Frequently Asked Questions about Carpal Tunnel Syndrome
Answer: No. It is a nerve entrapment disorder developmentally related to being born with a small canal within the wrist which gets even tinier as one ages as the bones of the wrist enlarge compressing the enclosed nerve.
Answer: No. Cold intolerance relates to blood flow. Hand circulation is independent of the two nerves predominantly affecting the hand, median and ulnar nerves. Arteries do not enter the hand via the carpal tunnel, so they are not subjected to the pressure on the compressed nerve in this situation with carpal tunnel syndrome. The most likely diagnosis is Raynaud’s syndrome wherein there is hyperactivity of the nerves going into the muscles of the blood vessels to the hand causing over-constriction and reduced blood flow. We have treatment for this. Contact us.
Answer: Absolutely. Numerous research studies have confirmed there is a strong familial tendency within families for a subsequent generation to have members with carpal tunnel syndrome. In fact, the largest study presented at an American Society of Surgery of the Hand meeting in about 2001 computed a 50% chance that if your mother or father had carpal tunnel syndrome you will develop it. Thus, there is a chance of up to 50% or more that each child born in a family will develop carpal tunnel syndrome. There are about 20 articles in the peer-reviewed medical literature confirming the strong genetic relationship to carpal tunnel syndrome within families. Most doctors are not aware and have not read this literature even though it is available for them.
Answer: No. Numbness in the small and ring fingers (ulnar two digits) are because of malfunctioning of the ulnar nerve. The situation you are describing is most likely cubital tunnel syndrome, or symptoms from pressure on the ulnar nerve at the elbow. It is less likely that you will have pressure on the ulnar nerve at the wrist and sometimes it can occur in both places. With physical examination and nerve conduction study we can confirm the problem.
Answer: Since you can’t determine who your parents are and it’s a genetic trait you just have to wait and see if you develop the symptoms. There is a sizable percentage of people who don’t go on to develop the frank syndrome even though they have the underlying pressure problem. This can even be picked up on a nerve conduction test before symptoms develop. We normally only treat the people who are symptomatic. People with confirmed median nerve dysfunction at the wrist which can be determined by nerve conduction study should really not take on employment with powerful vibratory tools or having to do a lot of work above shoulder level since this is likely to bring on the symptoms of the underlying problem. The savvy employer would know this and screen their employees such as meat packing plants and factories that require very vigorous use of one’s hands for packing or processing products.
Answer: Less than one in five of the people who come in with carpal tunnel syndrome will get relief with nonoperative intervention. For the most part that is only going to occur in the person who is taken away from the activity that they believe is precipitating the symptoms. In the event that symptoms don’t go away, surgery is still indicated. In my personal experience almost 100% of the people who come in with carpal tunnel syndrome need surgery. The science is overwhelming that the problem is age and genetic-related and related to being born with a small carpal tunnel and possibly nerves that are more sensitive to pressure. This situation worsens after age 30 and probably peaks in the mid-40s for most people.
Answer: This is a research tool. Ultrasound data comes out and is looking at shades of gray. The interpretation is very subjective. It is not objective like measuring the speed of nerve conduction with a nerve conduction test. You really can’t determine how the nerve is functioning.
Answer: In my opinion, none with the exception of the rare person who has unusual pain after surgery. In my experience this is less than 1 in 200 or 300.
Answer: It does appear that people with diabetes are more likely to develop nerve entrapment at the wrist, the elbow and certainly in the ankle (tarsal tunnel syndrome). Fortunately, diabetics respond to decompressive surgery just as well as non-diabetics, as long as the nerves are still physiologically in good condition.
Answer: Continuous night and day numbness, i.e. 24/7. Advanced arthritis of the neck (cervical spondylosis). Absence of nerve action potential on nerve conduction study with muscle wasting on physical exam is probably the worst finding. It is still unclear how much diabetes has in the prognosis of a person with carpal tunnel syndrome since the main thing is the need to take the pressure off the nerve.
Answer: Low-paid, repetitious, mundane work has a strong correlation between low socioeconomic status and attributing problems to one’s job even though there is probably a scientific relationship.
Answer: No. You are describing trigger digit also known as tenovaginitis stenosans. This occurs in the same individual who is genetically inclined to get carpal and cubital tunnel syndrome, de Quervain’s tendinosis, basilar thumb arthritis and tennis elbow. Thus, the doctor will check you for each of these conditions when you come in for consultation.
Answer: Yes. There are five articles in the English literature in the past 40 years demonstrating that a person may come in with the only sign of carpal tunnel syndrome being pain in the neck or shoulder that won’t go away until the pinched nerve at the wrist is decompressed with minor surgery.
