Treating Carpal Tunnel Syndrome

If you’re experiencing numbness, tingling, or discomfort in your hand or fingers, you may be dealing with carpal tunnel syndrome. This is a common condition that affects about 4-5% of the population. If you do receive this diagnosis, what can be done?

Dr. Matt Bliss, orthopedic surgeon at Fort HealthCare, offers advice and insights surrounding carpal tunnel syndrome and how it is treated.

What Exactly Is Carpal Tunnel Syndrome?

In simple terms, carpal tunnel syndrome arises from a pinched nerve; the median nerve. The carpal tunnel is a passageway bordered on three sides by the wrist bones and on the top by a very thick ligament called the transverse carpal ligament. When the nerve passes through that carpal tunnel it branches. If it’s getting pinched, symptoms manifest.

“When that nerve gets pinched or compressed, the small nerve fibers stop sending signals from your fingertips to your brain and your brain interprets that as numbness or tingling. This can be classically exacerbated by certain activities,” explains Dr. Bliss. “People who do mountain biking, people who drive a lot, anybody who uses vibratory equipment, such as a jackhammer or other machines; all can experience this.”

Carpal tunnel syndrome tends to be worse at night for two main reasons. One, the hands swell during sleep. Two, many people sleep with their wrists bent. Both of these factors increase pressure on the nerve. In many cases, people experience significant disruptions in sleep, which Dr. Bliss says is a primary impetus to schedule a doctor’s visit.

“Anybody who has experienced broken sleep knows how miserable that can be. So, that’s oftentimes the reason people will come to see me. They can’t sleep, or their husband or wife is making them come in because they can’t sleep either.”

What Causes Carpal Tunnel Syndrome?

Carpal tunnel syndrome is primarily a genetic disorder. It can be related to obesity, as well as medical conditions such as thyroid disease and diabetes. One common misconception is that the syndrome is related to repetitive motion, such as typing on a keyboard or cutting hair. Dr. Bliss wants to provide some clarity.

“There’s a very low correlation between repetitive motion and carpal tunnel syndrome. For people who use a mouse or a computer throughout the day, that is not necessarily a significant risk factor for carpal tunnel syndrome. I think that is something that’s probably not elucidated in the press very well.”

Treatment Options: Splinting, Injections, Surgery

Dr. Bliss explains that the first line in treatment of carpal tunnel syndrome is providing the patient a splint to wear at night. These are simple splints that keep the wrist from being flexed or bent. They can really improve the patient’s symptoms, at least at night. Sometimes, people use anti-inflammatories such as ibuprofen or naproxen, but such an approach can have mixed results.

The next potential treatment option is to administer a cortisone injection into the carpal tunnel. This helps reduce pressure on the nerve. While injections can be effective, they are not necessarily the most enjoyable experience. “They can be quite painful. Cortisone, by its nature, has a temporary effect. For people who want a permanent solution to their carpal tunnel syndrome, we then discuss surgical options,” says Dr. Bliss.

Carpal Tunnel Release Surgery

Carpal tunnel release surgery is one of the most common surgeries performed in the United States. It has evolved greatly since being introduced in the 1950s, when it was an inpatient procedure. Patients would have to stay overnight, and they would have a large incision and face a lengthy recovery.

“Our surgical techniques have improved today. Now, your choices are to have the carpal tunnel release done through either a small open incision or endoscopically with a telescope and a small surgical knife,” notes Dr. Bliss. “My preference is to perform the surgery through the incision, which is approximately one and a half centimeters in length, located in the base of the palm.”

The surgery itself takes 8-10 minutes. Post-procedure, patients typically have three or four small stitches in the skin and just a soft dressing. The stitches stay in for about two weeks and people can be fully recovered at the 3-4 week point, depending on their job demands and duties. It is a highly successful surgery with about a 95% success and patient satisfaction rate.

Dr. Bliss urges anyone who is considering this surgery to understand recovery does take time—but for many, it’s well worth it.

“There are very minimal complications to the surgery. But, it does take some time to heal. Patience is not a strong suit in a lot of Americans, and I’m one of them. I’m an inpatient person, so I totally understand that,” he shares. “I think a lot of people are very glad they had it done, particularly when it comes to the quality of their sleep. I’ve had countless people say, ‘Gee, I wish I had just gotten it done sooner and not put up with these symptoms for two years.’ That’s always gratifying.”