A healthy living blog from Marshfield Clinic

Carpal tunnel syndrome: Get a hand on pain using treatment, surgery

Lois Dover

Lois Dover, of Wisconsin Rapids, Wisconsin, continues to enjoy painting thanks to successful carpal tunnel surgery in both wrists.

Carpal tunnel syndrome starts with tingling or numbness in fingers and thumb, progressing to pain. If left untreated, it can cause such severe weakness that you can’t open a bottle or a jar.

Carpal tunnel is a common problem often associated with repeated use of your wrists and hands.

The carpal tunnel is a narrow passageway of ligament and bones at the base of your hand. It contains tendons and the median nerve, which provides feeling and sensation in the thumb and first three fingers of your hand.

When to treat hand pain

Sometimes the tendons can become irritated, causing swelling that narrows the tunnel compressing the median nerve. This causes tingling, numbness and ultimately, sharp pain in the wrist.

“Pain can become so bad my patients just assume they’ll need surgery,” said Dr. John McDonough, an orthopedic surgeon. “But there are many other ways to treat carpal tunnel syndrome before surgery.”

Diagnosing carpal tunnel

To diagnose carpal tunnel syndrome an orthopedic surgeon will first get a thorough medical history.

Dr. Steven Sanford, an orthopedic surgeon specializing in hand and upper extremity surgery at Marshfield Clinic, said he asks patients when symptoms were first noticed, did they get worse, did anything seem to trigger them and pain level. He’ll do a physical exam, and if there is still doubt about the cause, he can order a test that measures electrical activity in the nerves.

“When the diagnosis is made, the first treatment is often simple rest. Many patients need nothing further,” Sanford said. “Some may benefit from wearing a splint, especially at night or when doing repetitive motions, to keep the wrist from bending and creating more pressure on the median nerve.”

Oral medications may help ease pain, while steroid injections fight inflammation.

Wrist surgery can be an option

Some patients do become candidates for surgery. Even then, there’s a choice. The traditional surgical approach is an open incision through the palm. A newer alternative is endoscopy, which involves routing a tiny instrument through a smaller incision in the wrist.

Lois Dover, 57, of Wisconsin Rapids, Wis., underwent both techniques in her wrists. McDonough performed endoscopic surgery on her right wrist in November 2012. It healed, but then her left wrist flared. She had trouble with her painting and woodworking hobbies. Because of an abnormal muscle in the wrist, the doctor chose the traditional open incision.

“I just asked Dr. McDonough to keep my wrists well enough so I could continue to paint,” she said. “The scoped wrist seemed to heal faster, but I have no complaints about either.”

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