Symptoms of Carpal Tunnel Syndrome are actually quite predictable. Initially, people experience numbness and tingling as if they had fallen asleep on their hand. The distribution of that numbness and tingling is what alerts us to the fact that carpal tunnel syndrome may be responsible. The median nerve only supplies feeling to a very specific part of the hand. It’s the thumb index, middle and this half of the ring finger, so that’s where people begin to experience symptoms when they start having carpal tunnel syndrome. As the condition progresses, the motor portion of the nerve starts to become affected. That’s what provides input and strength to this group of muscles at the base of the thumb, obviously, because it’s the thumb, it’s a very important muscle group and the symptoms of weakness in that group of muscles are often very troublesome. People start having trouble buttoning buttons, turning keys. Anything where pinch and forceful grip are required. When people have numbness in that distribution and start having weakness, it’s absolutely a sign that carpal tunnel syndrome is likely to be responsible.

Carpal tunnel symptoms can be transient and can resolve on their own or with mild treatment or more often they can be gradually progressive until the condition is treated surgically and carpal tunnel release is performed. Intermittent symptoms that resolve on their own are usually the result of an episode, over use of the hand, or trauma to the hand and wrist, such as a fall on the risk that causes swelling or sometimes a medical condition. The most common being pregnancy, which is often a precipitant of carpal tunnel symptoms. When those conditions resolve, fortunately the symptoms often go away. If the symptoms persist and are progressive, then medical attention is indicated and people should seek out their doctor to ask about referral to a hand surgeon.

There are exercises that your hand surgeon or a hand therapist may prescribe for you to help minimize symptoms before surgery and certainly to help recovery after carpal tunnel surgery. Before surgery, the goal of exercise is to encourage gliding of the nerve and the tendons that accompany the nerve through the carpal tunnel. So simple finger exercises to encourage motion and wrist flexibility may help to minimize adhesions and stiffness that can contribute to your symptoms. People often ask about things like stress balls or gripping devices to help strengthen the wrist and will that help to minimize my carpal tunnel symptoms. In fact, the opposite is probably true. Forceful activities and repetitive gripping or one of the mechanisms that cause carpal tunnel symptoms in many people. So it’s important to know that flexibility and motion are important, but overly repetitive forceful activities and really forceful gripping are often not helpful. Exercises after surgery are often prescribed, again, to encourage the return of motion and eventually to strengthen the hand once the carpal tunnel incision has healed. Those can be done at home, or if your doctor feels that some therapy may be helpful, the doctor may refer you to a hand therapist to prescribe treatment and exercise to help recovery after your carpal tunnel surgery.

Hi, I’m Kyle Bickel. I’m a hand surgeon in San Francisco, California. I started my career in Baltimore, Maryland, where I was the co-director of hand surgery at Johns Hopkins University. I came back to California in 2000 and founded The Hand Center of San Francisco. I’ve been practicing here ever since. It’s a great place to live and to practice medicine. My wife, our dog, and our family, love being in the outdoors and enjoying all of the cultural opportunities that the Bay Area has to offer. It’s a great place to live in, a great place to practice.