Answer: None. They are placebos deceptively offered by unethical businesses trying to capitalize off the ignorance of the public. Only surgery will solve carpal tunnel syndrome and, if caught early, bracing will prevent progression and eliminate symptoms of cubital tunnel syndrome while minor surgery is necessary for many patients that present with a pinched nerve at the elbow.
Answer: No. There has been some suggestion that it might be but it doesn’t make any sense at all and there is no proof of benefit. Certainly if exercise was beneficial in eliminating or preventing carpal tunnel syndrome then any possible claim by a worker that there is an association between activity and their job is completely eliminated.
Answer: It depends on what the symptom is. Seven out of ten people come in awakening at night with numbness or pain in the hand; that goes away immediately after surgery. Some soreness in the wrist is going to persist after surgery because of the surgery itself. Clumsiness and dropping things depends on how bad the person’s numbness is and typically that improves within days to weeks. Carpal tunnel syndrome does not cause weakness. If a person has weakness it is due to either pain or another nerve entrapment, though one should not expect any effect on their strength based on carpal tunnel release.
With endoscopic carpal tunnel relief only the tight transverse carpal ligament that compresses the median nerve is released. The two tiny incisions are each only 3/8" and are displaced away from the wrist itself. The subcutaneus (layer just below the surface) nerve fibers are thus not injured. There is less injury to heal and less visible bruising and local discomfort with less effect on grip and pinch strength. This yields an absolute and psychologically superior, immediate outcome. Also after 6 months it's nearly impossible to detect a scar compared to the obvious scar from an open filet-of-wrist carpal tunnel release.
Good question. Laser is just a hot knife preventing any local bleeding when it comes to surgery. The units available for us are a bit cumbersome and their use requires a lot of extra expense. I was part of a Hand Surgeon's focus group on this issue. The consensus is that little would be gained. The only case of laser use for ECTR that I am aware of resulted in a severe complication-see Bibliography.
Since 1992 I have set the return to work record internationally to which other surgeons aspire. Initially, it took a week to get the most stubborn patients to use their hands fully. Then I started getting people back to work the Monday following a Friday surgery. In 2006 I pioneered return to work without even clocking out for office workers! In 2007 I extended this to some factory workers with a progressive safety manager at Tenneco. Most of my patients are able to return to at least modified duties the day of or after surgery progressing to unrestricted activity within one to two weeks. The only absolute restriction relates to the need to keep the incisions clean to prevent infection. Carefully crafted protocol using select medication and special exercise without formal physical therapy or braces has proven very successful. As can be seen in the section on "Best Solution" the best hand specialists have been able to do elsewhere is about 2 weeks time off. So you see, there is no good reason to procrastinate.
First, you will probably no longer fear your driver or irons flying out of your hands. Second, you will probably be able to resume golf the next day.
That is a very common and important question. Unlike placebos and quackery like magnets, copper bracelets, cortisone injections and "carpal tunnel exercises" for about 98%-99% of patients undergoing surgical release the result is permanent. In fact, after undergoing endoscopic carpal tunnel release a person has less chance of getting carpal tunnel syndrome back than a non-operated person has of developing the problem i.e. about a one in six chance. Most people who think that they have failed carpal tunnel surgery or recurrent CTS actually have untreated cubital tunnel syndrome (see associated ailments).
Absolutely, and now you can have endoscopic cubital tunnel decompression. This minimally invasive technique hurts less with less bruising. It requires only about a one inch incision. No restrictions are added so all you have to focus on is keeping your incisions clean.
It's probably a matter of economics. Insurers are not reimbursing specialists adequately yet specialists have a high overhead. This is unfortunate. I am results-driven and therefore I won't compromise. Most of my colleagues are not as efficient. Whether or not it says anything about insufficient dedication I don't know. You have a right to see the physician. You and others need to be vocal to your insurer about reimbursing at a level to allow survival. Contrary to propaganda we medical professionals can rarely raise our rates and reimbursement has only drifted downwards not upwards for the past 20 years.
Percutaneus A-1 pulley release is the least invasive and the least uncomfortable and therefore the best treatment for chronic trigger finger or trigger thumb. The open technique requires a trip to the operating room. The hand is painful for weeks and both the soreness and the need to keep the wound clean slow a person down. I have been using a needle technique for 13 years. Patients are evaluated and completely treated in a single office visit. Most patients require no medication for discomfort. The only stipulation is that the patient's finger or thumb has to be actively snapping in order to apply this technique. This usually means a morning appointment since obvious triggering predominates in the morning. I do not offer this technique for infants and toddlers for congenital trigger thumb due to lack of cooperation.<