The most common cause of hand or wrist pain we treat is carpal tunnel syndrome. Over time, prolonged positions — such as typing on a keyboard — can cause swelling along the carpal tunnel. This narrow passageway allows nerves and tendons to reach your fingers. Swelling can press down on the nerve, resulting in feeling pain in the hands, numbness or tingling with activity, cramping, or difficulty performing routine tasks.
Listen as David Harsha, MD discusses different treatment options for CTS according to levels of severity – i.e. how advanced does the disorder need to be to qualify for his non-surgical treatment.
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The Latest Non Surgical Treatments for Carpal Tunnel
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Learn more about David Harsha, MD
David Harsha, MD
David Harsha, MD brings extensive national experience in sports medicine, with a focus on the prevention and treatment of sports injuries for youth, adult recreational, collegiate and professional athletes.Learn more about David Harsha, MD
Transcription:
The Latest Non Surgical Treatments for Carpal Tunnel
Melanie Cole (Host): Carpal tunnel syndrome is a common condition that can cause pain, numbness, and tingling in the hand and arm. It can be quite painful and can significantly affect your quality of life. My guest today is Dr. David Harsha. He’s a Sports Medicine Physician with Hendricks Regional Health. Welcome to the show, Dr. Harsha. Let’s start with a working definition of carpal tunnel syndrome. What exactly is it?
Dr. David Harsha (Guest): Carpal tunnel syndrome is classically just as you mentioned, pain and numbness and tingling in the hand. It typically involves the thumb and first two fingers and part of the fourth finger -- the ring finger -- but it can involve all fingers. The pain is often in those fingers or on the thumb side of the wrist, and it’s classically aggravated by activities that involve bending of the wrist -- either flexing as we call it, or bending it down or up -- raising the arms above the head, or doing things like driving, reading, holding books, typing – which people do an awful lot of today with computer use – holding a telephone. Those are all things that tend to provoke this pain, numbness, and tingling and it can be off and on for awhile, but it can also become consistent, painful, and aggravate -- as you mentioned -- people to the point of having a significant effect on the quality of life. Many people often have nighttime symptoms and will shake their hands to try to get rid of the symptoms. That’s one of those classic things I talk to patients about and ask if they’ve felt like they needed to shake their hand to get rid of their symptoms. It can, later in the course of the illness, cause weakness, or clumsiness of the hand and people can start dropping things, changing their hand posture to try to get it better. Those are the things that we look for and typically what we call a clinical diagnosis, meaning we look at exam findings and the history to know who’s at risk for that. Factors that we look for that can increase your risk, such as diabetes, being pregnant, having arthritis in the wrist, certain underlying metabolic disorders like thyroid problems, being female, or having a genetic predisposition -- if people in your family have had it -- those all factor into who’s at risk and who we diagnose with carpal tunnel syndrome
Melanie: Dr. Harsha, backing up for a minute, you mentioned computer use and holding your phone -- everybody does that today – are you seeing more carpal tunnel than you’ve ever seen before because of texting and computer use?
Dr. Harsha: I think certainly it can aggravate the condition, but I’ve seen an awful lot of it for a long time with typing having always been there, but yeah, I think there’s probably an increased prevalence. I don’t know that I could tell you I’ve seen studies to show that, but certainly we look for those risk factors and you just mentioned some of the big ones we look for.
Melanie: After you’ve diagnosed that this is what’s going on, let’s start with first-line of defense, what do you tell people they can do at home to help whether it’s bracing, or icing, or trying topical anti-inflammatories, what do you tell them?
Dr. Harsha: Great question. There’s a few things that we recommend. Typically if the symptoms haven't been present very long, say less than ten months, and they’re mild – they’re not disrupting the individual’s lifestyle that much -- then we can start with conservative therapy. Splinting is probably the biggest one I recommend where we put a splint on mainly at night to stop people from flexing or bending their wrist into awkward positions that can compress the nerve and lead to increased symptoms. That’s the biggest one. Some people benefit from wearing the splint during the day, but there are another group that it can cause them to do things differently when they’re wearing the splint and may actually aggravate the symptoms, so we just have to watch for that. There are also position change – watch what you're doing when you’re driving, avoid those awkward positions. One of the ways we teach people to do that is to do an ergonomic assessment of their workstation or their computer use. We try and keep them in a neutral, non-bent position at the wrist, so they're not reaching awkwardly for the mouse, or trying to type in an awkward position reaching a lot. Those can aggravate symptoms of carpal tunnel. Icing certainly helps.