Testing for carpal tunnel syndrome involves clinical testing and diagnosis as well as specific physiologic tests that are performed by a neurologist. At its core, Carpal tunnel syndrome is a clinical diagnosis. That means that the testing to confirm that carpal tunnel syndrome is responsible are based on history, what the patient tells us about their symptoms, and a physical examination confirming that carpal tunnel syndrome is likely to be the cause. The physiologic tests are done by a neurologist and they are actually tests that can measure the function of the nerves in the upper extremity. That will tell us if the nerve traveling through the carpal tunnel which is called the median nerve is the only nerve affected and if it’s affected in the carpal tunnel. That helps to confirm that in fact, carpal tunnel syndrome is the cause of a patient’s symptoms. The clinical tests for carpal tunnel syndrome involve examining the nerve and its surrounding environment to see if the nerve is behaving in an irritable fashion. A normal healthy nerve is not easily stimulated externally. If you tap on a nerve over its course through the wrist, nothing should happen. If you tap on a nerve that’s irritated by compression, which is what happens in carpal tunnel syndrome, that nerve will be stimulated more easily and patients will experience numbness and tingling in their fingertips. That numbness and tingling is in the distribution of that nerve. So in the carpal tunnel, which is the median nerve tapping on the wrist forcefully such as this will cause numbness and tingling in the thumb through ring fingers. That’s called a tunnel sign and it’s one of the things we use to confirm that patients have carpal tunnel syndrome. The other way we can test for carpal tunnel syndrome externally is by reproducing that position that increases pressure in the carpal tunnel with the wrist flexed for any length of time. We ask the patient to flex the wrist and then we add a little external compression with our thumb over the carpal tunnel and in patients whose nerve is irritated from carpal tunnel syndrome, that will start to produce numbness and tingling in the thumb through ring fingers, the distribution of the median nerve. That’s called a Phalen’s test, and it’s another test that we use to confirm carpal tunnel syndrome.

If you think you have carpal tunnel syndrome, it may be tempting to diagnose yourself. We often do that with a cold or a stomachache. Carpal tunnel syndrome is not typically diagnosed by the patient. However, there are ways to tell if the symptoms that you’re having may in fact be the result of carpal tunnel syndrome. The distribution of that initial numbness and tingling in the thumb index middle finger and this half of the ring finger are a strong suggestion that your symptoms may in fact be carpal tunnel syndrome. Thinking about when the symptoms occur and what makes them happen is also a pretty strong clue that this may be carpal tunnel syndrome. If you’re waking up at night with numbness in both hands in that distribution and shaking your hands out makes them go away. That’s probably carpal tunnel syndrome. If reproducing that position by curling your wrists like this for 15 or 20 seconds starts to give you numbness and tingling and those specific fingers. That’s also probably carpal tunnel syndrome. So patients can have a good sense based on that initial symptom development and evaluation that in fact their problem is carpal tunnel syndrome, and that should lead them to talk to their doctor about it and get an appropriate referral to a hand specialist.

Having Carpal Tunnel Syndrome doesn’t mean that symptoms will always be present. Especially early in the condition, symptoms are often intermittent. Most often we hear people start to complain of Carpal Tunnel Syndrome with symptoms only at night when they’re sleeping. As the condition becomes more severe, the symptoms usually become more continuous. It’s also not uncommon for people to have symptoms primarily with certain activities, typing for long periods of time, or repetitive forceful activities such as occupational exposure, construction workers, assembly line workers, and the like. So continuous symptoms are not always present, and not having continuous symptoms doesn’t mean that you don’t have carpal tunnel syndrome.

At some point, as the condition progresses, symptoms become more profound. Patients will no longer just experience intermittent numbness, but they start to have more pain and become weak as the motor portion of the nerve becomes affected. At that point, people traditionally seek out medical attention because it starts to affect their daily life on a really profound basis. As carpal tunnel symptoms progress from mild to more profound symptoms, the nerve compression is starting to affect the nerve itself. Initially, it’s only the environment that the nerve is in that’s producing mild symptoms. As that compression persists, the nerve can actually start to become damaged. When that happens, the symptoms go from being very tolerable and mild to becoming much more profound. People start to become weak. They drop objects, they have trouble buttoning buttons or turning keys because the muscles at the base of the thumb become weak. When that happens, it’s no longer a matter of simply managing the symptoms. When people start to lose function and their numbness and pain becomes severe, they require medical treatment.

Carpal tunnel surgery as an outpatient procedure. It can be done at a hospital, in an office operating room, or in an outpatient surgery center. There are several different methods of performing carpal tunnel release surgery. However, they all have in common, a small incision and a release of the band of tissue that forms the roof of the carpal tunnel. Once that band is opened, pressure inside the tunnel is released and the nerve can go on to recover and function more normally.

