Dr. Nelson Shares What You Need to Know About Carpal Tunnel Syndrome

Many people have heard the term carpal tunnel syndrome. But, they may fail to recognize some of the most common symptoms. And, even more important, they may not realize there are effective solutions for this very common, yet often painful, condition!

Starling is pleased to have one of the leaders in orthopedic hand and wrist care – Dr. Andrew Nelson. In this interview below, he shares important information that can benefit people of all ages.

What is carpal tunnel syndrome?

Carpal means wrist. Carpal tunnel syndrome (CTS) is the most common compression neuropathy in the upper extremity and is caused by pressure on the median nerve at the level of the wrist.  It is like someone stepping on or kinking, a garden hose which results in a decreased flow at the end of the hose. You will feel this pressure as numbness, tingling, a “pins and needles” sensation, and even sometimes as pain.

What are the symptoms?

Symptoms can vary. The hallmark of CTS is numbness, tingling, or “pins and needles” in the thumb, index, middle and half of the ring finger. The small finger is generally not affected. Your hands can feel clumsy. There can be a sense of weakness, with difficulty holding objects or twisting off a jar top. Occasionally, there is the sensation of the feeling moving up the arm. 

When do symptoms occur?

Symptoms are quite often noted at nighttime. Frequently people are woken at night with their symptoms and massage their hand, lower it over the side of the bed or run it under warm water in order to “get the circulation back.” Others note the symptoms only as they awaken in the morning.  As the symptoms progress, people feel the numbness during daytime activities such as brushing one’s hair, reading the newspaper, driving, or even at work.

Who is at risk for carpal tunnel?

Anyone can get CTS but it is more common in certain patient populations:

• Any person who is involved in high use and repetitive activities with their hands can have CTS.  
• Carpal tunnel syndrome has a clear association with patients that have rheumatoid arthritis, diabetes, and thyroid disorders.
• Pregnant women, due to hormonal changes and the resultant fluid shifts in their bodies, can get temporary CTS that often goes away after childbirth.

How do I confirm a diagnosis of CTS?

If you experience the symptoms mentioned above, talk to your primary care doctor or schedule a visit with me. I will take a thorough history and then examine your neck, arm, wrist, and fingers.  I can perform some basic, pain-free tests in the office in order to confirm the diagnoses.  Since this problem is one of pressure at the level of the wrist and palm, I will try to duplicate it.

If there is any question, I will order an electrodiagnostic or nerve study.  This study measures how fast your nerve is working.  It is like putting a water flow meter on a garden hose and measuring how fast the water is getting to the end. If there is pressure on the nerve (i.e., the hose) then the test will show slowing of the nerve conduction to the fingers.  Not everyone who has CTS has a “positive” or abnormal test.

What is the initial treatment?

Treatment always begins with the use of a wrist splint. The goal is to keep the wrist straight. The type of splint is important only in that it is comfortable for you. We begin by using the splint at bedtime in order to prevent sleeping all night long with your wrist bent which would be like kinking the garden hose.  Occasionally, the splint is also worn during daytime activities or at work.  Modifying or lessening the frequency of certain activities that aggravate your symptoms is also important.

Often, hand surgeons will give a steroid injection into the carpal tunnel.  The use of a splint in combination with a steroid injection can give 20-25% of patients permanent relief, decreasing the chances of surgery. 

When is surgery required?

If your symptoms are severe or when conservative measures do not provide full relief, then surgery is considered. The surgery is an operative release of the tight carpal tunnel ligament in the palm and wrist region. There are two major methods to perform the surgery. 

• The “open” technique uses a one-and-a-half-inch incision in the middle of the palm.
• The “endoscopic” technique uses a half-inch incision along the wrist. In the endoscopic technique, the tight ligament is cut using a TV-guided device through a much smaller incision in less sensitive skin than the palm. Although a laser is not used, some people refer to the endoscopic technique as the “laser technique” which is a misnomer.

Carpal tunnel surgery using the endoscopic technique has come a long way with quicker recovery, less pain, and no scarring. It is important to find a hand surgeon, like myself, who has extensive experience with this non-invasive method. Only a third of surgeons are skilled in this method. Although the end results of both methods are the same after 6 months, the endoscopic technique will allow you to return to personal and work activities earlier than the open technique.     

How long does the surgery take?

The actual surgery using the endoscopic technique takes just minutes. The entire process from check-in to check-out can take a few hours.  I perform the surgery in Cheshire and Hartford outpatient surgery centers.

What does the recovery entail?

After the endoscopic operation, a bulky bandage is used for about 2 days.  You are allowed to use your fingers the very first day and return to work as soon as you are comfortable—some people return to light work the next day.  

After the stitches are removed you are allowed to perform light activities. Within two to three weeks, most people are using their hand normally.  The heaviest of activities such as power grip, heavy lifting, and push-off activities become natural after several more weeks.

Will I need therapy after surgery?

Most patients will benefit from a short course of therapy that is individualized.

How do I get started?

If you believe you suffer from CTS, the first step is to schedule a consultation. I will assess your symptoms, do a physical exam, and determine if additional tests are needed.

I see patients at 1 Lake Street in New Britain. I welcome new and existing patients for a consultation. My office can be reached at (860) 832-4666. You don’t have to suffer from CTS – there are many options available to get you on the path to recovery.

About Dr. Nelson
Dr. Andrew Nelson is a leading orthopaedic hand and wrist specialist. He did his medical training and orthopaedic residency at Boston University, followed by a fellowship in Hand and Microvascular Surgery at Brown/ Rhode Island Hospital. He has been in practice for over 25 years, frequently recognized as one of Connecticut’s ‘Top Doctors’. Dr. Nelson provides a wide range of hand surgery services that includes both non-operative and operative procedures. He has a special interest in complex wrist fractures, nerve surgery, and Dupuytren’s disease. To learn more about Dr. Nelson and the conditions he treats, visit www.starlingphysicians.com/hand.