Are you experiencing numbness, tingling and pain — primarily in the first three fingers of your hand? You may have carpal tunnel syndrome. Here, Dr. J. Michael Bennett describes your options for carpal tunnel syndrome treatment and the anatomy of your hand and wrist. Dr. Bennett has another video on carpal tunnel syndrome from his Whiteboard series of videos.
Doctor Bennett is a Board-Certified Orthopedic Surgeon, and he’s also a Fellowship Trained Sports Medicine Physician. He has many years of experience treating conditions like carpal tunnel syndrome, hand injuries and arthritis of the hand. We serve patients from all over the Metro Houston area from offices in Sugar Land and in Houston, near the Houston Galleria.
This is a summary of the video:
Carpal tunnel syndrome usually is first noticed when someone feels numbness, tingling, and pain, primarily involving the first three fingers of the hand. Occasionally it can happen to someone who does repetitive activities like using a keyboard or heavy lifting. It can also happen in some patients who are pregnant or notice any shift in their body’s fluid status. But however it happens, what carpal tunnel syndrome comes down to is compression across the median nerve.
The median nerve is a large nerve that runs through the center of the wrist, and innervates these three and a half fingers. You will notice pain, numbness, tingling, and sometimes, when it is really bad or when it’s been going on for many years, you’ll have atrophy, which means the muscle starts to waste.
When carpal tunnel syndrome gets to the point where this muscle starts to shrink and you are dropping objects because you’re having so much weakness in the hand, usually that means that some of the nerve damage may be irreversible. So it’s important to understand that if you do have any nerve symptoms in the fingers of your hand, you need to be evaluated before this irreversible damage occurs.
The standard approach for carpal tunnel syndrome is a conservative approach depending on how long you’ve been dealing with the symptoms. If you have these symptoms acutely, within a few months, typically what the physician will do in a standard exam is confirm your symptoms and, if you do not have any atrophy or weakness, usually prescribe an anti-inflammatory and the wearing of a night splint.
Some patients have what’s called transitional carpal tunnel syndrome. If a patient comes in and says “I only have numbness and tingling at night, but during the day it goes away,” more than likely it has to do with the position of their hands when they’re sleeping. Some patients will sleep in what I call the Praying Mantis Position, where they’re on their belly or on their side with their hands flexed and their elbows flexed.
Sleeping this way puts pressure on this median nerve and can actually irritate the nerve and create carpal tunnel syndrome symptoms. This is quickly and easily addressed by just using a night splint that you wear when you’re sleeping that keeps your hand in a neutral position. If that takes care of your symptoms – that and an anti-inflammatory – then more than likely you’ve had transitional carpal tunnel syndrome.
If, on the other hand, you notice numbness, tingling and weakness not only at night but during the day as well, then there may be something more serious going on. We will try the night splints as well as an anti-inflammatory medications, but typically we will get what’s called a nerve conduction test, or an EMG (electromyography), which tells us how bad the carpal tunnel is, or how bad this median nerve is being compressed. We will grade it according to mild, moderate or severe. That assessment of the severity of the median nerve compression will usually determine the next step in treatment.
If you’re a patient who has not responded to conservative measures such as anti-inflammatories, bracing, and modification of activities, and you have a positive EMG finding that is anywhere from moderate to severe, then typically we would recommend a release of that carpal tunnel ligament.
The carpal tunnel ligament forms the roof of the carpal tunnel, underneath the median nerve. Above that median nerve is the ligament. And there are two ways of releasing that ligament. The old classic way of releasing that ligament is an open approach, where a small incision is made along the crease that runs through the middle of the palm of your hand. This allows us to open the carpal tunnel and release the ligament. Relieving the compression on the median nerve allows the nerve to become vascularized and to get its blood supply back. That starts the healing process for the median nerve.
The newer way that we use in releasing the carpal tunnel ligament is through an endoscopic carpal tunnel approach. This requires two small incisions, one at the base of the wrist and one up in the mid-palm, which allow us to put a camera within the wrist and look at that ligament and under direct visualization release that ligament with a small, micro knife without disrupting the skin over the nerve itself.
You’ll probably prefer the endoscopic carpal tunnel release because it is less invasive. There is no scar in the middle of the palm so the endoscopic carpal tunnel release may be better for patients who have to do manual labor or pushing off of the hand or wrist.
I do find that the endoscopic carpal tunnel release also usually heals slightly faster and there’s a better-looking palm for the patient. Either way is acceptable, but I find that an endoscopic approach is definitely a good option for patients who prefer that and we definitely do offer that.
If you’re experiencing numbness or tingling in your hand, please call us for an evaluation at 281-633-8600 for our Sugar Land office or 713-234-3152 for our Houston office. Most problems can be treated with conservative, non-surgical methods, but if you wait too long, surgery might become your only option for relief.
