cts

Hand Pain & Carpal Tunnel Syndrome

/ Thomas Cohn, MD

Genetic Testing PainHand pain can be caused by a number of different ailments. There are a huge number of structures in the hand that allow it to have its functional ability. The bones, joints, muscles, ligaments, tendons, and nerves all may be sources of pain. Trauma can easily damage any of these specific structures.  However, one of the most common syndromes to affect the hands is carpal tunnel syndrome.

Pressure on the median nerve in the wrist may cause pain, numbness, tingling and weakness in the hand. The median nerve and several tendons of the hand travel through a narrow space in the wrist called the carpal tunnel. The median nerve provides sensation and motor function to the thumb and first two fingers. Difficulty with pain, tingling and weakness in these fingers is often from median nerve injury in the carpal tunnel region.

Causes

The cause of carpal tunnel syndrome is pressure on the median nerve in that confined space. Swelling in the region of the wrist can cause pressure. Medical conditions such as diabetes, hypothyroid, and rheumatoid arthritis may also be causes. Obesity, hypertension, and pregnancy with fluid retention can also bring about symptoms. Even more commonly, repetitive motions of the hands and wrists, such as typing or the use of a keyboard or mouse, can cause the injury.

The diagnosis can be made by a physician exam with several tests that may reproduce pressure on the nerve and symptoms in the distribution of the median nerve. Confirmation of the diagnosis is made with electrodiagnostic testing of the median nerve and comparing it to other nerves in the hand. If the study is abnormal, the diagnosis is confirmed.

Treatment Options

Treatment of carpal tunnel syndrome depends on the severity of symptoms. Mild symptoms and changes to the median nerve are treated by reducing the repetitive activities and causes. Rest and splints are great at alleviating mild CTS cases. Moderate cases may be helped by anti-inflammatory medications and steroids with hand physical therapy. Severe cases, where significant damage has occurred to the median nerve, usually require surgery to resolve damage or prevent further damage.

Carpal Tunnel Syndrome Treatment Options

/ Thomas Cohn, MD

Carpal Tunnel Treatment st. cloudAs a follow up to our previous post about the causes and symptoms of carpal tunnel syndrome, we have put together this post outlining some treatment options for CTS. Carpal tunnel syndrome can be treated both surgically and non-surgically depending on the severity of symptoms.

Non-Surgical Treatments

For mild forms of carpal tunnel syndrome, non-surgical treatments are usually the best option. Here are some treatments that can help alleviate pain without having to undergo surgery:

  • Icing your wrist and hand. Applying cold to the area can decrease inflammation.
  • Taking breaks from activities that may be aggravating the condition, such as typing on a keyboard.
  • NSAIDs. Nonsteroidal Anti-Inflammatory Drugs (such as aspirin or ibuprofen) can be used to temporarily reduce pain from carpal tunnel syndrome.
  • A wrist splint can be applied at night or during the day when wrist movement is not needed.
  • Corticosteroid injections. These cannot be administered at home, but by a skilled pain management doctor. Injections like cortisone can cut down on inflammation, which in turn, decreases pain.

Surgical Treatments

If none of the above treatment options work for you and your symptoms persist or  worsen, surgery may be the best path.

Generally, surgery for this condition will be endoscopic or open. In endoscopic surgery, a small telescope-like device is inserted through a small incision. This allows the surgeon to perform the operation in the least invasive manner. With open surgery, an bigger incision must be made and the surgeon must cut through ligament to solve the problem.