Carpal Tunnel Q&A with Dr. Neil Singh | UPMC HealthBeat (2023)

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Do you wake up with numb hands or fingers? Do you often feel tingling in your hand and wrist? It may be carpal tunnel syndrome, a common orthopedic condition.

Neil Singh, orthopedist specializing in hand and upper extremity surgery, will answer your questions about carpal tunnel.

What is carpal tunnel syndrome?

Carpal tunnel syndromeIt's compression of your median nerve. This is the nerve that runs from the forearm to the palm. This nerve is sometimes compressed as it travels through a passage in the wrist called the carpal tunnel.

The carpal tunnel contains both the median nerve and the tendons responsible for bending some of your fingers. The tunnel thickens and sometimes swells, irritating the nerves and tendons. This causes numbness, tingling, and pain in the hand.

Carpal tunnel syndrome is a common condition, but sometimes it goes untreated.

Where exactly do people feel the carpal tunnel?

Affected people often feel numbness and tingling in the thumb, index and middle finger and in the middle of the ring finger.

People tend to notice it when they wake up in the morning. You feel like you have to shake your hands. Or they feel tingling or even pain.

Why does sleep affect it?

At night, we are mostly unaware of what we are doing when we sleep. Often people sleep with their wrists bent. This leads to compression of the nerve, which can make symptoms worse.

Does carpal tunnel get worse over time?

Carpal tunnel syndrome often gets worse over time and there are different stages. With a mild carpal tunnel, you may feel numb right after waking up. It may start to be more frequent during the day.

At some point you may start to feel pain. It can get to the point where it affects the muscles in the hand, making them feel weak or awkward. Sometimes people complain that they drop objects due to deafness or weakness.

Who is at risk of having carpal tunnel?

It could be everyone. But people who perform repetitive manual tasks on a daily basis or operate certain machines are at risk.

Your risk also increases with age, and there may also be a genetic component. Conditions that increase your risk include diabetes, rheumatoid arthritis, and, surprisingly, pregnancy.

How does pregnancy increase the risk of carpal tunnel?

There are many swellings that can occur during pregnancy. This inflammation can irritate the carpal tunnel nerve. A wrist splint can help, and after the pregnancy ends, symptoms usually improve.

What can you do if you work on the computer all day?

An ergonomic keyboard can be very useful. Certain anti-inflammatory medications can also help. I can also teach people some simple exercises that can keep symptoms at bay.

How is carpal tunnel diagnosed?

To diagnose carpal tunnel syndrome, I look at the patient's medical history and pay attention to what the patient is telling me, which can provide insight. We also perform a physical exam using various wrist and hand maneuvers.

how do you treat it

First I talk to patients about the disease and explain it to them so that they are better informed. It's always good to connect with people.

Our first line of treatment is usually conservative, including night splints and anti-inflammatory drugs. And there are different carpal tunnel exercises that I can show patients every time they come into the office. We could also try cortisone shots, which can relieve pain.

What about the rails?

Splinting the wrist at night prevents bending and can be very effective. It prevents the nerve from being repeatedly injured at night.

When do some people need surgery?

Carpal tunnel can become a really debilitating problem. After a period of follow-up and conservative treatment, surgery may be recommended, particularly if other treatments have not helped or if symptoms progress. Waiting until symptoms are constant or severe is generally not recommended, as this can compromise nerve recovery and prognosis. We may also request a nerve conduction study to get an objective reading of the severity of nerve compression.

Can you describe the carpal tunnel removal surgery?

The traditional approach would be an incision through the palm. But we've had a lot of success with minimally invasive surgery through an endoscopic approach. This uses an incision at the wrist along the crease that is more hidden.

People like the endoscopic approach because you don't see the scar as much. People also say that they experience less postoperative pain and are able to return to work faster.

In addition, depending on the age of the person, we can customize the type of surgery they may need. If they can't get anesthesia, we have techniques we can use that don't require anesthesia at all.

How's the recovery?

Recovery can take anywhere from two to four weeks, depending on the type of access, the incision, and the patient's lifestyle. In the first few days after the operation, I let the patients start to move their hand and fingers. And then I'll see you in the office in about two weeks to see the wound.

But I always tell people that nerve recovery is different than injury recovery. Once we've taken the pressure off the nerve we need to give him more time to recover. So as you get back to the things you want to do, you may still see a gradual improvement in your carpal tunnel symptoms over time.

After two weeks, people undergoing endoscopic access are usually ready to return to work, depending on their occupation. People with the traditional approach are sometimes ready to get back to work, but sometimes they need a little more time.

What do you say to people who are struggling with the thought of surgery?

People can be miserable and still think, "There's no way I can have surgery."

But we can do different things tailored to what is comfortable for you. We can perform the operation under minimal anesthesia or just local anesthesia. So talk to us: don't wait until the pain is excruciating or the symptoms are constant, because we want to avoid long-term nerve problems.

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