In your wrist, there is a narrow structure called the carpal tunnel. Here, the median nerve controls the feeling inside the palm of your hands, including flexor tendons that allow you to bend your fingers and thumb. When there is swelling on the tissues around the tendons, and as they compress and crowd the median nerve, painful symptoms may occur.
Carpal tunnel syndrome is one of the most common problems affecting the hands. Here at the Fitzmaurice Hand Institute in Scottsdale, Arizona, our team strives to always administer the best, most effective care for our patients. We are committed to providing carpal tunnel syndrome treatment that’s optimally effective at providing relief and restoring hand function, giving patients a quick return to life, work, and activity.
Carpal tunnel syndrome is a condition that affects your hands or arms, causing numbness, uncomfortable tingling and an eventual weakness of the hand. The carpal tunnel is a small passage located on the inside of your wrist. This tunnel covers the nine tendons of the hand and fingers as well as a median nerve. A number of ligaments and bones enclose the tunnel. Swelling inside your wrist increases pressure in this tunnel and compresses or pinches the median nerve, causing carpal tunnel syndrome. Factors that contribute to the pinching of the nerve include underlying health problems. In addition, certain harmful patterns of hand use and the anatomy of your wrist are possible causes. Fortunately, many people who develop this condition can find efficient treatment that alleviates the tingling and numbness while restoring proper hand and wrist function.
Women are more likely than men to develop carpal tunnel syndrome. People who are at risk are those with jobs or activities that involve the same hand movements particularly, repetitive finger use that’s associated with extreme wrist motions, vibration, high force, and long-term use. Those who are prone to developing the condition include carpenters, assembly-line workers, musicians, and those who use computers. Hobbyists who are into gardening, golfing, canoeing, and needlework are likely to develop symptoms as well. Other factors that can increase your risk are:
Symptoms of carpal tunnel syndrome typically begin slowly and become severe over time. Initially, you will find your hand frequently “falling asleep.” Other symptoms include:
As the condition worsens, these symptoms will become more constant. You may experience weakness in the hand and in its most severe case, your muscle at the base of the thumb will shrink in size and sensations and strength may be permanently lost.
You can prevent carpal tunnel syndrome by making the necessary lifestyle changes that can help reduce your risk factors for developing it. Treating and managing health conditions such as arthritis and diabetes lowers your risk. In addition, you must avoid activities that overexert the use of your wrist and perform physical therapy exercises.
An exercise program is a treatment option that I may recommend. Consistent exercises may help relieve the pressure on your wrist’s median nerve. You can benefit from specific exercises that will help the median nerve move more freely within the carpal tunnel, as well as improve joint range of motion and hand function. As published on the American Academy of Orthopaedic Surgeons website, the following are therapeutic stretching exercises for carpal tunnel syndrome:
This exercise along with the Wrist Flexion Stretch (#2) should be done throughout the day, especially before activity. After recovery, this stretch should be included as part of a warm-up to activities that involve gripping.
For this exercise and Tendon Glides (#4), apply heat to your hand for 15 minutes before performing these exercises. After completing the exercises, apply a bag of crushed ice or frozen peas to your hand for 20 minutes to prevent inflammation. Hold each position below for 3 to 7 seconds.
Proceed from position 1 through 3 in sequence. Hold each position for 3 seconds. As the exercises become easier to complete, increase the number of repetitions, or how many times per day you do them.
Keep in mind that I, or your occupational therapist, will tell you when you can begin these exercises and which ones will work best for you. Ease off the program if you start to have pain.
The treatment for carpal tunnel syndrome varies from one patient to another and depends on the degree and duration of carpal tunnel symptoms suffered. In cases where numbness is slight, a mere shake or movement of the arm can remove numbness and you will experience wrist pain relief.
People who use computer keyboards daily are at risk for this condition. These individuals should try to avoid activities that worsen the symptoms. In the case of persistent symptoms, both non-surgical and surgical procedures are viable treatment options. This is especially true if you suffer an underlying health problem, such as rheumatoid arthritis.
Traditional carpal tunnel treatments include corticosteroid injections and wrist splints. In addition, non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed. Other options include stem cell treatments, chiropractic therapy, and acupuncture procedures. Stem Cell Treatments (NeuroRejuvenation) In recent years, stem cells have become a very popular way to treat various joint and ligament pains. At the Fitzmaurice Hand Institute, our regenerative medicine experts are excited to offer various stem cell therapies for the treatment and alleviation of joint pain. At our hand and wrist center, we provide patients with a stem cell treatment that obtains stem cells from a patient’s own fat cells. We call this treatment NeuroRejuvenation.
During a NeuroRejuvenation procedure, local anesthesia is administered to a patient and a mini liposuction is performed in order to remove the necessary fat cells. From here, the fat is placed in a centrifuge which separates the stem cells from other tissues. These stem cells are then expertly administered into a patient’s joints and ligaments, ultimately providing pain relief and a higher quality of life.
There are many benefits to a NeuroRejuvenation stem cell treatment. Most notably, recovery and nerve regeneration are enhanced during this procedure. Additionally, since these stem cells are taken from a patient’s own body, no embryonic stem cells are used at any point in the procedure.