After surgery, the hand is usually bandaged and a soft bandage and patients are encouraged to take it easy for the first several days. Vigorous physical exercise can precipitate swelling and sometimes bleeding which are best avoided. Elevation of the hand is encouraged to minimize swelling and throbbing pain and we usually like patients to keep their incisions dry for the first three to five days to minimize the risk of infection or wound problems. After surgery, we actually encourage patients to begin moving their fingers and doing very light activities with the hand almost immediately. The reason for this, the purpose of the surgery is to free the structures in the carpal tunnel to move and glide freely and to relieve any obstruction in motion and pressure on the nerve. Therefore, mobility in the fingers and light use is actually therapeutic. However, we ask patients to refrain from forceful activities that require forceful grip or a lot of pressure on the hand for several weeks to allow the area to heal and to avoid trauma to the tissues as they heal. Six weeks seems to be a pretty good rough estimate for patients to be able to start returning to more forceful activities, putting all of their weight on their hand, gripping very tightly and lifting heavy objects. It’s not uncommon for patients to have some tenderness in the palm at the incision for about that long, or maybe a little bit longer. That’s often a guide as to when to start to resume more forceful and more normal activities as that pain subsides more and more. It does take people about six months for the incision to be completely healed, the swelling to be entirely resolved and for strength to return to normal after carpal tunnel surgery. However, patients are usually back to full activity and about half that time.

People often ask how common is carpal tunnel syndrome? In fact, for hand surgeons, it’s one of the most common conditions we treat. It actually affects approximately 5% of the overall population. However, when carpal tunnel syndrome is the result of an underlying medical condition such as diabetes, hypothyroidism, or inflammatory arthritis, that incidence can become much, much higher than the baseline 5% it’s a very, very common condition.

If you need more information about carpal tunnel syndrome, the American Society for Surgery of the Hand and the American Association for hand surgery, the ASSH and the AAHS are great resources for patient information. They have video tutorials, they have printed material, and they have referral sources where you can get further information about how to understand your condition and where to go to seek medical attention.

Pain after carpal tunnel surgery is fortunately usually very mild, and it resolves either on its own or with some mild medications, Tylenol, or an anti-inflammatory medicine. There is a specific post-operative pain that some patients experience called pillar pain. It’s pain in the palm on either side of the carpal tunnel, and it affects patients who’ve had carpal tunnel surgery. Fortunately, that pain is usually transient and gets better with simple management such as avoiding forceful activities for a while and taking minor pain medication, Tylenol or anti-inflammatories. A course of physical therapy may also be helpful in alleviating pillar pain. However, pillar pain is rare and it’s not something that patients should expect to experience after an uncomplicated carpal tunnel release.

Prevention is always the first line of defense in medical care. There are ways to help minimize the likelihood that you will develop carpal tunnel syndrome and there are certainly ways to help minimize the likelihood that your condition will progress and become severe. If you start to experience numbness and tingling and waking up at night with numbness in your thumb, index, and middle finger, the first thing to do is to get a wrist brace. A simple neutral wrist brace that leaves the fingers free, but keeps the wrist in a neutral position, preventing flexion and extension while you sleep will often help to alleviate those symptoms. And it’s important to try that early on to help prevent the pressure on the nerve from building up and making the problem worse. Because patients often experience symptoms with repetitive activities, being aware of how you’re doing those activities and taking frequent breaks during them can help to minimize symptoms and in fact, if the condition is mild, it may help to resolve the condition. So making sure that your work setup is proper, that your keyboard height is low, that your tray is not cramped, that your elbows are not flexed, and your risks are not flexed and cramped during activities can be very helpful in minimizing your symptoms. In addition, practicing good work habits, getting up out of your chair periodically, stretching your arms and your neck, and shaking your hands out can help to minimize the repetitive and damaging nature of your activities. So being aware of your environment and how you’re doing things can often be the very first line of treatment in carpal tunnel syndrome.

