Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

With the dreaded summer heat behind us, many of us are spending more time outdoors sprucing up the home. One effective way of ridding our area of debris is by power washing. Although a great cleaning tool, your prolonged grasp and the consistent vibration of the machine can make your hand numb and tingly. This combination may cause the flare-up of carpal tunnel syndrome.

What is Carpal Tunnel Syndrome?

Carpal tunnel occurs when the largest nerve (median nerve) in the wrist is compressed. This compression can cause numbness, tingling, and even weakness. In some cases, pain may radiate from the fingers into the hand and arm. The median nerve provides feeling and movement to the thumb side of the hand. The area where your palm and wrist connect is the carpal tunnel and is also where the median nerve sits. If swelling builds in the tunnel, the pressure pushes on the nerve and affects its function.

Symptoms of Carpal Tunnel Syndrome

The symptoms of carpal tunnel syndrome include sensory and motor dysfunction. Numbness or tingling most often occurs in the thumb, index, middle, and ring fingers and is frequently noticed at night. However, symptoms may develop during daily activities such as power washing, driving, or reading a newspaper. Sometimes, a weaker grip may develop with a tendency to drop objects. In more severe cases, sensation may be permanently lost and the muscles at the base of the thumb slowly shrink, resulting in a difficulty to pinch objects.

The diagnosis of carpal tunnel syndrome remains a clinical diagnosis. The clinical criteria for the diagnosis includes numbness and tingling in the median nerve distribution; nighttime numbness; weakness and/or atrophy of the thumb muscles; Tinel’s sign (tapping over nerve results in “pins and needles” in fingers); Phalen’s test (forced wrist flexion results in “pins and needles” in fingers); and loss of 2-point discrimination. If clinical testing is positive and surgery is being considered, a hand surgeon may perform an electrodiagnostic test to confirm carpal tunnel syndrome and check for other possibilities of nerve problems.

How to Treat Carpal Tunnel Syndrome

Non-Operative Treatments

When treating carpal tunnel, it’s important to exhaust all non-operative treatments first. Wrist splints can be used to help reduce pressure on the nerve and relieve symptoms, especially at night. Another non-operative option is the use of steroid injections to reduce swelling around the nerve to relieve symptoms.  Oral steroids, mobilization exercises, and ultrasound are other options to provide relief.

Operative Treatments

When symptoms are too severe or do not improve, surgery should be considered. Surgery helps to make more room for the nerve by releasing the tension in the tunnel. Following surgery, numbness and tingling may disappear quickly or slowly depending on the patient. The strength of the hand and wrist may take several months to return with the help of a hand therapist. In some cases, the symptoms of carpal tunnel syndrome may not completely go away, especially in the more severe instances. Overall, after carpal tunnel surgery, patients are satisfied by the improvement in their symptoms and can return to functional abilities again.

Getting Back to Normal

If you do suffer from carpal tunnel, it’s important to remember the different ways you can minimize symptoms when performing everyday activities. Reduce your grip in instances like vacuuming or mowing the lawn, take frequent breaks, stretch, and in cooler months, stay warm by wearing gloves. When you are not busy performing housework or at the office, try to maintain a neutral wrist position by wearing a brace. By making simple modifications to performing everyday tasks you can help alleviate flare-ups and reduce the reoccurrence of symptoms. Remember, a hand specialist can help you find the best path to recovery.


Nicholas Smerlis, MD

About Nicolas A. Smerlis, MD, FAAOS, CAQSH

Board certified Orthopedic hand surgeon, Nicholas A. Smerlis, MD, FAAOS, CAQSH has over a decade of experience specializing in the surgical and non-surgical treatment of the hand, wrist, and elbow. Although he specializes in surgery of the hand, not all problems need surgery. Dr. Smerlis often uses non-operative treatments such as medications, splints, injections, and hand therapy to restore function to the hand and wrist. Dr. Smerlis joined TPMG Orthopedics in June 2019 and sees patients in the Newport News and Williamsburg offices.

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