By Elizabeth Anne Shaw
Carpal tunnel syndrome (CTS) is so common that even if you don’t have it yourself, you probably know someone who does. But it’s no big deal — just wear a wrist brace and move on, right? Not so fast. When the condition isn’t treated properly, what started as occasionally annoying pins-and-needles feeling in your hand and wrist can, over time, develop into permanent atrophy, weakness and numbness, says Brandon Earp, M.D., Chief of Orthopedic Surgery at Brigham and Women’s Faulkner Hospital in Boston.
Fortunately, there’s no reason for CTS to get that far. Treatment options are becoming easier and better, and if surgery is required, it doesn’t have to be ultra-invasive. Just 10 minutes and one small incision later, you could have full function (and comfort) back.
But first, let’s back up: To understand carpal tunnel, it’s important to understand how it starts. CTS develops when the median nerve, which travels through the carpal tunnel as it passes from the forearm to the hand, gets compressed within the tunnel. The carpal tunnel is a relatively tight space bordered by the wrist bones and the transversal carpal ligament, a band of fibrous tissue that runs across the base of the palm. The wrist bones and the transversal carpal ligament form the carpal tunnel: the bones run along the floor and sides; the ligament is the roof. Keep in mind, the tendons that allow you to bend your fingers and thumb also run through the tunnel — so even in healthy hands, space is fairly tight.
Conditions that trigger swelling, including pregnancy and rheumatoid arthritis, are associated with the onset of symptoms. Working with tools that vibrate or require prolonged gripping are a risk factor, too. Occasionally, fractures play a role. “Most of the time, though, we can’t point to a definitive cause,” says Dr. Earp. And despite popular belief, computer use hasn’t been proven to cause carpal tunnel, though it may contribute. “While good ergonomics still matter, the connection to computers is still very unclear,” Dr. Earp explains. Which is all to say, there isn’t a whole lot you can do to prevent CTS.
Instead, what matters most is taking action when symptoms do occur to prevent degeneration. “This isn’t something to wait on,” says Dr. Earp. “If it’s left alone, it will continue to get worse,” though the timeline specifics vary. Early signs of CTS include tingling and numbness in the hand, usually affecting the thumb, index, and middle fingers. Some people may also experience pain, including a burning or a pins-and-needles sensation. Discomfort often comes and goes, occurring frequently at night — this is likely due to position during sleep, like tucking in arms, or the curling of hands under the pillow, which can put additional pressure on the nerve.
A doctor will do a physical exam and may order an x-ray and/or a test called an EMG that can check for nerve problems. If symptoms are fairly mild, she’ll likely recommend wearing a splint at night to help keep the wrist in a neutral position. Some people also find relief with cortisone shots, which can ease swollen tissues. But if these strategies don’t work and the pain and numbness become persistent—or you start to lose strength—surgery is usually called for, says Dr. Earp. “These are the symptoms we want to avoid so patients don’t develop permanent nerve damage.”
The surgery Dr. Earp prefers to perform is called mini open-release, and it can be done in about 10 to 15 minutes. Here’s how it works: Patients receive local anesthetic and, occasionally, mild sedation. The surgeon makes about a half-inch incision in the palm and cuts the ligament, which takes pressure off the nerve. The wound requires just three or four stitches and no splinting afterward. Recovery takes about 10 days.
“Most people can use their hand without restriction at that point,” says Dr. Earp. Compare that to traditional carpal-tunnel release surgery, which usually involves a 2-inch incision followed by a far more prolonged recovery. Research shows that both procedures are equally effective, even in patients with severe symptoms. In fact, a study in the medical journal Hand found no significant differences in outcome.
If it turns out that surgery is the best option for you, Dr. Earp recommends working with a board-certified hand surgeon who performs this procedure regularly (you can verify credentials with the American Board of Orthopaedic Surgery). Once you've found a doctor you trust, relief will soon follow — and it could only take a few minutes and a few stitches.
