April 14, 2024
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April 14, 2024
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True or false: “Carpal tunnel syndrome is when your wrist hurts from typing too much.”

If you said “false,” you’re right! In fact, the only part of that sentence that is correct is the spelling of carpal tunnel syndrome.

While carpal (not “corporal” or “carpo,”) tunnel syndrome is one of the most common reasons that people see a hand specialist, it is arguably the most misunderstood. Carpal tunnel syndrome is not wrist pain from typing. It is a very common nerve condition which, according to modern studies, occurs at the same rates in people who type a lot and people who don’t type much at all. And it doesn’t usually cause wrist pain at all.

Contrary to popular belief, computer work is not a known risk factor for developing carpal tunnel syndrome (CTS). The only type of work that has been shown to lead to increased rates of CTS is heavy vibrational exposure (specifically the extended use of a jackhammer), as this repeated concussive force is thought to cause cumulative trauma to the nerve.

Since CTS is a nerve condition, the symptoms are usually related to sensation — think tingling, shooting, numbing-type pain in the hand. The median nerve supplies the palm side of the thumb, index finger, middle finger and part of the ring finger, so these are the areas most commonly affected.

Symptoms are often worse at night, which is thought to be because patients inadvertently lay on their wrist and/or flex the wrist, which decreases the available space for the nerve and further compresses it. Night is also the time when you don’t have much else distracting you from the signals your body is sending and receiving.

People often wake up at night from the numbness and tingling in their hands and feel the need to shake the hand out or hang it off the side of the bed, which forces more blood into the nerve, to help wake it up.

The feeling is often compared to when your legs fall asleep from sitting in a certain position for an extended period of time. This makes sense logically, because the same process is occurring — a nerve is compressed, limiting the blood flow to the nerve, which causes a feeling of cold, tingling, and decreased sensation in the areas supplied by that nerve (not that the blood flow to the limb itself is compressed, as many people think).

The symptoms can be mimicked by a pinched nerve in the neck (cervical radiculopathy), but usually that causes pain shooting down a wider portion of the arm. Cervical radiculopathy can cause the entire arm — from shoulder to fingertips — to feel a similar type of burning nerve pain. Nerves can also be pinched in other locations, but that is less common. An orthopedic surgeon can use various techniques to help differentiate these conditions.

Certain populations are higher at risk of developing CTS, including those with diabetes, low thyroid, rheumatoid arthritis and gout. Pregnancy is also a common risk factor — as many as half to two-thirds of pregnant patients experience carpal tunnel syndrome symptoms, but they often get better after delivery.

The workup for CTS usually involves a detailed history and physical examination; usually nothing else is needed. X-rays are generally not helpful, as X-rays only show bones and give no information about nerves.

In some cases, nerve testing (called electromyography or EMG) is performed. This test, which can be performed by a neurologist or a physiatrist, involves using small needles to conduct electricity and measure how the body’s nerves are working. EMG can be very uncomfortable and also is not usually needed for routine cases of CTS. If possible, patients usually prefer to avoid it.

If left alone for years, CTS can worsen to the point where a muscle in the thumb pad becomes weak and atrophies. In severe, long standing cases, the nerve damage can be severe and difficult (if not impossible) to reverse.

Thankfully, CTS can be treated, and if caught early serious problems can be prevented. Treatments for CTS depend on the stage and severity, but range from simple interventions like ergonomic modifications and nighttime brace wear, all the way to surgery.

Therapy, stretching exercises and steroid injections are occasionally useful but not the most common ways to address this problem. Patients should be wary of receiving multiple injections for carpal tunnel syndrome — the risks can outweigh the benefits after just one or two injections, but patients are sometimes encouraged to keep trying injections (even though that can be risky) so they can avoid surgery.

Surgery is what scares many people about CTS, as they may have heard or read about unhappy patients after CTS surgery. However, CTS surgery is no less successful than other types of surgery; in fact, studies show it is more successful than the average surgery. CTS surgery patients are usually very happy with their outcomes.

The reason that it’s somewhat common to hear about unsuccessful CTS surgeries is that there are so many CTS procedures done (about half a million done each year in the U.S.) that the small percentage of unhappy patients (typically around 1%) still ends up being a large number. Combine that with the fact that the majority of satisfied patients don’t go around discussing their ordeals or posting about their experiences online (because they expected that outcome and are busy living their lives) and this misalignment between perception and reality is easily understood.

Even though it is the “most invasive” treatment, CTS surgery does not have to be a big deal. In many cases, the patient can remain awake and have the surgery done comfortably under local anesthesia, and the average CTS procedure takes less than 10 minutes. Surgery can be done through a small incision requiring only a few stitches and a light dressing, and patients are often able to return to computer work and unrestricted showering within a few days.

Full recovery is expected if the nerve compression is identified and treated early, but cases that have progressed to the point of constant numbness and/or muscle atrophy more commonly have less-than-full recovery after surgery. That’s why we don’t recommend ignoring these symptoms for too long.

So, if you have “wrist pain from typing,” you can still see a hand specialist — just don’t expect the diagnosis to be carpal tunnel syndrome!

However, if you get woken up at night by tingling and/or painful, numb fingers, find a hand specialist to see if it might be a treatable problem. Many times, surgery can be avoided altogether, and early treatment is most effective.

Joseph A. Rosenbaum, M.D. is a board-certified, fellowship-trained hand and upper extremity specialist orthopedic surgeon. He serves as the clinical director of hand surgery at Holy Name Medical Center and sees patients in Teaneck.

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