Carpal tunnel surgery is in fact curative for most patients. It will get rid of and eliminate carpal tunnel syndrome and patients’ symptoms usually disappear after they have successful carpal tunnel surgery. There is a risk that carpal tunnel syndrome can recur after even successful surgery. That risk is about 5% over a patient’s lifetime. So we tell patients that it’s very likely that the surgery will be successful, their symptoms will get better, and the risk of this coming back again is very small, but not zero.

Because swelling inside the carpal tunnel can be one of the main causes of nerve compression, it’s important to do things to minimize swelling. That’s especially true after you’ve had carpal tunnel surgery. We want the swelling around the nerve to resolve as quickly as possible. Gravity is one of the things we can use to simply minimize swelling around the nerve. If you’re waking up at night with numbness and tingling in your hand or if you’re having symptoms during activities throughout the day, the first thing you can do is simply elevate your hand higher than your heart. Gravity will then help to pull some of the fluid out of the hand and can help to minimize the pressure on the nerve and relieve symptoms. Other things that can resolve swelling are light motion exercises with the hand elevated to encourage pushing fluid out of the hand and into the arm and allowing it to resolve. Because gravity is effective as an assistant, it’s also potentially harmful if you’re not using it right? So if you’re having symptoms during activities, you really want to be careful not to hold your hand down and swing it at your side for long periods of time when you’re walking or running. Elevate your hand periodically and allow the fluid to come out and to allow the swelling to resolve. Icing can also be helpful to help resolve swelling. So if you’re feeling tight, if your symptoms are worsening and elevation is not helping, you may want to apply an ice pack or soak your hand for a few minutes in an ice bath to help resolve some of the swelling and minimize the symptoms.

People often ask why they develop carpal tunnel syndrome. People get carpal tunnel syndrome for a variety of reasons. Most often there’s no identifiable cause. It simply happens. In those cases, we believe that people are simply genetically predisposed to develop carpal tunnel syndrome, probably because of their anatomy. The other group of people who develop the syndrome are people who have underlying conditions. Those conditions are diabetes, rheumatoid arthritis, or other inflammatory diseases, hypothyroidism and pregnancy. The other two factors that increase the incidence of carpal tunnel syndrome are age and female gender. Women and older people get carpal tunnel syndrome more frequently.

When symptoms of carpal tunnel syndrome persist and progress, it’s time to seek out medical care. The first line of defense is often having a conversation with your primary care doctor about your symptoms. If it’s likely that carpal tunnel syndrome is the cause, the next appropriate step is to see a hand specialist. A hand surgeon will be better able to confirm that carpal tunnel syndrome is the source of your symptoms, and will be able to outline appropriate treatment steps for you.

There are other conditions that can mimic the symptoms of carpal tunnel syndrome fairly closely. Things like nerve compression in the neck or in the shoulder can produce numbness, tingling, and even pain in a similar distribution to the carpal tunnel. Therefore, assuming that symptoms are the result of carpal tunnel syndrome is not the best policy. If you have these symptoms, if they’re troubling and if they persist, it’s important to seek out medical attention and an accurate diagnosis to be certain that you know what the condition is, because that will lead to proper treatment.

Because carpal tunnel surgery is a relatively limited operation in terms of its scope and involvement, surgery is most often performed under local anesthesia, and some patients prefer a little bit of mild sedation as well. It’s usually not necessary to undergo general anesthetic, and it’s certainly not necessary to stay in a hospital overnight after carpal tunnel release. It should be a relatively small and straightforward outpatient procedure.

It’s important for people to be aware that carpal tunnel syndrome is not a lifetime sentence. Symptoms sometimes resolve on their own. Women who get carpal tunnel symptoms during pregnancy often have complete resolution after they deliver their baby. People who have carpal tunnel syndrome as a result of an injury will get better as their injury heals, and people with progressive carpal tunnel syndrome in whom medical treatment is indicated can and most often are cured by surgical treatment with release of the carpal tunnel.

