What is carpal tunnel syndrome and what causes it?
Dr. Matthew Phinney: Carpal tunnel syndrome, lot of people deal with it, lot of people suffer. What it is, is pressure on the media nerve, so the nerve that passes through the carpal tunnel, branches out and controls all the functions of the hand. What happens is, there can be some sort of a narrowing of that carpal tunnel, putting pressure on that media nerve. That’s what a true carpal tunnel syndrome actually is.
How do you know the difference between carpal tunnel, arthritis and tendonitis?
Dr. Matthew Phinney: Great question. Typically, symptomatology. We look at what sort of things are they experiencing. Carpal tunnel will often feel like numbness, tingling in a certain area of the hand, middle portion of the hand. We’ll also see weakness over a period of time, weakness in the hand. So people let’s say that drop things, that can be a carpal tunnel. Arthritis, if it’s a true arthritis like a degenerative type arthritis, often times the pain is unrelenting. It doesn’t want to go away. Tendinitis is the inflammation of the muscles, tendons, ligaments and the same sort of thing. We’ll see it can be at the wrist, can be at the elbow, can be at the shoulder, just really depends on symptom-wise.
We’ll also take a detailed case history to see if there’s anything that they’re doing that may be potentially increasing the likelihood that they have either carpal tunnel, arthritis or tendinitis. There’s certain things that people do which would pre-dispose them to one of these different symptoms or diseases.
What are some signs and symptoms of carpal tunnel?
Dr. Matthew Phinney: With carpal tunnel, what we’ll typically see is numbness, tingling into the hands. There’s a couple of different orthopedic tests. There is Phalen’s Test – if you put your hands together, you’ll get numbness, tingling that will re-create that. Same thing if you bent your wrist down, both wrists down – and then bring those together and you push against them. Those will often re-create the symptomatology. You’re closing down that carpal tunnel. Another way to tell orthopedically is one called Tinel’s Test, so it’s actually tapping on the bottom. If you put your hands facing up towards the sky, and then you repeatedly tap right at the base of the wrists, that will often times aggravate that carpal tunnel and you’ll have a re-creation of the symptoms. But yes numbness, tingling, weakness, aching, that type of sensation in the hands. Sometimes we’ll see swelling with the hands as well in the wrists.
What types of jobs or activities tend to cause carpal tunnel?
Dr. Matthew Phinney: A lot of the times, people that come in with the carpal tunnel are the repetitive use things. Typing is a big one. I’ll see it a lot of time with painters, people that are using their wrists a lot like electricians, plumbers and mechanics. A lot of times the repetitive use type movements put a lot of stress and strain on the wrist itself, causes inflammation. Inflammation shuts down that carpal tunnel and it can put pressure on that nerve. Pregnancy, again, same thing. You’re retaining more water throughout a pregnancy so often times that will shut down that carpal tunnel. A lot of pregnant women will suffer from it. Hypothyroidism is another one. People with different degenerative types of arthritis, they’ll often times deal with some rheumatoid, that sort of thing. Those are some of the people, the categories. A lot of times job stuff, it’s a lot of the repetitive use stuff.
Can carpal tunnel syndrome be healed and cured if it is caught in time?
Dr. Matthew Phinney: Yeah, as always the case, the sooner that you get on something, the sooner that you start taking care of it, the better the outcomes typically are. Conventionally, what they’ll typically want to do, they’ll do a couple of different orthopedic tests. The Gold Standard: They usually will do what’s called the “nerve conduction test” and see if your nerve conduction velocity will actually shoot a current through that carpal tunnel. If there’s any sort of delay or slowing of that current, they’ll diagnose that as a carpal tunnel syndrome. Their treatment is, usually they’ll go non-steroidal, like anti-inflammatory, some physical therapy, sometimes a wrist splint that they’ll have people wear up at night they call a cock-up splint. All of these things, typically, the outcomes are fairly poor and can lead to a surgery down the road.
When they end up doing a surgery, any time you cut any area of the body, the body’s designed to heal. It will start to fill in those little gaps and cracks and spaces and that can actually create more compression on the media nerve passing through the carpal tunnel. The long-term outcomes for the carpal tunnel surgery are typically quite poor. The faster that you can get to something and determine whether or not it’s a true carpal tunnel … A lot of times what we’ll see as well is a syndrome called the “double crush syndrome” where it’s actually pressure coming from the base of the neck. That increases the sensitivity of that nerve passing all the way down into the arms and hands. When we correct that, when we take the nerve pressure off there, that decreases the sensitivity of that nerve and the numbness and the tingling in the hands goes away.
Before you go and have somebody cut on you or have some sort of surgery, the first thing you want to it first determine whether or not this is a true carpal tunnel. Unless you’ve actually taken a film of the upper back and neck then it’s very difficult to determine that. That’s one of the things that’s often times overlooked especially if you’re getting it in both hands. Numbness, tingling in both hands, the majority of the time it’s coming from up top because that’s where those nerves are exiting. That would be one of the signs, I would say, “Hey, get that checked before you go and have a surgery, so that you don’t have an unneeded surgery. Once you have it, you can’t undo it.”
RC: Right. Okay. That’s it for today. Thank you so much, Dr. Phinney. We know you’re really busy, so I just want to thank you for your time and help today.
Dr. Matthew Phinney: Yeah, thanks so much, Liz. I appreciate you having us on.
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This article was reviewed and approved by Dr. Matthew Phinney.