Medical Associates Clinic
Quality Care Close To Home
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Quality Care Close To Home |
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CENTRAL SOUTH DAKOTA MEDICAL NEWS Carpal Tunnel Syndrome I was struck this past week by three individuals who came to the clinic and were diagnosed with a condition called "carpal tunnel syndrome". The word syndrome means a group of symptoms that seem to group together and allow the healthcare professional to make a diagnosis of a specific condition. These three individuals are presented below. One of these individuals was a secretary who did a great deal of typing. The second was a person who had a long history of diabetes beginning in childhood. The third was a carpenter who did a great deal of handwork. They all indicated that they had numbness developing in the middle three fingers of the their hand. It seemed to be worse in one hand or the other but both hands seemed to be involved. They described having pain in the palm and the fingers of the hand, and the pain seemed to radiate up into the forearm and occasionally to the shoulder. The carpenter had learned that if he tried to hold nails or other items between his fingers, he was having difficulty because he was dropping them. He indicated that sometimes he just could not feel that the nails were there and other times his fingers were too weak to hold his fingers together. This story allows the healthcare professional to make a presumptive diagnosis of carpal tunnel syndrome. Once that diagnosis is suspected, the next step in the process is to do what is called a nerve conduction study. This is a specialized test in which the speed of the impulse conduction of the nerves in the arm is measured. It is a relatively easy test performed by a specialty doctor called a neurologist. The diagnosis can be made firmly with the clinical syndrome and the nerve conduction study. Once the diagnosis of carpal tunnel syndrome is made, there are relatively few treatment options. Perhaps one-third or less of people that have this problem can be treated with a change in their activity. The carpenter was not about to try a different occupation nor was the secretary. As long as the stress on the hands and wrists of these occupational endeavors went on, their carpal tunnel syndrome was not going to go away. Thus, a change in activity is not always available. A second treatment option is to use what is called a wrist splint. Many people sleep with the back of their hand tucked against their neck or their head. This tightly flexed position of the wrist pinches the nerve in the wrist that causes carpal tunnel syndrome. By using a wrist splint to keep the hands straight at night, relief of symptoms can be obtained in some people. Most people with carpal tunnel syndrome bad enough to seek medical attention will need surgical treatment. The surgery is really very simple and consists of releasing a tight band of tissue in the wrist that causes too much pressure on the median nerve in the wrist. When this band is released, the person has no disability but the pressure on the median nerve is alleviated and the carpal tunnel syndrome goes away. Recovery from the surgery may take three to six weeks but then relatively normal function is reestablished.
I am struck by the number of
people who say "they don't want surgery" or "they have heard that the surgery is
ineffective". This needs to be clarified. If one thinks that the carpal tunnel
syndrome is coming from a frayed wire, it just makes sense that the more fraying
that goes on, the worse the damage to the median nerve. If one of your
electrical appliances at home were seen to have the insulation coming off of a
wire or seeing the wire frayed, most people would fix it before it shorts out.
The same thinking applies to the carpal tunnel syndrome. The longer one allows
this to progress and the worse the symptoms get, the more damage occurs to the
median nerve. The more damage that occurs to the median nerve, the less recovery
of function will come from the surgery. Thus, it does not make a lot of sense
for the person to say, "I am going to put up with this as long as I can." By
that time there has already been major damage to the median nerve and recovery
of function is not going to be complete. It just makes sense to fix a carpal
tunnel syndrome early before damage occurs and especially if conservative
measures such as changing activity or using a wrist splint is ineffective.
The healthcare professional at your local clinic can help diagnose carpal tunnel
syndrome and arrange for the appropriate diagnostic steps and treatments
necessary. The surgery can be done as an outpatient without the need for
hospitalization or general anesthesia. In my opinion, this is one of the medical
conditions best treated by early attention to ensure that permanent damage does
not occur. |
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