When managing the symptoms at home with wrist braces, motion exercises, and frequent breaks at work are no longer giving adequate relief, and especially if the symptoms are starting to interfere with normal daily life, then it’s important to seek medical attention for carpal tunnel syndrome. The best way to do that is to talk to your primary doctor about referral to a hand specialist. A hand surgeon and a neurologist can often work in tandem to confirm that your symptoms are in fact related to carpal tunnel syndrome and to determine the severity of the nerve compression. This will help to guide treatment as the treatment is often determined by how severe the compression is and not simply the presence of symptoms.

Carpal Tunnel Syndrome is specifically limited to the wrist. Patients will often experience symptoms higher up, in the neck or shoulder, that they may attribute to carpal tunnel syndrome. But in fact, carpal tunnel syndrome is only compression of the one specific nerve, the median nerve, as it travels through the wrist and the carpal tunnel.

The first thing people usually experience when they start having carpal tunnel symptoms is numbness. The numbness is often first noticed when people are sound asleep at night. It’s not uncommon for people to wake up once or twice a night with their fingers asleep. The fingers that are affected by carpal tunnel syndrome are the thumb index, middle and ring finger. Initially the symptoms can be mild and short lived, but as the condition progresses, those symptoms become more continuous so that people can start waking up several times a night. This is obviously distressing and is usually the first thing that leads people to seek medical attention for their problem. As carpal tunnel symptoms progress, they often then start to affect people with activities during the day. Repetitive and forceful activities or the things that are usually the most concerning for people as they can elicit increasing symptoms with use. As carpal tunnel symptoms progress from mild into more moderate compression, the numbness can then be associated with pain and even weakness as the symptoms of the nerve compression begin to be manifested in other ways. Eventually patients do seek medical care because the symptoms are typically not tolerated for very long before people become worried about it, and that’s natural.

Carpal tunnel syndrome develops when the small space that the nerve is traveling in through the rest becomes tight. That tightness occurs as a result of swelling. There are other structures in the carpal tunnel along with the nerve. There are nine tendons plus the median nerve in that very small space. The tendons are surrounded by a structure called synovial tissue, which normally is very thin and supple and glides freely. It encourages those tendons to move back and forth as we move our fingers. However, that synovial tissue is also a potential site for swelling and fluid accumulation. That happens with overuse, it happens with injury, and it happens with medical conditions. Believe it or not, it can also happen as we simply get older. All of those reasons for swelling will eventually be reasons for the median nerve to become compressed in the carpal tunnel syndrome, and that’s when people begin to experience symptoms.

Carpal tunnel syndrome is a nerve compression that affects patients in predictable ways. The nerve involved in carpal tunnel syndrome is called the median nerve. It’s one of the three main nerves in the upper extremity. It provides feeling to the thumb index, middle and ring finger or this side of the hand, and it also provides motor input to the thumb, which makes it a very important nerve. Patients with carpal tunnel syndrome experience symptoms because that nerve becomes compressed in the wrist as it travels through a very tight space called the carpal tunnel. Initially, patients begin to experience numbness as the sensory portion of that nerve is affected. As the condition progresses, which is its natural history, eventually they began to experience pain and then weakness as the motor portion of the nerve becomes affected. At that point, it starts to affect people functionally and they start to seek medical attention.

Although quite bothersome, people with carpal tunnel syndrome should be reassured that there are many ways to experience improvement in the symptoms, and in fact, there is a way to eradicate the problem entirely and to cure carpal tunnel syndrome. Therefore, if people feel that they’re having symptoms, which suggests that carpal tunnel syndrome may be responsible, they should absolutely seek medical attention and get help for their problem. Suffering with the condition usually only prolongs it and can lead to further damage to the nerve, whereas early intervention can cure people of their symptoms before it becomes a bigger problem. It’s really important to talk to your doctor about your symptoms and determine if carpal tunnel syndrome may be responsible and therefore get appropriate treatment in a timely fashion.

When it has been confirmed that carpal tunnel syndrome is the source of your complaints and the nerve tests confirm that it’s no longer mild, but has now become moderate or severe, that’s the time to consider surgical treatment. Nonsurgical options such as ultrasound, acupuncture, and physical therapy can help to minimize symptoms, but they do not provide a cure. The only cure for carpal tunnel syndrome is surgical treatment. Surgery is typically an outpatient procedure, is minimally invasive, and leads to resolution of symptoms in a short period of time.

