Carpal tunnel syndrome is a common hand condition that can cause pain, numbness and even leave you unable to grab items or perform other manual tasks.
Learn from an expert at the UVA Hand Center about the range of available treatment options to relieve your pain.
Selected Podcast
Effective Treatment Options for Carpal Tunnel Syndrome
Featured Speaker:
UVA Hand Center
Dr. Bobby Chhabra
Dr. Bobby Chhabra is a board-certified hand surgeon, co-founder of the UVA Hand Center and chair of UVA’s Department of Orthopaedic Surgery.UVA Hand Center
Transcription:
Effective Treatment Options for Carpal Tunnel Syndrome
Melanie Cole (Host): Carpal tunnel syndrome is a common hand condition that can cause pain, numbness and even leave you unable to grab items or perform other manual tasks. My guest is Dr. Bobby Chhabra, he is a Board Certified Hand Surgeon and cofounder of the UVA Hand Center and chair of UVA’s Department of Orthopedic Surgery. Welcome to the show Dr. Chhabra, tell us about carpal tunnel syndrome, what is it.
Dr. Bobby Chhabra (Guest): Thank you Melanie for having me on the show. Carpal tunnel syndrome is compression of the median nerve at the wrist. The median nerve provides sensation to the thumb, index, middle and part of the ring finger and also provides motor function to the thumb muscle, so carpal tunnel syndrome is compression of that nerve at the wrist joint like someone stepping on a garden hose, the nerve conductions are slowed down across the nerve at the wrist and it affects your sensory and motor function to the hand.
Melanie: Dr. Chhabra who is most at risk for developing carpal tunnel syndrome and give us some of the causes, things that we are doing that might predispose us to this.
Dr. Chhabra: Pretty much anyone with time and as we age can be susceptible to carpal tunnel syndrome. There is no specific one thing that can cause carpal tunnel syndrome but there is a variety of things, repetitive type wrist flexion activities, a lot of people who work at a desk on a computer can get symptoms, people who are very active if they are doing repetitive wrist flexion exercises or just repetitive type gripping exercises can be susceptible to carpal tunnel syndrome as they get older. There is also carpal tunnel syndrome associated with fractures of the wrist joint, distal radius or fractures of the wrist and those are acute carpal tunnel syndrome issues but the vast majority of carpal tunnel symptoms and people who have carpal tunnel, it is a slow process where it starts out with numbness of the fingers and then progresses to constant numbness of the fingers and then eventually can lead to weakness in the hand.
Melanie: So the numbness starts out, that is the first symptom. People tend to, Dr. Chhabra, think oh may be it’s a pinched nerve in my neck or how do we define the difference between something that is located in the hand and something that may be is coming from somewhere else.
Dr. Chhabra: So that is a very good question, it is sometimes difficult because all the nerves start up in the neck from the spinal cord and it can sometimes be a combination of pinched nerve at your neck as well as the nerve compression at your wrist. A lot of times, a pinched nerve in the neck will present as hand pain and numbness, so you need to be evaluated by someone who deals with peripheral nerve compression or hand surgeon will be able to delineate that. Frequently, people who have pinched nerve at their neck will have neck pain that radiates down the arm. People with carpal tunnel syndrome usually first start out by having nighttime symptoms, they wake up at night, their hand feels numb, they will have tingling and a pins and needles feeling in their fingers and as they shake their hand when they wake up, the symptoms improve, so frequently carpal tunnel syndrome starts out with night symptoms and then it will progress to symptoms during the day with specific activities, using a computer for a long period of time or talking on the phone for a long period of time holding a phone to your ear, you can end up getting symptoms in your hand that will resolve but eventually the symptoms become more persistent during the course of the day and untreated carpal tunnel syndrome will result in more constant pain, numbness in the fingers and then as I said eventually the muscle does not get normal nerve signal, so the muscle begins to get weak. The analogy I use is frequently if someone step on a garden hose long enough, the grass does not get enough water and it begins to die and that is really what happens with carpal tunnel syndrome, if your sensory nerve endings and your muscle in the hand do not get normal nerve signal with time, you begin to get constant numbness and weakness in the hand.
