Dr. Toni Brayer, Medical Advisor for MyLifeStages, discusses the rapid changes in science, medicine, health and healing, addressing issues of interest to everyone who wants a healthy life and increased longevity.
Carpal Tunnel Syndrome (CTS) is common and is the result of the median nerve becoming squeezed or "entrapped" as it passes through the wrist down into the palm of the hand. Because this is a sensory nerve, the compression causes tingling, burning and itching numbness in the palm of the hand and fingers. A different nerve goes to the little finger and the lateral half of the 4th finger so the sensation there would feel normal. There is often a sensation of swelling even though there is rarely any true edema that can be seen in CTS.
The symptoms of Carpal Tunnel Syndrome usually start at night when people sleep with flexed wrists. As it progresses, the tingling and numbness can be felt on and off during the day. It can cause decreased grip strength and weakness in the hands.
CTS can be worsened by medical conditions like rheumatoid arthritis, diabetes, pregnancy or wrist trauma. Women are three times more likely to develop CTS than men, and it is rare in children. Most of the time no cause is found. The space that the median nerve traverses is very tiny and it doesn't take much to compress the nerve. Even small amounts of tissue swelling such as occurs in pregnancy can cause severe symptoms.
The treatment for Carpal Tunnel Syndrome starts with simple remedies like aspirin or NSAIDs. Some people are helped by wearing wrist splints at night to avoid flexion. Stretching and strengthening exercises can help, but if the nerve is inflamed exercises are not going to help.
For severe CTS, a corticosteroid injection into the wrist to reduce swelling can provide prolonged symptom relief (4-12 months). If injections fail or if there are signs of hand weakness, carpal tunnel surgery that releases the trapped nerve can be the answer. This surgery, done under local anesthesia, is quick and usually provides permanent cure.
Thanks to my patient, SP, for providing this photo immediately post-op after undergoing endoscopic surgery. Two tiny incisions are made in the wrist and the palm, and a camera attached to a tube visualizes the carpal ligament that can then be cut by the hand surgeon. The patient can resume normal activities within days.
Dr. Toni Brayer has practiced Internal Medicine in San Francisco for over 20 years. She graduated Cum laude from the University of Arizona College of Medicine and she is a Fellow in the American College of Physicians. Dr. Brayer has served as President of the San Francisco Medical Society and Chief of Staff at California Pacific Medical Center, and is currently the Regional Chief Medical Officer at Sutter Health, as well as the Medical Advisor for the MyLifeStages program . She is a known speaker and writer on a variety medical topics.