Wrists and Hands Can Result from our Work: But is it Carpal Tunnel?
Prompt and Proper Diagnosis Key to Receiving Correct Treatment
Do you feel numbness, burning pain or a tingling
sensation in your hand or wrist that seems to increase at night; have
difficulty holding objects without dropping them; or find it
increasingly difficult to perform repetitive movements such as using
your computer mouse or keyboard without pain? If so, then you may be
one of the estimated 2 million people in the United States affected by
carpal tunnel syndrome, according to the American Association of
Neurological Surgeons (AANS).
About half of all cases are work-related, and in
fact, carpal tunnel syndrome accounts for the highest average number of
days missed at work, when compared to all other work-related injuries
An estimated 260,000 carpal tunnel surgeries are
performed annually in the U.S. and of those, more than 35,000 were
performed in 2006 by neurosurgeons, according to AANS statistics. A
neurosurgeon's primary role in the treatment of carpal tunnel syndrome
is diagnosis, interpretation of test results, and when necessary,
surgery. There are frequently other medical professionals involved in
the treatment process, such as physical therapists.
Carpal tunnel syndrome most often occurs when the
median nerve in the wrist becomes inflamed, caused by a combination of
thickened ligaments over the nerve and repetitive movements. "Carpal
tunnel syndrome is most prevalent in women ages 40 to 60, and also
tends to affect people more frequently who use their hands excessively,
such as pianists, concert violinists, hairdressers, computer operators,
manual laborers, artists, sculptors, dentists, and even neurosurgeons,"
says Dr. James R. Bean, AANS president-elect.
Any repetitive motions that cause significant
swelling, thickening or irritation of membranes around the tendons in
the carpal tunnel can result in pressure on the median nerve,
disrupting transmission of sensations from the hand up to the arm and
to the central nervous system.
Diseases or conditions that may increase your
chances of developing carpal tunnel syndrome include pregnancy,
diabetes, menopause, broken or dislocated bones in the wrist, and
obesity. Additional causes include repetitive and forceful grasping
with the hands, bending of the wrist, and arthritis.
It is important to seek medical advice when you
first notice persistent symptoms. Do not wait for your pain to become
intolerable. Before your doctor can recommend a course of treatment, he
or she will perform a thorough evaluation, including a medical history,
physical examination and diagnostic tests. Your doctor will ask about
the extent to which your symptoms affect daily living. Sometimes a case
turns out to be tendonitis and not carpal tunnel, but only a doctor can
make a proper diagnosis.
The main purpose of conservative treatment is to
reduce or eliminate repetitive injury to the median nerve. In some
cases, carpal tunnel syndrome can be treated by immobilizing the wrist
ina splint to minimize or stop pressure on the nerves. If that does not
work, patients are sometimes prescribed anti-inflammatory medications
or cortisone injections in the wrist to reduce swelling. Your doctor
may suggest specific types of hand and wrist exercises, which may be
helpful. Treatment for carpal tunnel syndrome may include rest, the use
of a wrist splint during sleep, or physical therapy.
Conservative treatment methods may continue for up to eight weeks.
If conservative treatment methods do not provide
sufficient relief, your doctor may perform diagnostic studies to
determine if surgery is an effective option. These diagnostic tests
include x-rays and electromyogram and nerve conduction studies. X-rays
can help determine if any abnormalities in bones of the wrist may be
contributing factors. Electromyogram and nerve conduction studies can
reveal significant compression on the median nerve in the carpal
If patients suffer from severe pain that cannot be
relieved through rest, rehabilitation or nonsurgical treatment, there
are several surgical procedures that can be performed to relieve
pressure on the median nerve. The most common procedure is called a
carpal tunnel release, which can be performed using an open incision or
with endoscopic techniques. The open incision procedure or carpal
tunnel release, involves the neurosurgeon making an incision in the
wrist or palm and then releasing the ligament that is compressing and
placing pressure on the median nerve. The endoscopic carpal tunnel
release procedure involves making a smaller incision and using a
miniaturized camera to assist the neurosurgeon in viewing the carpal
Risks of carpal tunnel surgery are minimal. The
majority of individuals recover completely. "The results of surgery are
usually excellent, with most patients receiving nearly full relief of
their symptoms. The earlier you get diagnosis and treatment, generally
the better the outcome," states Dr. Bean.
Founded in 1931 as the Harvey Cushing Society, the
American Association of Neurological Surgeons (AANS) is a scientific
and educational association with more than 7,200 members worldwide. The
AANS is dedicated to advancing the specialty of neurological surgery in
order to provide the highest quality of neurosurgical care to the
For information on carpal tunnel and a wide range of other neurosurgical topics, visit www.neurosurgerytoday.org/what/patient_e/condition_treatments.asp.