Carpal tunnel syndrome: It’s not what you think

Orthopedic Hand Surgeon Michael Vender, M.D., on staff at Northwest Community Healthcare (NCH), has been in practice for over 30 years and annually performs about 125 carpal tunnel surgeries, mainly at the NCH Day Surgery Center. Below, he answers common questions about carpal tunnel syndrome, including misconceptions, symptoms and treatment.

What is carpal tunnel syndrome?

It’s an abnormality of the median nerve at the wrist level caused by pressure on the nerve.

How can I combat carpal tunnel syndrome when I spend hours a day on my computer?

This is a common misconception. You don’t get carpal tunnel syndrome from computers, laptops and tablets. That’s an ‘old wives’ tale.’ You just happen to notice the symptoms while you’re on the computer, and you associate those symptoms with that particular activity. That’s not really the cause.

What is another common misconception people have about carpal tunnel syndrome?

People think it’s a bad condition to have and that treatment isn’t effective. In most cases where carpal tunnel syndrome surgery doesn’t work, it’s because of a misdiagnosis. If you have pain from arthritis and you call it carpal tunnel syndrome and you do surgery, of course it’s not going to work.

Why do certain people develop it?

About half of the cases of carpal tunnel syndrome have no cause or known risk factors for developing this (called idiopathic). The other half may have a risk factor.

The most common are:

• Diabetes
• Hypothyroidism
• Increased body mass index (being overweight)
• Smoking
• Trauma to the wrist, such as a fracture

In addition, women get it more often than men. The older you get, the more common it becomes. Pregnant women will get it, but it usually resolves after the pregnancy.

What are the symptoms of carpal tunnel syndrome?

The most common complaints I hear are:

• My hand is falling asleep.
• My hand feels numb and tingling.
• I’m dropping objects.
• I wake up in the middle of the night with pain and numbness.
• My hand is falling asleep when driving, talking on the phone, holding a book, newspaper or magazine, using a hair dryer, putting on makeup or other activities.

How is it diagnosed?

With most cases, you can tell by talking to the patient and listening to his or her complaints. It’s verified by doing Electromyography (EMG) and Nerve Conduction Velocity (NCV) studies. The EMG portion uses small needles to test the function of the muscles. The NCV is probably the most important part. It provides light shocks to the hand and upper extremity, and measures how fast those shocks travel down the length of the nerve using electrodes. Both tests are performed in the doctor’s office.

What is the treatment for carpal tunnel syndrome?

1. Surgery
   When the symptoms warrant it, surgery is the definitive treatment for the condition. Everybody reacts differently to pain. Some people will have a sore knee and deal with it their whole life while others will go to the doctor right away. It’s a very personal decision as to when and if you want to have the surgery. However, if there are certain findings on the nerve test, I would more strongly encourage surgery. Those would be findings that show actual nerve damage, especially involving the muscles. About 20 percent of patients will present with nerve damage.
2. Wrist splint
   If symptoms are minor and there is no nerve damage and you are only bothered at night, I would recommend trying a wrist splint.
3. Steroids
   Under some circumstances, I would consider a steroid injection, but I don’t consider that a significant component of treatment.

Can carpal tunnel syndrome be misdiagnosed?

You can have generalized neuropathy. You can have other painful conditions in the hand, such as arthritis or trigger finger and you may think it’s caused by carpal tunnel syndrome. You can have a pinched nerve in your elbow or your neck that can be confused with carpal tunnel syndrome, which is why the nerve test is so important.

How is the surgery performed?

The carpal tunnel is a tunnel where three sides are bones. The top of the tunnel, which is in your palm, is a ligament. We cut through that ligament and that allows the tunnel to slightly open up, making it larger and taking pressure off of the nerve. The surgery itself takes five minutes. It is performed without general anesthesia. From preparation to the time you go home, it’s just a few hours.

What is recovery like?

You can use your hand right away and you can do light activities. Household chores are OK but playing tennis, using hammers or carrying heavy objects could take weeks. Usually, there are three follow-up appointments. Some people like to go to physical therapy. Some people go once or twice and then don’t need it.

If I have carpal tunnel in one hand, will I develop it in the other?

There’s no real pattern and it’s definitely not based on your dominant hand. It can be your right hand, your left hand or both.

How many people in the U.S. today suffer from carpal tunnel syndrome?

I believe it’s less than 5 percent.

Besides carpal tunnel surgery, Dr. Vender performs surgeries and procedures for fractures, tendons, nerves, arthritis, ligament injuries, Dupuytren’s contracture, elbow tendinitis, neuropathy and ganglion cyst. His practice, Hand to Shoulder Associates, is located at 515 W. Algonquin Road in Arlington Heights. To schedule an appointment, call 847-956-0099.

The NCH Day Surgery Center is located on the hospital campus at 675 W. Kirchhoff Rd. in Arlington Heights. For more information, call 847-618-7060.