In this video, Dr. J. Michael Bennett describes the causes, symptoms and treatment options for carpal tunnel syndrome. Many people automatically think “surgery” when they think of carpal tunnel syndrome, but in many mild cases, surgery is not necessary. Dr. Bennett describes how a wrist splint or night splint can be used to treat mild cases of carpal tunnel syndrome.
Dr. Bennett is a Board Certified Orthopedic Surgeon and Fellowship Trained Sports Medicine Specialist with a Certificate of Added Qualification in Sports Medicine. We have clinics in Sugar Land, near First Colony Mall, and in Houston, near the Houston Galleria.
Here’s Dr. J. Michael Bennett talking about the causes of carpal tunnel syndrome and some of the treatment options:
Here’s the summary of the video:
Hello, and welcome. My name is Dr. J. Michael Bennett; I’m an Orthopedic Sports Medicine Physician practicing in the Sugar Land/Houston areas. I specialize in minimally invasive and arthroscopic surgery of the shoulder, elbow, and knees, as well as sports medicine. Today, we’re going to talk about carpal tunnel syndrome, which is a very common problem. We see a lot of it. Usually, there’s a number of different reasons you can get carpal tunnel syndrome: You see it in women that are pregnant, you see it in people that use their hands quite a bit for their jobs and their daily tasks. Sometimes you can have it secondary to trauma or a fall. Sometimes we see it in patients that have other pathologies or other problems and health risks such as thyroid problems or even diabetics. There’s a number of reasons you can get carpal tunnel. Today, we’re just going to talk about some of the symptoms and what is carpal tunnel.
Just going through the anatomy, basically, if you look at your hand, all your fingers are basically controlled by tendons that allow you to flex your fingers. Those tendons run through the wrist in this region here, and they basically share the space with the nerve. The nerve is called the median nerve, and that nerve . . . this is not exactly anatomically correct because you may have a few more tendons than this, but just to get the point across. These are a couple of bones, and then you’ve got a ligament that goes on top. It acts like the roof of that area. What happens is that you get a difference in your pressure, whether it be swelling from fluid, from trauma, for whatever reason; the pressure increases and it squeezes this little blue nerve here, and it causes some inflammation within the nerve. Sometimes, that can lead to chronic scarring of the nerve and symptoms associated with carpal tunnel, which is actually numbness, tingling, and burning, primarily involving these 3 fingers, because that nerve comes through the mid portion of the wrist and actually innervates these 3 fingers and then half of this finger.
You’ll notice burning, tingling, primarily involving these 3 fingers. You may even notice some muscle atrophy or sinking of this muscle in the palm area, because the nerve branches off and it has a motor branch to this thumb region. This is called the thenar eminence. You can actually, if you look at your hand and you start seeing a difference in your hands and you start seeing a flattening of this muscle in addition to the numbness and tingling, that means you have carpal tunnel syndrome. It may be a chronic situation if you start to see muscle issues going on, particularly weakness. Typical symptoms with carpal tunnel syndrome is consistent burning, tingling that wakes you up at night, affects you during the day, dropping objects. Patients have dropped objects where they’ve hurt themselves or burned themselves, not even noticed it. That would be indicative of some sort of neuropathy. If you have any of these symptoms, you do want to be evaluated by an orthopedic specialist or even a neurologist to actually get the appropriate tests to determine what exactly is causing this neurologic change.
Typically, in the majority of patients that have carpal tunnel, it can be secondary to position and the way that your hands or wrists are positioned in most of the day. Some patients sleep with their wrists flexed at night. As I mentioned before in the cubital tunnel talk, you can have what we call the praying mantis position, where your elbows are flexed and your wrists are flexed, and they’re sleeping on that. It actually compresses this nerve and irritates that nerve, and makes your symptoms worse. A lot of times, you’ll wake up in the middle of the night and shake your hand because you’re getting numbness and tingling, and it’s really bothering you and you’re not able to sleep. If that’s the case that’s . . . and it just occurs at night, that may just be positional carpal tunnel syndrome. The first thing you want to do is see if you can change your position to see if that makes a difference.
