McLEOD HEALTH 6 JUNE 2023

By: Dr. Christopher Zust
McLeod Neurologist
McLeod Neurological Associates

Carpal tunnel syndrome is a common condition caused by a pinched or compressed median nerve in the wrist. The median nerve provides the feeling in the thumb and all fingers except the pinky. As the nerve goes to the hand through the wrist, it passes through the carpal tunnel, which is a narrow path made of bone and ligament. When there is swelling or irritation in the carpal tunnel, the median nerve can be squeezed or pinched, causing the symptoms of carpal tunnel syndrome.

Anything that squeezes or irritates the median nerve in the carpal tunnel space may lead to carpal tunnel syndrome. Many activities can cause carpal tunnel syndrome, such as working with vibrating power tools or activities requiring prolonged or repetitive flexing of the wrist, such as working on an assembly line. These activities can create harmful pressure on the median nerve in the carpal tunnel.

Other things that may be contributing factors to carpal tunnel syndrome include:

●      Frequent, repetitive small movements like keyboarding

●      Frequent, repetitive grasping movements such as with some sports

●      Joint or bone disease like arthritis

●      Hormonal or metabolic changes like menopause or pregnancy

●      Family history

●      Injuries of the wrist such as a strain, sprain, or break

The symptoms a patient suffering from carpal tunnel syndrome can experience include a painful burning, tingling, itching, numbness, or a “pins and needles” sensation in the hand and sometimes the forearm. Some patients will have weakness in the hand and trouble holding objects. Patients may also say their fingers feel swollen even though little or no swelling is apparent. The dominant hand is usually affected first and produces the most severe symptoms, but many patients have carpal tunnel syndrome in both hands (bilateral carpal tunnel syndrome). In most cases, carpal tunnel syndrome gets worse over time without appropriate treatment.

Women are three times more likely than men to develop carpal tunnel syndrome. This may be because the carpal tunnel area is relatively smaller in women than in men. Those with diabetes are also at higher risk.

Early diagnosis and treatment are important to prevent permanent damage. Carpal tunnel syndrome is classified as a nerve disorder, which makes a Neurologist the perfect provider to help manage the condition. If a Primary Care Provider suspects their patient may be suffering from carpal tunnel syndrome, especially if symptoms are worsening, then a referral to a Neurologist for evaluation can be the next course of action.

At the appointment, the Neurologist will perform a physical examination and ask about symptoms. The Neurologist may ask the patient to perform specific hand movements to try and produce the symptoms they are experiencing. If warranted, the Neurologist will perform an electrodiagnostic study, which includes a nerve conduction study and a needle electromyography (EMG). The nerve conduction study looks for the proper functioning of the nerves. The EMG study assesses both nerve and muscle function.

The Neurologist will also be able to provide effective treatments to relieve symptoms associated with nerve compression. Treatments may include a cortisone injection, splinting the hand to ease the compression of the nerve, and/or anti-inflammatory medication. Worksite ergonomic changes, that could help ease symptoms, should also be considered. This can include changing the position of the computer keyboard and mouse at work.

Some cases require surgery to relieve the pressure of the compressed nerve. Carpal tunnel release is one of the most common surgical procedures in the United States. It is usually performed under local anesthesia and does not require an overnight stay in the hospital. There are two surgery types: open and endoscopic. In both cases, the surgeon cuts the ligament around the carpal tunnel to take the pressure off the median nerve at the wrist and relieve symptoms.

To help prevent carpal tunnel syndrome, it is generally recommended to minimize stress on the hands and wrist by taking short regular breaks when performing frequent, repetitive movements. Gently stretch and bend the hands and wrists periodically.  Avoid bending the wrist all the way up or down. A relaxed middle position is best. A keyboard should be kept at elbow level or slightly lower and make sure the computer mouse is comfortable and doesn’t strain the wrist.

Anyone experiencing the signs and symptoms of carpal tunnel syndrome that interferes with their normal activities, should see their Primary Health Care Provider and consider a referral to a Neurologist.

Dr. Christopher Zust is a board-certified Neurologist who cares for patients at McLeod Neurological Associates located in the McLeod Medical Plaza, 800 E. Cheves Street in Florence. He treats a broad range of neurologic disorders including multiple sclerosis, Parkinson’s Disease, and seizures. Dr. Zust is accepting new patients by physician referral.