Carpal tunnel syndrome is an extremely common condition that affects millions of people every day. It can be troublesome, waking up at night with a numb hand, experiencing pain and weakness during activities that would otherwise be normal. You should rest assured that carpal tunnel syndrome is treatable and that there is a way to cure the condition entirely. Treatment may be simple modification of your behaviors. It may be wearing a wrist splint at night to prevent flexion and therefore numbness of the hand while you sleep, or it may involve medical treatment, a steroid injection to shrink swelling around the nerve, medication to treat your pain, or when the condition is progressive and nerve conduction studies show that there’s some risk of damage to the nerve, surgical treatment can and usually does cure carpal tunnel syndrome. Talk to your doctor about your symptoms and seek out medical attention when you feel it’s necessary.

The causes of carpal tunnel syndrome fall into two basic categories. One category is simply unknown cause, people who are prone to develop carpal tunnel syndrome. The medical word we use for that is an idiopathic condition. That means it happens, but we can’t identify a specific cause. The other group of people who develop carpal tunnel syndrome, develop the condition as a result of some underlying medical problem or a physical problem. The medical conditions that are most often associated with carpal tunnel syndrome, are pregnancy, rheumatoid arthritis, diabetes, and uncontrolled hypothyroidism. Trauma to the hand and wrist or vigorous over use of the hand and wrist can also precipitate carpal tunnel symptoms. So taking those two groups combined, the unknown cause and the direct result from underlying conditions, that gives us the overall 5% distribution of carpal tunnel syndrome in the population.

Carpal tunnel release is an operation designed to relieve the symptoms of carpal tunnel syndrome. The carpal tunnel is a fixed space in the wrist. It starts a centimeter above the wrist crease in the forearm and it extends to the midpalm. The purpose of surgery is to open the carpal tunnel and relieve pressure on the nerve. We like to think of the carpal tunnel as a small box. The floor and the two walls of the box are actually made up of the wrist bones and therefore there’s not much that we can do to modify their position or to change the volume by addressing those structures. The roof of the carpal tunnel is a tight band of Fascia and that band of Fascia can be opened to relieve pressure inside that tight box. That’s the purpose of a carpal tunnel release.

Carpal tunnel syndrome is not only possibly bilateral or affecting both hands, it’s most often by lateral. Typically people get carpal tunnel syndrome either because they have a strong anatomic basis for it. They’re just born prone to develop carpal tunnel compression or because the syndrome is the result of some underlying medical problem. Because of both of those factors, it does often affect both hands rather than just one hand at a time.

When symptoms persist and medical attention is indicated, the purpose of that initial visit is twofold. One, it’s to diagnose the condition and make sure that the symptoms are in fact the result of carpal tunnel syndrome. There are conditions that mimic those symptoms fairly closely, so your doctor is going to want to know your history, when the symptoms occur, what they feel like, what precipitates them, what makes them better. The other purpose is to outline treatment. The first stage of treatment is to confirm the diagnosis with a set of tests. Those tests are called nerve conduction studies and EMG, and they’re typically performed by a neurologist. Your hand doctor may refer you to a neurologist for testing. The tests will confirm whether or not your symptoms are in fact related to carpal tunnel syndrome, and very importantly, they’ll also categorize the severity of the syndrome as mild, moderate, or severe. That in turn helps guide your doctor in determining the best treatment for your condition.

When patient history and physical examination are strongly suggestive, that carpal tunnel syndrome is the source of your complaints, your hand specialist is likely to refer you to a neurologist to perform nerve conduction testing and EMG. Those tests measure the actual function of the nerves and the extremity. And in the case of carpal tunnel syndrome, they’ll show a very localized decrease in function of the median nerve as it travels through the carpal tunnel. The tests therefore are used to confirm the diagnosis. In addition, those same tests can tell us the severity of the nerve compression. Is this mild compression or is it more significant? Is it moderate or severe compression that may be more likely to lead to nerve damage if left untreated? So those nerve tests are very important in confirming that carpal tunnel syndrome is in fact the cause of your symptoms and in determining how it should be treated.