When it comes to medications, over-the-counter things like ibuprofen, or Aleve can certainly help with the pain, but they don’t really change the course of what’s going on with carpal tunnel. Things that can change the course of it include both oral or injectable corticosteroids or steroid injections. If people don’t respond early on to splinting and activity modification and ergonomic adjustment of their workstation, then I typically will step to a cortisone injection next. I use ultrasound to guide that injection to improve the accuracy.
Melanie: Speak about that a little bit. What’s involved? Is it an office procedure? Tell the listeners what’s involved in that ultrasound-guided injection.
Dr. Harsha: Yes, it is an office procedure. It’s been one of the new, and exciting things that changed my practice. Using ultrasound is different than what we think of when it comes to a physical therapist putting ultrasound, which increases heat in the muscle. This is an ultrasound that actually does visualization of images, of the nerves and tendons in the wrist so that we can identify where we’re going with our injection and place it next to the nerve without injuring the nerve. It gives us a great look at where we’re putting the steroid, making sure we’re putting it in te right spot, and that we’re not injuring any surrounding structures such as nerves and blood vessels, especially that median nerve, which is the nerve that can be injured in carpal tunnel on a chronic basis. It’s been a great change to what I do, and I think it improves the accuracy and improves my ability to know that I’ve done the injection accurately.
Melanie: And Dr. Harsha, what can listeners expect -- and patients expect from the length of how long this injection is going to work for?
Dr. Harsha: That’s one of the things that my patients certainly want to know. It can give several weeks’ worth of relief. For some people, maybe about a third of the time, it will give prolonged relief -- several months, or if not longer than that. There’s a fairly sizeable group, however, where if they’ve had prolonged symptoms, as I mentioned, more than ten months or they’re getting moderate to severe symptoms, certainly we can try injections, but they may just give a few weeks’ worth of relief. In that group, we want to do an additional evaluation and go beyond those traditional, non-surgical treatments. Usually, I’ll get an EMG, or a nerve conduction study, which is a test to evaluate the nerve and how well it’s functioning. If it’s not doing well -- it’s moderate to severe problem with the carpal tunnel, then it increases the risk of that nerve being damaged over time and also makes us know that conservative and, or, nonsurgical treatment may not be the best option for that patient.
Melanie: After you do an ergonomic assessment to see about their desk in their office, does physical therapy work, or massage, or acupressure? If the nerve does sustain some damage, does that damage come back? Can that be fixed?
Dr. Harsha: There are a lot of different treatments out there that are nonsurgical. Some that have some evidence behind them that are reasonable to consider include yoga. Occupational therapists typically do the therapy for this where they’ll do some manipulation of the wrist and some, what are called nerve glides to stretch and try and relieve some pressure in the carpal tunnel. We hope that it certainly relieves that compression and improves the status of the nerve and gives it more time, if not relief of the symptoms. So those are reasonable things to do and, again, as I mentioned, as things progress, we would want to step back and reassess, but many times those therapies can be a good useful adjunct. Acupuncture and acupressure have been looked at and have some mild evidence that they might be helpful, so if people wanted to just try that and didn’t really want to try an injection, those would be reasonable options to consider.
Melanie: So wrap it up for us, with your best advice about people possibly preventing carpal tunnel syndrome in the first place and then if they do come up with some pain in their wrist and what you’ve described, what they can do to get out.
Dr. Harsha: I’d love to see if we could prevent carpal tunnel, and certainly some of the things that I would recommend people do are to make sure you do have a good workstation and that you’re careful in the positioning of the wrist and hands and keep them in a neutral position and avoid reaching or awkward postures. When you’re at your desk, take a break every hour, get up, move around for five minutes every hour to give your carpal tunnel a break and it can improve circulation in the carpal tunnel. Make sure you stay physically active. Things that can make carpal tunnel worse include some lifestyle issues like smoking and weight gain, so stay active, avoid problems with diabetes and weight gain, obesity. Those are things that will help avoid carpal tunnel syndrome. If you do end up getting carpal tunnel syndrome, don’t ignore those symptoms of the hand and wrist – pain and numbness and tingling – they can be a warning sign that something’s wrong and you need to have it assessed by a physician to make sure that we keep that nerve healthy.