Melanie: So what treatments are available if it becomes something that a person really cannot live with and they cannot use their hand very well, what do you do for them Dr. Chhabra.
Dr. Chhabra: So frequently, the initial treatment is first diagnosing the problem correctly, making sure it is not a pinched nerve in your neck, cubital tunnel syndrome is a pinched nerve at the elbow that usually causes numbness into the small and part of the ring finger, so you are having seeing someone who can make the correct diagnosis is the first correct step in treatment, then there is different options for treatment, it can be as simple as wearing a splint at night to keep you from fluttering your wrist while you are sleeping and that is helpful particularly if you have nighttime symptoms. Then there is, if some people just have, it can well respond to appropriate vitamins, combination of vitamin B6 and splinting and that has been shown to help people who have mild cases of carpal tunnel syndrome and as the disease progresses and it is usually progressive with time, there are other treatment options such as cortisone injections into the carpal tunnel to help limit the irritation of the nerve and that may provide some part-time benefit but frequently as symptoms progress or if they don’t improve, the best option is surgical treatment and that involves dividing the ligament that, the carpal tunnel is a space where there are several tendons and the nerve together and it is a confined space and a carpal tunnel surgery is where you release the ligament that is on top of that space, so it gives more room for the nerve.
Melanie: What is involved in the surgery, is it a long recovery process, are we splinted for long time afterward.
Dr. Chhabra: Right, there are different ways to do a carpal tunnel release. In open carpal tunnel release through a small incision in the palm is done, it is a very frequent procedure and it is about four to six week recovery, some surgeons splint the patient for a short period of time, a week or 10 days and then start a therapy program to appropriate nerve gliding and allow the wound to heal in the palm in several weeks and there is often tenderness in the palm that may take a couple months to improve but most people are back to activities and desk type activities, computer work within a few days or within 7 to 10 days. Another way to do the procedure is endoscopically with a small camera, a minimally invasive technique where the incision is actually in the forearm and a camera just like a knee arthroscopy or a knee scope, you use a camera to see the ligament that is on top of the carpal tunnel and you divide it with a minimally invasive technique, those patients frequently do not require splinting and can get back to activities faster and have less pain but ultimately whether it is done with an open procedure or an endoscopic procedure, patients tend to do very well, this procedure has high success rate if the diagnosis is correct and the recovery after about two months is the same between either approach but our literature has shown that endoscopic procedures, people tend to have less pain and can get back to activities faster.
Melanie: Dr. Chhabra, why should patients choose UVA Hand Center for their care.
Dr. Chhabra: Well, in our region we are the only true hand center, we have a one location where you will be seen and evaluated by a hand and upper extremity specialist. My team of physicians and physicians assistants only take care of the hand, wrist, elbow and nerve problems and we have specialized cast technicians or therapists that are in the clinic, so when you come to clinic after surgery or if you need therapy, if we are managing you nonsurgically, you will see the therapist at that time right there in clinic. Our MRI scanner or x-rays, everything you need for care of your problem in the hand or upper extremity is taken care of in one location. We have fellowship trained hand and upper extremity surgeons, we have therapists who are certified, are hand therapists and we have cast technicians and wound specialists and we are the only center in our region that is available 24 x 7 not just for arthritis or nerve problems but for trauma of the hand and upper extremity and we have the fellowship trained surgeons, we have the ability to take care of you whether you have a traumatic injury, if you injure your hand in a car accident or while mowing the lawn, we have the specialists to be able to take care of that and my partners just do hand, wrist, elbow and nerve surgeries, so the level of care and expertise of care is really the highest you will receive anywhere, so having this consolidated approach and having everyone in one place provides for an efficient patient care experience, our goal is to make sure the patient has an excellent experience in our clinic, we have educators in our clinic that can help you understand the problem that you have and the best way to get back to the things you normally like to do, so we treat everything from arthritis, nerve compression, fractures, trauma, sports related injuries, congenital hand issues and we do it all in one location.