Patients often experience numbness, tingling, weakness, and pain in their hand. For a variety of reasons. Carpal tunnel syndrome is not the only reason those symptoms occur. In fact, people often come to me with carpal tunnel symptoms and also complain of pretty significant neck and shoulder pain. Because they’re having the two problems simultaneously, it’s not uncommon for people to combine them in their mind and think that they’re directly related when in fact it’s not at all uncommon for both carpal tunnel syndrome and neck pain to be occurring at the same time. They’re both very common problems. However, carpal tunnel syndrome in and of itself cannot cause pain in the neck. It’s simply a matter of two problems coexisting in the same patient. That having been said, there is something called double-crush phenomenon, which is when you have a nerve that’s affected in more than one location at the same time. In this case, we’re talking about the carpal tunnel and the neck. They’re both places that contain nerves and the nerves can be effected at both sites. When that happens, the combination of the two sites will magnify the symptoms that would be experienced from one site or the other, and it can be quite uncomfortable.

As with most medical conditions, patients often ask if there’s any medication that can help them with their symptoms. Because pain is not as often a problem with carpal tunnel syndrome as it is with some other problems, medication is not usually necessary or helpful. However, when the nerve compression becomes more severe, pain can become problematic. In that case, medications which address pain such as anti-inflammatory medications may be helpful. We also have a group of specific medications designed to treat nerve pain. Those medications can be used if severe nerve pain is part of the problem and they can help to minimize that discomfort. However, it’s important for patients to realize that medication by itself will not address the underlying nerve compression and will not cure carpal tunnel syndrome.

Surgical treatment for carpal tunnel syndrome, like many conditions has evolved over the years. The incisions for carpal tunnel surgery used to be quite large and extensive, and the surgery itself led to a lot of discomfort and morbidity after the procedure. Recent efforts have been directed at minimizing the invasiveness of carpal tunnel surgery, and there are number of different techniques that have been devised to accomplish this. This is something you should talk to your hand surgeon about and ask them what their recommended method of treatment is and what the alternatives are. It will lead you to come to a conclusion as to the best way to manage your carpal tunnel syndrome.

Because carpal tunnel syndrome is a well recognized medical condition with identifiable causes and treatment, this is something that insurance companies typically cover. They cover not only the diagnosis and the testing, but they also cover treatment, both surgical and nonsurgical treatment options. So you should be assured if you’re experiencing carpal tunnel syndrome, that medical care is indicated and that it should be covered by your insurance plan.

People often ask me about non-medical treatment options for their carpal tunnel syndrome. Are their dietary changes or lifestyle changes that can resolve their symptoms? And in fact, some of that may be true because swelling throughout the body can affect the carpal tunnel, avoiding excessive salt intake and anything that can cause fluid retention may help to minimize symptoms. Activity modification is also very important in helping to minimize and even treat early symptoms of carpal tunnel syndrome. If your natural habits are to sit at your desk for eight to 10 hours at a time, typing away and using the mouse without any breaks, and without changing your hand and wrist position, you may be setting yourself up for worsening symptoms of carpal tunnel syndrome. So practicing good habits with frequent breaks, changing your posture, making sure that your workstation is set up properly, can help to minimize symptoms. However, if your symptoms persist despite these remedies and they progress and become more bothersome, it’s important to talk to your doctor and to seek a referral to a hand specialist so that carpal tunnel syndrome can be effectively treated and not get worse.

Carpal tunnel syndrome does often resolve on its own. If the condition is the result of an underlying medical problem and the problem can be treated, carpal tunnel symptoms will often improve. An injury to the wrist that produces carpal tunnel symptoms may heal and the symptoms may go away. So sometimes carpal tunnel syndrome will resolve on its own and not require medical treatment to do so. If the symptoms progress and if they persist for any length of time, then it’s important to seek medical attention and get appropriate treatment.