Melanie: Thank you so much, Dr. Harsha. That’s great information for people to hear. You’re listening to Health Talks with HRH, Hendricks Regional Health. For more information, you can go to Hendricks.org, that’s Hendricks.org. This is Melanie Cole. Thanks, so much, for listening.
The Latest Non Surgical Treatments for Carpal Tunnel
Melanie Cole (Host): Carpal tunnel syndrome is a common condition that can cause pain, numbness, and tingling in the hand and arm. It can be quite painful and can significantly affect your quality of life. My guest today is Dr. David Harsha. He’s a Sports Medicine Physician with Hendricks Regional Health. Welcome to the show, Dr. Harsha. Let’s start with a working definition of carpal tunnel syndrome. What exactly is it?
Dr. David Harsha (Guest): Carpal tunnel syndrome is classically just as you mentioned, pain and numbness and tingling in the hand. It typically involves the thumb and first two fingers and part of the fourth finger -- the ring finger -- but it can involve all fingers. The pain is often in those fingers or on the thumb side of the wrist, and it’s classically aggravated by activities that involve bending of the wrist -- either flexing as we call it, or bending it down or up -- raising the arms above the head, or doing things like driving, reading, holding books, typing – which people do an awful lot of today with computer use – holding a telephone. Those are all things that tend to provoke this pain, numbness, and tingling and it can be off and on for awhile, but it can also become consistent, painful, and aggravate -- as you mentioned -- people to the point of having a significant effect on the quality of life. Many people often have nighttime symptoms and will shake their hands to try to get rid of the symptoms. That’s one of those classic things I talk to patients about and ask if they’ve felt like they needed to shake their hand to get rid of their symptoms. It can, later in the course of the illness, cause weakness, or clumsiness of the hand and people can start dropping things, changing their hand posture to try to get it better. Those are the things that we look for and typically what we call a clinical diagnosis, meaning we look at exam findings and the history to know who’s at risk for that. Factors that we look for that can increase your risk, such as diabetes, being pregnant, having arthritis in the wrist, certain underlying metabolic disorders like thyroid problems, being female, or having a genetic predisposition -- if people in your family have had it -- those all factor into who’s at risk and who we diagnose with carpal tunnel syndrome
Melanie: Dr. Harsha, backing up for a minute, you mentioned computer use and holding your phone -- everybody does that today – are you seeing more carpal tunnel than you’ve ever seen before because of texting and computer use?
Dr. Harsha: I think certainly it can aggravate the condition, but I’ve seen an awful lot of it for a long time with typing having always been there, but yeah, I think there’s probably an increased prevalence. I don’t know that I could tell you I’ve seen studies to show that, but certainly we look for those risk factors and you just mentioned some of the big ones we look for.
Melanie: After you’ve diagnosed that this is what’s going on, let’s start with first-line of defense, what do you tell people they can do at home to help whether it’s bracing, or icing, or trying topical anti-inflammatories, what do you tell them?
Dr. Harsha: Great question. There’s a few things that we recommend. Typically if the symptoms haven't been present very long, say less than ten months, and they’re mild – they’re not disrupting the individual’s lifestyle that much -- then we can start with conservative therapy. Splinting is probably the biggest one I recommend where we put a splint on mainly at night to stop people from flexing or bending their wrist into awkward positions that can compress the nerve and lead to increased symptoms. That’s the biggest one. Some people benefit from wearing the splint during the day, but there are another group that it can cause them to do things differently when they’re wearing the splint and may actually aggravate the symptoms, so we just have to watch for that. There are also position change – watch what you're doing when you’re driving, avoid those awkward positions. One of the ways we teach people to do that is to do an ergonomic assessment of their workstation or their computer use. We try and keep them in a neutral, non-bent position at the wrist, so they're not reaching awkwardly for the mouse, or trying to type in an awkward position reaching a lot. Those can aggravate symptoms of carpal tunnel. Icing certainly helps.
