What you need to know about Carpal Tunnel

Researchers now say it may have more to do with a person’s genetic makeup than occupation

What started as a sporadic tingling in the thumb has now progressed to an undeniable numbness that disrupts sleep, signaling a real health problem.

This discomfort and sometimes pain is what will lead up to 6 percent of all Americans to be diagnosed with carpal tunnel syndrome at some point in their lives. Carpal tunnel syndrome occurs when the median nerve, running through the center of the wrist, becomes compressed or squeezed by an abnormally thick ligament. The result is painful numbness in the hand, sometimes radiating up the arm.

According to the National Institute of Neurological Disorders and Stroke (NINDS), carpal tunnel syndrome is “the most common and widely known of the entrapment neuropathies, in which the body’s peripheral nerves are compressed or traumatized.”

Michael Rymer, MD, a surgeon with Hand and Reconstructive Surgeons and Associates, said there has been an increase in the number of cases diagnosed with carpal tunnel syndrome, mainly due to better recognition of the disease, as well as to an increase in obesity in the population.

Many patients who develop carpal tunnel syndrome may never know the exact cause. At one time, the condition was thought to be linked to excessive keyboard repetition. However, researchers at Harvard Medical School believe that may not be the case. They found that working for as much as seven hours a day on a computer keyboard doesn’t increase an individual’s risk of developing the condition.

Certain occupations with vibration exposure – such as assembly line work – have been known to contribute to carpal tunnel syndrome; however, for a good portion of Americans, the cause may be linked more to genetics. Some individuals may have a smaller carpal canal, which make them predisposed to the condition. Women are at a greater risk for developing the condition, and an individual’s chance of being diagnosed with it increases with age. The average age at which people are diagnosed is 55 years old.

“Patients with certain co-morbidities also have a higher risk of developing carpal tunnel syndrome,” said Dr. Rymer, who practices with Premier Health Specialists. “These can include diabetes, hypothyroidism, auto-immune diseases, and obesity. Women who are pregnant may also be at a higher risk due to excessive swelling in the extremities or weight gain.”

The American College of Rheumatology (ACR) notes it is important for individuals to know the symptoms of carpal tunnel syndrome and seek medical attention for an accurate diagnosis. A rise in the familiarity of the condition has led many people to make erroneous conclusions that any pain or discomfort in the hand or wrist should be attributed to carpal tunnel syndrome. Other conditions can cause similar complaints, which is why it is important to seek medical advice to help determine the exact cause in any particular case.

Symptoms of carpal tunnel syndrome include numbness and tingling of the thumb, index finger and part of the ring finger. There may be loss of the small hand muscles that move the thumb. It is also very common for individuals to complain of nighttime symptoms that may wake them several times a night. Sustained grip position, such as occurs when driving, can increase symptoms. The hand may be so numb that it becomes difficult for the patient to feel and handle small objects. The frequency and intensity of symptoms usually progress over months to years, Dr. Rymer said.

The diagnosis of carpal tunnel syndrome is sometimes confirmed or further evaluated by electrophysiologic tests which can grade the nerve abnormality as mild, moderate or severe. These findings can help guide physicians as to what treatment is best for a given patient. When no nerve damage is seen on testing, carpal tunnel syndrome may be treated conservatively through physical therapy, splinting, activity modification or cortisone injections. More advanced cases of the disease require surgery.

Surgery relieves the pressure on the nerve by cutting the transverse carpal tunnel ligament, which is the tissue band pinching the median nerve. The size and location of the incision and type of surgical instrument used to cut the ligament vary depending on each patient’s circumstance and surgeon preference. Night numbness is the symptom most reliably relieved by surgery. As with any surgery, individual results vary and the best way to assess if surgery is indicated is to work with your physician.

Carpal tunnel syndrome should not be ignored because it can have a significant impact on a person’s quality of life. Symptoms may be occasional or mild at first, but if left untreated, can progress to a point where the median nerve is damaged resulting in permanent numbness and loss of small muscle control of the thumb.

ABOUT PREMIER HEALTH SPECIALISTS: Premier Health Specialists is one of the largest groups of specialty care practices in Southwest Ohio. More than 130 physicians serve patients in a variety of specialties such as bariatrics, breast care, burn and wound, cardiology, cardiothoracic surgery, cardiovascular-thoracic surgery, general surgery, gynecologic oncology, hand and reconstructive surgery, infectious diseases, maternal-fetal medicine, neurosciences, obstetrics and gynecology, orthopedic surgery, orthopedic spine surgery, ophthalmology, palliative care, physiatry, plastic surgery, podiatry, psychology, pulmonology, sports medicine and urology. Premier Health Specialists is part of Premier Health, which includes Miami Valley Hospital, Good Samaritan Hospital Dayton, Atrium Medical Center and Upper Valley Medical Center. For more information, visit http://www.premierhealthspecialists.org.

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