When managing the symptoms at home with wrist braces, motion exercises, and frequent breaks at work are no longer giving adequate relief, and especially if the symptoms are starting to interfere with normal daily life, then it’s important to seek medical attention for carpal tunnel syndrome. The best way to do that is to talk to your primary doctor about referral to a hand specialist. A hand surgeon and a neurologist can often work in tandem to confirm that your symptoms are in fact related to carpal tunnel syndrome and to determine the severity of the nerve compression. This will help to guide treatment as the treatment is often determined by how severe the compression is and not simply the presence of symptoms.

Carpal tunnel is a common problem in the population. Many people have it. Some people need to have it addressed and seen by health professionals, but not everyone. You should not be afraid to see a health professional. There are conservative treatments as we’ve outlined, and for those for whom the conservative treatments don’t work, surgery is a very effective option.

Generally (in my experience) carpal tunnel syndrome does not improve with over the counter medications such as Ibuprofen. Generally, my suggestion for first line of treatment for carpal tunnel syndrome would be splint immobilization, activity modification, and perhaps a cortisone injection.

The risk of carpal tunnel after surgery should be low that it will come back. Once you’ve been operated on, it should be gone. Occasionally patients do get it back, but they do well with repeat surgery and even conservative measures.

Everybody has a carpal tunnel. The question is: do they have enough compression to cause problems? It is very common. If you ask around to your friends, most of them will have said that at some time in their life they’ve had trouble with a numb hand that then extends up the arm. So it comes, it goes, and it’s present in many of us, but when it becomes bothersome – that’s the time to think about “what should I do about it?”

There’s been a lot of talk as to what causes carpal tunnel. Well, clearly it’s higher in women than it is in men. Probably same size nerves and tendons, but in a smaller canal. But also there were a lot of what we now call Òwives talesÓ about that if you were clerical, i.e. on a typewriter or keyboard, or if you worked as a checker in a grocery store. But now we have much better data that suggests that those aren’t the causes. Interestingly enough, probably the one common thread is that people who have repeated blunt trauma – hammers, drills, things like that – that probably increases your carpal tunnel risk. But also don’t forget bicyclists who lean on those grips on the handlebars and push on those nerves day in, day out in their training.

If you’re thinking “I’m not sleeping so well during the night because I wake up and I have to shake my hands or lean them off the bed.” Or: “Gee, when I drive for long periods of time, my hands seem to go numb.” Or “Gosh, my hand when it’s on the cell phone and I’m talking for awhile, it just doesn’t feel right.” You probably have carpal tunnel. An easy thing to do is to buy yourself a set of what are called rollerblade wrist guards and they bring the wrist up like this *Demonstrates*. They’re nylon and they’re plastic. They can be found online and they can be found in sporting goods stores. You’ll think: “I should wear them during the day.” But in reality you should wear them at night and the reason is that by resting the nerves, tendons, and the inflammation at night, you’ll improve the daytime symptoms too.

So you have carpal tunnel. What’s the first line of treatment? Generally wearing the splints at night. Different practitioners have different thoughts about the positioning of the splints, but generally wearing them at night is a good thing to start with. It’s conservative, it’s safe, it’s hard to get into trouble, and probably 40-70% of people will be made better with that.

Most physicians who see patients with carpal tunnel will order a very special test. We call it the Electrical Pins and Needles Test, but its real name is an EMG – an Electro Myogram with nerve conductions. It’s sort of like looking at an intersection and seeing how long it takes for a car to get across the intersection. The EMG looks and it sees: how long does it take for the nerve impulses to go underneath the ligament, from the wrist and into the palm? If that time is prolonged (and it can be variably prolonged – meaning some people may have it a little long, some people may have it a lot long) – that determines a degree of carpal tunnel – mild, moderate or severe. If that same test (the EMG) also shows that there are muscle cells dying, something definitely needs to be done.