Melanie: Thank you for such great information Dr. Bobby Chhabra, board certified hand surgeon and cofounder of the UVA Hand Center. You are listening to UVA Health Systems Radio. For more information, you can go to UVAHealth.com. This is Melanie Cole. Thanks for listening.
Effective Treatment Options for Carpal Tunnel Syndrome
Melanie Cole (Host): Carpal tunnel syndrome is a common hand condition that can cause pain, numbness and even leave you unable to grab items or perform other manual tasks. My guest is Dr. Bobby Chhabra, he is a Board Certified Hand Surgeon and cofounder of the UVA Hand Center and chair of UVA’s Department of Orthopedic Surgery. Welcome to the show Dr. Chhabra, tell us about carpal tunnel syndrome, what is it.
Dr. Bobby Chhabra (Guest): Thank you Melanie for having me on the show. Carpal tunnel syndrome is compression of the median nerve at the wrist. The median nerve provides sensation to the thumb, index, middle and part of the ring finger and also provides motor function to the thumb muscle, so carpal tunnel syndrome is compression of that nerve at the wrist joint like someone stepping on a garden hose, the nerve conductions are slowed down across the nerve at the wrist and it affects your sensory and motor function to the hand.
Melanie: Dr. Chhabra who is most at risk for developing carpal tunnel syndrome and give us some of the causes, things that we are doing that might predispose us to this.
Dr. Chhabra: Pretty much anyone with time and as we age can be susceptible to carpal tunnel syndrome. There is no specific one thing that can cause carpal tunnel syndrome but there is a variety of things, repetitive type wrist flexion activities, a lot of people who work at a desk on a computer can get symptoms, people who are very active if they are doing repetitive wrist flexion exercises or just repetitive type gripping exercises can be susceptible to carpal tunnel syndrome as they get older. There is also carpal tunnel syndrome associated with fractures of the wrist joint, distal radius or fractures of the wrist and those are acute carpal tunnel syndrome issues but the vast majority of carpal tunnel symptoms and people who have carpal tunnel, it is a slow process where it starts out with numbness of the fingers and then progresses to constant numbness of the fingers and then eventually can lead to weakness in the hand.
Melanie: So the numbness starts out, that is the first symptom. People tend to, Dr. Chhabra, think oh may be it’s a pinched nerve in my neck or how do we define the difference between something that is located in the hand and something that may be is coming from somewhere else.
Dr. Chhabra: So that is a very good question, it is sometimes difficult because all the nerves start up in the neck from the spinal cord and it can sometimes be a combination of pinched nerve at your neck as well as the nerve compression at your wrist. A lot of times, a pinched nerve in the neck will present as hand pain and numbness, so you need to be evaluated by someone who deals with peripheral nerve compression or hand surgeon will be able to delineate that. Frequently, people who have pinched nerve at their neck will have neck pain that radiates down the arm. People with carpal tunnel syndrome usually first start out by having nighttime symptoms, they wake up at night, their hand feels numb, they will have tingling and a pins and needles feeling in their fingers and as they shake their hand when they wake up, the symptoms improve, so frequently carpal tunnel syndrome starts out with night symptoms and then it will progress to symptoms during the day with specific activities, using a computer for a long period of time or talking on the phone for a long period of time holding a phone to your ear, you can end up getting symptoms in your hand that will resolve but eventually the symptoms become more persistent during the course of the day and untreated carpal tunnel syndrome will result in more constant pain, numbness in the fingers and then as I said eventually the muscle does not get normal nerve signal, so the muscle begins to get weak. The analogy I use is frequently if someone step on a garden hose long enough, the grass does not get enough water and it begins to die and that is really what happens with carpal tunnel syndrome, if your sensory nerve endings and your muscle in the hand do not get normal nerve signal with time, you begin to get constant numbness and weakness in the hand.
Melanie: So what treatments are available if it becomes something that a person really cannot live with and they cannot use their hand very well, what do you do for them Dr. Chhabra.