When it comes to medications, over-the-counter things like ibuprofen, or Aleve can certainly help with the pain, but they don’t really change the course of what’s going on with carpal tunnel. Things that can change the course of it include both oral or injectable corticosteroids or steroid injections. If people don’t respond early on to splinting and activity modification and ergonomic adjustment of their workstation, then I typically will step to a cortisone injection next. I use ultrasound to guide that injection to improve the accuracy.
Melanie: Speak about that a little bit. What’s involved? Is it an office procedure? Tell the listeners what’s involved in that ultrasound-guided injection.
Dr. Harsha: Yes, it is an office procedure. It’s been one of the new, and exciting things that changed my practice. Using ultrasound is different than what we think of when it comes to a physical therapist putting ultrasound, which increases heat in the muscle. This is an ultrasound that actually does visualization of images, of the nerves and tendons in the wrist so that we can identify where we’re going with our injection and place it next to the nerve without injuring the nerve. It gives us a great look at where we’re putting the steroid, making sure we’re putting it in te right spot, and that we’re not injuring any surrounding structures such as nerves and blood vessels, especially that median nerve, which is the nerve that can be injured in carpal tunnel on a chronic basis. It’s been a great change to what I do, and I think it improves the accuracy and improves my ability to know that I’ve done the injection accurately.
Melanie: And Dr. Harsha, what can listeners expect -- and patients expect from the length of how long this injection is going to work for?
Dr. Harsha: That’s one of the things that my patients certainly want to know. It can give several weeks’ worth of relief. For some people, maybe about a third of the time, it will give prolonged relief -- several months, or if not longer than that. There’s a fairly sizeable group, however, where if they’ve had prolonged symptoms, as I mentioned, more than ten months or they’re getting moderate to severe symptoms, certainly we can try injections, but they may just give a few weeks’ worth of relief. In that group, we want to do an additional evaluation and go beyond those traditional, non-surgical treatments. Usually, I’ll get an EMG, or a nerve conduction study, which is a test to evaluate the nerve and how well it’s functioning. If it’s not doing well -- it’s moderate to severe problem with the carpal tunnel, then it increases the risk of that nerve being damaged over time and also makes us know that conservative and, or, nonsurgical treatment may not be the best option for that patient.
Melanie: After you do an ergonomic assessment to see about their desk in their office, does physical therapy work, or massage, or acupressure? If the nerve does sustain some damage, does that damage come back? Can that be fixed?
Dr. Harsha: There are a lot of different treatments out there that are nonsurgical. Some that have some evidence behind them that are reasonable to consider include yoga. Occupational therapists typically do the therapy for this where they’ll do some manipulation of the wrist and some, what are called nerve glides to stretch and try and relieve some pressure in the carpal tunnel. We hope that it certainly relieves that compression and improves the status of the nerve and gives it more time, if not relief of the symptoms. So those are reasonable things to do and, again, as I mentioned, as things progress, we would want to step back and reassess, but many times those therapies can be a good useful adjunct. Acupuncture and acupressure have been looked at and have some mild evidence that they might be helpful, so if people wanted to just try that and didn’t really want to try an injection, those would be reasonable options to consider.
Melanie: So wrap it up for us, with your best advice about people possibly preventing carpal tunnel syndrome in the first place and then if they do come up with some pain in their wrist and what you’ve described, what they can do to get out.
Dr. Harsha: I’d love to see if we could prevent carpal tunnel, and certainly some of the things that I would recommend people do are to make sure you do have a good workstation and that you’re careful in the positioning of the wrist and hands and keep them in a neutral position and avoid reaching or awkward postures. When you’re at your desk, take a break every hour, get up, move around for five minutes every hour to give your carpal tunnel a break and it can improve circulation in the carpal tunnel. Make sure you stay physically active. Things that can make carpal tunnel worse include some lifestyle issues like smoking and weight gain, so stay active, avoid problems with diabetes and weight gain, obesity. Those are things that will help avoid carpal tunnel syndrome. If you do end up getting carpal tunnel syndrome, don’t ignore those symptoms of the hand and wrist – pain and numbness and tingling – they can be a warning sign that something’s wrong and you need to have it assessed by a physician to make sure that we keep that nerve healthy.
Melanie: Thank you so much, Dr. Harsha. That’s great information for people to hear. You’re listening to Health Talks with HRH, Hendricks Regional Health. For more information, you can go to Hendricks.org, that’s Hendricks.org. This is Melanie Cole. Thanks, so much, for listening.