Wrist splints help keep the wrists in the most neutral position possible. While the splints do not apply pressure on the carpal tunnel, they prevent the wrist from bending. When the wrist bends, it can exert pressure on the median nerve and aggravate pain and other symptoms.
After four weeks of wearing the splint, you should expect positive results after which you can remove it. We can recommend a reputable supplier or alternatively, you can purchase one from a large pharmacy or order online.
Corticosteroids are steroid medications that introduce hormones to help reduce inflammation, pain, numbness, and other symptoms associated with carpal tunnel syndrome. They are ideal if a wrist splint does not work. Depending on the severity of your condition, I may prescribe corticosteroid tablets to be taken orally. Otherwise, an injection directly into the carpal tunnel may yield results faster. I would administer one injection first and observe the symptoms. If they recur, additional injections may be necessary.
If the above treatments do not work, carpal tunnel surgery is usually the only other alternative. Traditional carpal tunnel surgery is ideal when you still suffer symptoms after a couple of weeks or months of non-surgical treatment. In addition, surgery is usually recommended when your severe symptoms prevent you from doing your daily activities. Pain that disturbs sleep, a persistent loss of feeling, poor coordination of fingers, and decreased strength of the thumb will need surgical remedy. You should also pursue surgery when nerve tests indicate damage to your median nerve.
During an open carpal tunnel surgery, doctors make a large incision at the base of the palm of your hand. This allows them to see the transverse carpal ligament. After the ligament is cut and the underlying pressure has been released, the skin is closed with a couple of stitches, leaving the cut ligament gap open. It will fill up with tissue in due course. The procedure not only releases pressure from the median nerve but also rids you of the symptoms of carpal tunnel syndrome. Doctors can conduct an open carpal tunnel surgery under local anesthesia and discharge you to go home the same day. Before going home, a surgeon will wrap your hand and ask you to make another visit two weeks later to remove stitches. Usually, the pain and discomfort will have subsided by the time of your second visit.
EndoTech® is a minimally-invasive system that provides the safest and most advanced treatment option for carpal tunnel syndrome. This unique technology combines the benefits of an open technique (such as excellent visualization) with the significant improvement in recovery and minimal pain seen with endoscopic techniques. The EndoTech® nerve release enables complete visualization of the entire band of tissue causing pressure, ensuring that a complete release can be performed. Aside from visibility, the system also allows for smaller incisions (less than 1 cm) in the treatment area, less associated pain, faster recovery with much less downtime, and higher patient safety. During this procedure, I use a thin flexible tube called an endoscope, which has a tiny camera attached to one end. I will then guide the endoscope via a small cut in your wrist or palm, enabling me to see the underlying structures. I will insert tiny cutting tools via the same incision or another small one. At this point, I’ll be cutting the transverse carpal ligament, a process that releases pressure from the median nerve. As the symptoms of the syndrome diminish, I will close the small incisions. The healing after an EndoTech® carpal tunnel surgery is typically faster than an open carpal tunnel surgery and often leads to better patient outcomes.
Overall, recovery time will depend on your age, general health, the severity of your condition, and the length of time your symptoms have been present. If you had open carpal tunnel surgery, recovery time typically takes 6-8 weeks. After EndoTech®, you should recover within one week. Your strength and sensations should continue to improve over the following year. Combining the EndoTech® carpal tunnel release with the NeuroRejuvenation® procedure improves the process with a faster recovery and less risk of scar tissue which could require a revision surgery. If your dominant hand was the one involved in the surgery, you will need 6-12 weeks to resume daily activities. If the operation was done on your less dominant hand, you may need just a few days of rest before resuming work. In this case, try to learn to work with the other hand. You should not lift heavy objects or do a lot of work for three months after the procedure. The ability to return to work depends on the activities of your day-to-day employment. For faster healing, dedicate more time and commitment to physical therapy to rehabilitate the functions of your hand.
After surgery, you will experience reduced or no numbness and pain on the operated hand. In very rare cases, complications arise where a patient experiences a recurrence of symptoms. Since the transverse carpal ligament has been cut, you may have loss of strength when gripping or pinching things. According to AAOS, “Grip and pinch strength usually return by about 2 to 3 months after surgery. If the condition of your median nerve was poor before surgery, however, grip and pinch strength may not improve for about 6 to 12 months.” Otherwise, only one in 100 patients report nerve damage after surgery. Few patients report effects of general anesthesia and infection.
If you are looking for the best, most innovative remedy for carpal tunnel syndrome, contact the Fitzmaurice Hand Institute in Scottsdale, Arizona, where operating rooms dedicated to hand procedures, an urgent care facility, and my hand surgery expertise can help you achieve optimal results that will allow you to quickly resume your normal activities. Schedule an appointment with us today.
Studies have shown that this remarkable visualization significantly decreases surgical risks, with zero complications to date in over 4000 procedures performed. EndoTech® results in the least amount of pain and fastest recovery compared to other surgical techniques. This allows for a much higher success rate and a greater overall patient outcome.