2 approaches to treating it:
- temporary pain treatmentswhich just treat pain for the time being
- permanent pain treatmentswhich treat & eliminate the source of the pain
I highly recommendyou use thepermanent pain treatmentsfor obvious reasons. I list the temporary ones below because you’ve probably tried them – with no long-term effects.
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.
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Coordinated Specialized Care Through A Dedicated Institute
Our orthopaedic specialists work together through our dedicated Penn State Bone and Joint Institute. There, they focus on providing you with multidisciplinary, tailored care and state-of-the-art treatments and technologies. This produces the highest-quality patient outcomes. All physicians at the institute are fellowship-trained and subspecialize in additional niche areas of orthopaedics, including arthritis care and joint arthroplasty .
Carpal Tunnel Syndrome Explained
Carpal tunnel syndrome is a direct result of pressure on the nerve that is located at the base of the palm of the hand. This is medically termed as the median nerve.
The carpal tunnel is a narrow region located in the wrist, on the side of the palm. It is an area that aids in the protection of the tendons that are responsible for bending the fingers, as well as the median nerve.
If pressure builds in this area, it can result in the development of weakness and pain in the wrist and the hand. It may also result in a numb or a tingling sensation in one or more fingers.
The overall functionality of the arm may be detrimentally impacted. Additionally, many individuals experience extreme bouts of shoulder pain with carpal tunnel syndrome.
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Other Conditions Which May Be Misdiagnosed As Cts
Carpal tunnel syndrome is frequently misdiagnosed due to the fact that it shares symptoms with several other conditions, including arthritis, wrist tendonitis, repetitive strain injury and thoracic outlet syndrome. Symptoms which CTS shares with other conditions include:
- Hot-and-cold sensations
- Difficulty grasping or using oneÃ¢â¬â¢s hand
It is important to be aware of the key differences between CTS and some other conditions which share its symptoms, in order to avoid a misdiagnosis. Other conditions which are commonly misdiagnosed as CTS include:
Arthritis can affect all the fingers in the hand, whereas CTS cannot affect the little finger. Whereas CTS is worse at night, arthritis is not affected by the time of day. The symptoms of CTS can be absent and then suddenly become triggered by a particular activity, whereas the pain associated with arthritis is usually constantly present but alters in intensity during activities which put strain on the hands and wrists.
Nerve compression due to conditions affecting the spine
Conditions such as spinal disc herniation and cervical stenosis can cause nerve compression that may result in similar sensations to those of CTS.
Thoracic outlet syndrome
Repetitive strain injury
What About Carpal Tunnel Release Surgery
Contrary to what most patients are told, carpal tunnel release surgeryis atemporarytreatment. The reason is because surgery does not eliminate the root cause of carpal tunnel pain and other symptoms that is, adhesions and restrictions on flexor tendons.
In all, less than 25% of patients are satisfied with their results by year 3 because all symptoms have been relieved.This means fewer than 25% of patients see permanent relief.
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