It came on slowly, over time. Now in her early 60s, she’s really worried about the numbness in her hands. Like many women, though, she’s too busy taking care of others to pay attention to the warning signs of a condition that could lead to permanent nerve damage.
Although fictitious, this example is typical of many patients seeking help for chronic numbness and pain associated with carpal tunnel syndrome, says David Chan, M.D., with Suncoast Orthopaedic Surgery & Sports Medicine, which has offices in Venice, Englewood and coming soon to North Port.
“Because our population in the Venice area and Southwest Florida tends to be older, we see many conditions that have advanced over time to where a patient can’t function the way they want,” said Dr. Chan, a fellowship-trained, board-certified orthopaedic hand surgeon. “Carpal tunnel syndrome is one of those, and its effects on the median nerve of the hand can be severe. Patients who ignore their symptoms can starve the nerve of blood and cause permanent damage and lifelong numbness and pain.”
Fortunately, he said, there is a minimally invasive surgery called endoscopic carpal tunnel release that is highly effective in resolving symptoms and can allow the nerve to recover. Dr. Chan performs the procedure at Venice HealthPark, the outpatient surgery center for Venice Regional Bayfront Health.
Is it carpal tunnel syndrome?
Carpal tunnel syndrome (CTS) occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist. The carpal tunnel — a narrow, rigid passageway of ligament and bones at the base of the hand — houses the median nerve and the tendons that bend the fingers. The median nerve provides feeling to the palm side of the thumb and to the index, middle, and part of the ring fingers (although not the little finger). It also controls some small muscles at the base of the thumb.
Sometimes, thickening from the lining of irritated tendons or other swelling fills the tunnel and causes the median nerve to be compressed. The result may be numbness, weakness, or sometimes pain in the hand and wrist, or occasionally in the forearm and arm. CTS is the most common and widely known of the entrapment neuropathies, in which one of the body’s peripheral nerves is pressed upon.
Diagnosing CTS is based mainly on symptoms, although nerve studies are frequently obtained to rule out other conditions. Symptoms usually start gradually, with frequent burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers. Some carpal tunnel sufferers say their fingers feel useless and swollen, even though little or no swelling is apparent. The symptoms often first appear in one or both hands during the night, since many people sleep with flexed wrists.
A person with CTS may wake up feeling the need to “shake out” the hand or wrist. As symptoms worsen, people might feel tingling during the day. Hands may go numb while driving or holding a book. Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In chronic and/or untreated cases, the muscles at the base of the thumb may waste away. Some people are unable to tell between hot and cold by touch.
Women are three times more likely than men to develop CTS, perhaps because the carpal tunnel itself may be smaller in women than in men. The dominant hand is usually affected first and produces the most severe pain. Persons with diabetes or other metabolic disorders that directly affect the body’s nerves and make them more susceptible to compression are also at high risk. CTS usually occurs only in adults.
The risk of developing CTS is not confined to people in a single industry or job, but is especially common in those performing assembly line work. CTS is three times more common among assemblers than among data-entry personnel. Dr. Chan sees many patients with CTS who work in construction and operate equipment that vibrates, such as jack hammers.
Nerves need blood, like lawns need water
Dr. Chan said the symptoms of CTS progress gradually, so patients may wait too long to seek treatment. The sooner the nerve is released, the more likely it will recover full function.
“I compare the effects of CTS to those of not watering your lawn,” Dr. Chan said. “In CTS, increasing pressure on the nerve gradually deprives the nerve of necessary blood flow, which can lead to permanent nerve damage. It’s like starving your lawn of water gradually causes it to turn brown and die. If you restore the water supply to your lawn in time, you can save the grass. Restoring the blood flow to the nerve can do the same.”
Medications, physical therapy, and alterations to the workplace can help ease symptoms, but CTS is progressive, meaning it is generally not resolved with those approaches. That’s where minimally invasive endoscopic carpal tunnel release comes in.
The out-patient procedure is performed under light sedation and takes just minutes. Dr. Chan makes a half-inch incision in the wrist and inserts a camera attached to a tube. He observes the nerve, ligament, and tendons on a monitor, and cuts the carpal ligament (the tissue that forms the roof of the carpal tunnel) with a small razor that is inserted through the tube.
Before the advent of endoscopic surgery, a similar procedure was performed with a larger, open incision, requiring a much longer recovery time. While the open procedure is still used in some cases, Dr. Chan said that the endoscopic approach works for most patients, and recovery time is swift.
“With the endoscopic procedure, patients can remove the surgical bandage the next day, shower, and use a small Band-Aid to cover two small stitches, which are removed after one week,” Dr. Chan said. “Over-the-counter Tylenol or ibuprofen is all that is needed afterwards. Some people are completely comfortable and require nothing.”
A person who does office work can return to work the day after surgery, he said. A construction worker is usually cleared after two weeks, compared to six weeks with the open procedure. The main concern is to prevent infection at the site of the incision, so no heavy lifting or yard work until the stitches come out.
The best time to perform carpal tunnel release is when symptoms are mild, he said. The results can last 20 to 30 years, and some patients may need another procedure. While the nerve may not recover to 100 percent, results are better with early intervention.
“I know a manual laborer in his 50s whose fingers are always numb, and the muscles in his hand have wasted away,” Dr. Chan said. “This is a severe case, but a reminder that delaying treatment can mean permanent damage that dramatically impacts your quality of life.”
For more information on CTS and endoscopic carpal tunnel release, call 941-483-7978.
Information from the National Institute of Neurological Disorders and Stroke, a division of the National Institutes of Health, was used in this report.
David Chan, M.D., is a fellowship-trained, board-certified orthopaedic hand surgeon with Suncoast Orthopaedic & Sports Medicine, which has offices in Venice, Englewood and coming soon to North Port.
Call 941.483.7978 or visit VeniceRegional.com