What I recommend is if you don’t want to go to see a doctor at that point, go ahead and go to the store and pick up a wrist splint. It’s called a night splint that you’re going to use at night. All it does is basically holds your wrist in a stable position so you don’t flex it at night and pinch that nerve. It’s a very simple wrist splint. This is what we give a lot of our patients here in our office. You can find different types of splints out there. All you do is slide your hand through the splint and tighten the splint itself. It wraps up like that. All it does is keep you from flexing that wrist at night. When you’re sleeping, you’re not going to bend that wrist, so it actually keeps your carpal tunnel open, and it keeps you from adding to that pressure across the nerve.
If you decide to see an orthopedic surgeon or a neurologist, the first thing they’re going to do is get what’s called an EMG, which is an electromyogram, which actually looks at the nerves themselves and sees exactly where the nerves are being compressed, whether it’s going to be in the wrist, whether it’s in the elbow, whether it’s coming from the neck. They can actually determine that through this test. Depending on what that grade of compression is on the result will determine how you’re going to respond to treatment. Majority of patients will have mild carpal tunnel syndrome; they’re usually going to respond to a night splint and maybe an anti-inflammatory if they can tolerate it and if it’s okay with their physician. The majority of people get better with that after a couple of weeks. However, there are some people that are more severe in regards to their symptoms and have noticed this atrophy and wasting in the hand. If you have moderately-severe to severe carpal tunnel syndrome and you have the EMG to show that, and the night splints haven’t worked for you, and the numbness and tingling is during the day and it’s not just at night, then you may need to have a carpal tunnel release.
What a carpal tunnel release is an old way we used to do a carpal tunnel release is just a mid palmar incision right in the middle of the palm. What you would do is just make an incision in the palm, and you’d release this band of ligament here. Now there is a number of different techniques out there regarding the endoscopic approach for a carpal tunnel release. We do an endoscopic approach here, where we actually put a camera into the carpal tunnel and release the ligament from the inside out. That way, you’re not having a big incision in the wrist. We make a little incision at the base of that ligament and a little incision up top in the palm. Then we go underneath this ligament, and we just use a little knife that actually splits that ligament and releases it. It just releases it from the inside out. It opens up that ligament so it decompresses that area, the carpal tunnel, so now this nerve can breathe again. Basically, the nerve is decompressed, the blood flow gets back to the nerve. the nerve starts to heal. The nerve can actually heal 1 millimeter a day, depending on how long it’s been compressed and how long of an area of compression you have across the nerve.
Sometimes you can have it to the point where it’s severe enough that even doing a release may not reverse the symptoms that you’re having. That’s why it’s important not to ignore your symptoms if they’re bad enough. If you’re starting to notice muscle atrophy and weakness in the hand, I highly recommend that you have it evaluated by a physician just to make sure that you’re not at that point where you’re not going to see the benefits of having the release. These are one of the things that it’s better to have it treated earlier than later, and you don’t want to miss the opportunity to have it fixed. That being said, that’s really carpal tunnel in a nutshell.
If you have any questions, please feel free to call our office at 281-633- 8600 in Sugar Land or 713-234-3152 in Houston, near the Houston Galleria.
Dr. J. Michael Bennett is a Board Certified Orthopedic Surgeon and a Fellowship Trained Sports Medicine Physician with offices in Sugar Land and in Houston. Dr. Bennett specializes in treating injuries of the shoulders, elbows, and knees.
Our office is part of the highly-regarded Fondren Orthopedic Group and we refer complex wrist and hand injuries to hand specialists at Fondren for treatment. The Fondren hand surgeons are board certified and have added qualifications in hand surgery.
Dr. J. Michael Bennett treats certain wrist and hand injuries including carpal tunnel syndrome, distal radius fractures (broken wrist), trigger finger and metacarpal fractures of the hand. He specializes in using the endoscopic approach to carpal tunnel syndrome, when appropriate for the patient, which means that the carpal tunnel surgery consists of two small incisions instead of a longer incision across the middle of the palm of the hand. Please check Dr. Bennett’s patient education video library on topics such as carpal tunnel syndrome and trigger finger.
