Know your treatment options for carpal tunnel syndrome

The tingling and numbness associated with carpal tunnel syndrome can seem like a nuisance. However, when it starts to affect your quality of life, it may be time to see a physician.

But what is carpal tunnel syndrome exactly?

According to Dr. Chia Wu, an orthopedic surgeon at Baylor College of Medicine, carpal tunnel syndrome is a pinched nerve in the wrist associated with symptoms such as tingling, numbness, weakness, or a burning sensation. It usually affects the thumb, index finger and middle finger and is not usually associated with pain.

It’s common to feel the symptoms at night, and people often complain of having to wake up and shake their hand to reduce sensations.

In severe cases, people report losing muscle bulk in their hand, which causes them to have trouble gripping and even drop objects.

What are the causes?

While some risk factors have been studied, there is not a conclusive cause of carpal tunnel syndrome. Pregnancy and diabetes can be risk factors, but generally the cause is multifactorial. It is common in older adults, although not exclusive to this age group, Wu said.

“It can also sometimes be associated with heavy manual activity that causes the ligament to push on the nerve.”

When should you see a doctor?

Wu says seeking treatment for carpal tunnel syndrome is all about your quality of life. He cautions that in severe cases, some of the changes, such as loss of strength or sensation, can be irreversible since it is a nerve-related problem.

When you see a doctor, you can also be evaluated for other problems. The symptoms might be related to other types of peripheral neuropathies.

“This is where an evaluation and conversation with your doctor about exact symptoms can be helpful.”

What are the treatment options?

There are both non-operative and surgical options for treating carpal tunnel syndrome.

“In terms of deciding on treatment, I rely on patients to tell me how much it’s interfering with their daily life. We can take a more aggressive route with people who need to get back to an activity but are hampered by the symptoms.”

One option is to wear a splint at night to keep your wrist from moving too much. Research has shown that the pressure inside the carpal tunnel is lowest when you are able to maintain it in a neutral position.

A slightly more invasive option is injecting corticosteroids into the carpal tunnel, which can be done at the doctor’s office.

As a last resort, or in some cases of advanced symptoms, surgery is the best option. This involves making a small incision in the wrist that releases the tight ligament that is compressing on the nerve.

The surgical procedure is outpatient and requires some sedation as well as local anesthesia in the wrist. No narcotics are generally required during recovery.

However, it’s important to know that recovery from carpal tunnel syndrome can take longer following surgery.

“Patients describe carpal tunnel syndrome as their hand is falling asleep, so the waking up process where the nerve comes back can take up to a year after the surgery,” Wu said. “It takes a while to recover compared to other injuries we see in orthopedics.”

In severe cases, the nerve may never recover, but Wu still recommends surgery to prevent it from getting worse.

Prevention

Because carpal tunnel syndrome doesn’t have a clear cause, there is not anything you can do to prevent it.

“It’s quite possible that the symptoms will go away for a period of time and then come back.”

While some patients say that applying a cream or other product on their hand can improve, Wu said he has not found that to be useful and does not generally recommend it.

“People also ask about supplements, and there is no medical evidence that suggests they can prevent or treat carpal tunnel. If you feel like it’s helping you, that’s fine – but don’t go out of your way to buy supplements, which can be very expensive.”

“Depending on your lifestyle and where you are in the spectrum of symptoms, talk to your doctor to see what suits you,” he said. “You can select from a menu of options that fits wherever you are in life, based on what you feel you need.”

Dr. Wu is an assistant professor in the Joseph Barnhart Department of Orthopedic Surgery. Learn more about orthopedic services at Baylor or call (713) 986-6016.

-By Dipali Pathak