Dr. Chhabra: So frequently, the initial treatment is first diagnosing the problem correctly, making sure it is not a pinched nerve in your neck, cubital tunnel syndrome is a pinched nerve at the elbow that usually causes numbness into the small and part of the ring finger, so you are having seeing someone who can make the correct diagnosis is the first correct step in treatment, then there is different options for treatment, it can be as simple as wearing a splint at night to keep you from fluttering your wrist while you are sleeping and that is helpful particularly if you have nighttime symptoms. Then there is, if some people just have, it can well respond to appropriate vitamins, combination of vitamin B6 and splinting and that has been shown to help people who have mild cases of carpal tunnel syndrome and as the disease progresses and it is usually progressive with time, there are other treatment options such as cortisone injections into the carpal tunnel to help limit the irritation of the nerve and that may provide some part-time benefit but frequently as symptoms progress or if they don’t improve, the best option is surgical treatment and that involves dividing the ligament that, the carpal tunnel is a space where there are several tendons and the nerve together and it is a confined space and a carpal tunnel surgery is where you release the ligament that is on top of that space, so it gives more room for the nerve.
Melanie: What is involved in the surgery, is it a long recovery process, are we splinted for long time afterward.
Dr. Chhabra: Right, there are different ways to do a carpal tunnel release. In open carpal tunnel release through a small incision in the palm is done, it is a very frequent procedure and it is about four to six week recovery, some surgeons splint the patient for a short period of time, a week or 10 days and then start a therapy program to appropriate nerve gliding and allow the wound to heal in the palm in several weeks and there is often tenderness in the palm that may take a couple months to improve but most people are back to activities and desk type activities, computer work within a few days or within 7 to 10 days. Another way to do the procedure is endoscopically with a small camera, a minimally invasive technique where the incision is actually in the forearm and a camera just like a knee arthroscopy or a knee scope, you use a camera to see the ligament that is on top of the carpal tunnel and you divide it with a minimally invasive technique, those patients frequently do not require splinting and can get back to activities faster and have less pain but ultimately whether it is done with an open procedure or an endoscopic procedure, patients tend to do very well, this procedure has high success rate if the diagnosis is correct and the recovery after about two months is the same between either approach but our literature has shown that endoscopic procedures, people tend to have less pain and can get back to activities faster.
Melanie: Dr. Chhabra, why should patients choose UVA Hand Center for their care.
Dr. Chhabra: Well, in our region we are the only true hand center, we have a one location where you will be seen and evaluated by a hand and upper extremity specialist. My team of physicians and physicians assistants only take care of the hand, wrist, elbow and nerve problems and we have specialized cast technicians or therapists that are in the clinic, so when you come to clinic after surgery or if you need therapy, if we are managing you nonsurgically, you will see the therapist at that time right there in clinic. Our MRI scanner or x-rays, everything you need for care of your problem in the hand or upper extremity is taken care of in one location. We have fellowship trained hand and upper extremity surgeons, we have therapists who are certified, are hand therapists and we have cast technicians and wound specialists and we are the only center in our region that is available 24 x 7 not just for arthritis or nerve problems but for trauma of the hand and upper extremity and we have the fellowship trained surgeons, we have the ability to take care of you whether you have a traumatic injury, if you injure your hand in a car accident or while mowing the lawn, we have the specialists to be able to take care of that and my partners just do hand, wrist, elbow and nerve surgeries, so the level of care and expertise of care is really the highest you will receive anywhere, so having this consolidated approach and having everyone in one place provides for an efficient patient care experience, our goal is to make sure the patient has an excellent experience in our clinic, we have educators in our clinic that can help you understand the problem that you have and the best way to get back to the things you normally like to do, so we treat everything from arthritis, nerve compression, fractures, trauma, sports related injuries, congenital hand issues and we do it all in one location.
Melanie: Thank you for such great information Dr. Bobby Chhabra, board certified hand surgeon and cofounder of the UVA Hand Center. You are listening to UVA Health Systems Radio. For more information, you can go to UVAHealth.com. This is Melanie Cole. Thanks for listening.