If you’re one of the more than 4 million Americans who suffer from carpal tunnel syndrome (CTS), you’ll be glad to know that there are more options for treatment for the painful condition than ever before.
Dr. Alan R. Blackburn of South Florida Orthopedics and Sports Medicine, which has offices in Tradition and Stuart, is not only a fellowship-trained hand and upper extremity subspecialist, he’s also a collector of old medical books and says that CTS was first described hundreds of years ago.
According to Dr. Blackburn, people often put off seeing a doctor until the pain gets intense.
“In fact, it’s important to get resolution before a nerve is damaged. Plus, it’s easily fixed if treatment is required.”
Exactly what is carpal tunnel syndrome, what are the symptoms, when should you seek medical help and what treatment should you choose?
As the American Society for Surgery of the Hand explains, “carpal tunnel syndrome is a condition affecting the median nerve, one of the main nerves in the wrist area. The carpal tunnel is a space created by the natural arch of the wrist bones.
“A thick band called the transverse carpal ligament creates a roof to the tunnel. This means that the size of the tunnel cannot change, as the bones and ligament act like solid walls.
Nine tendons that bend the fingers and thumb and the median nerve pass through the tunnel.
“The median nerve provides feeling (sensation) to the skin of the thumb, index and middle fingers, as well as half the ring finger The nerve also provides the communication line to the muscles at the base of the thumb.” It passes through the tunnel with all the tendons.
Carpal tunnel syndrome is caused by pressure on the median nerve. When the nerve is compressed, symptoms can include pain, numbness, tingling, and weakness in the hand and arm.
The anatomy of the wrist, certain health problems and repetitive hand motions can contribute to carpal tunnel syndrome.
“You can’t change your anatomy,” says Dr. Blackburn. “But you can make good choices in the treatment you seek and the medical expert you elect to see” if a problem develops.
“One of the signs indicating that you may have CTS is pain that becomes worse at night,” Dr. Blackburn continued.
“Most people sleep with the wrist unflexed. Splinting, which keeps the wrist out of the bent position, has been shown to improve, but not cure symptoms, even when carpal tunnel is severe.”
Other initial treatments include steroid injections and other medications to reduce inflammation.
Dr. Blackburn always involves his patients in the decision-making process when it’s time to treat CTS more aggressively. “I discuss the pros and cons of the three different options. I offer all these choices and, as far as I know, am one of just two doctors on the Treasure Coast who works with Sonex, which uses ultrasound guidance.”
In the first option, an open release surgery, the surgeon cuts about a 2-inch incision on the wrist or palm. Then he or she uses common surgical instruments to cut the carpal ligament and enlarge the carpal tunnel. “It takes about 10 minutes and is traditionally done in a surgery center,” says Dr. Blackburn.
In endoscopic carpal tunnel release, a thin, flexible tube that contains a camera is put into the wrist through a tiny incision. It guides the doctor as the surgery is done with miniature tools put into the wrist through another small cut.
“This is also done in a surgery center and – like open release surgery – takes 10 or 15 minutes.”
Both types of surgery are performed with some type of anesthesia.
“A Sonex procedure is done in the office,” says Dr. Blackburn. “The patient is wide awake.”
The ultrasound device has a tapered tip that is inserted through a small incision and balloons create space for the procedure to be performed.
“Together, we decide on the course of action that the best suits the patient,” adds Dr. Blackburn.
The American Academy of Orthopedic Surgeons’ list of CTS symptoms includes:
- Numbness, tingling, burning and pain.
- Occasional shock-like sensations that radiate to the thumb and index, middle and ring fingers.
- Pain or tingling that may travel up the forearm toward the shoulder.
- Weakness and clumsiness in the hand which may make it difficult to perform fine movements such as buttoning your clothes.
- Dropping things due to weakness, numbness, or a loss of proprioception (awareness of where your hand is in space).
In most cases, symptoms begin gradually, without a specific injury. Many people find that their symptoms come and go at first. However, as the condition worsens, symptoms often occur more frequently or persist for longer periods of time.
Mayo Clinic lists several factors associated with carpal tunnel syndrome that may not directly cause it but can increase the risk of irritation or damage to the median nerve. Among them are:
- Anatomic factors – a wrist fracture or dislocation, or arthritis that deforms the small bones in the wrist.
- People with small carpal tunnels.
- Gender – CTS is more common in women, possibly because the carpal tunnel is smaller than it is in men.
- Some chronic illnesses, such as diabetes, increase the risk of nerve damage, including damage to the median nerve.
- Rheumatoid arthritis and other conditions with an inflammatory component can affect the lining around the tendons in the wrist and put pressure on the median nerve.
- Obesity.
- Conditions such as menopause, thyroid disorders, kidney failure and lymphedema may increase the chances of CTS.
- Working with vibrating tools or on an assembly line that requires prolonged or repetitive flexing of the wrist may create harmful pressure on the median nerve or worsen existing nerve damage.
Scientific evidence is conflicting, however, and these factors haven’t been proven as direct causes of carpal tunnel syndrome.
Years-long controversy has existed about the association between computer use and carpal tunnel syndrome. Some findings suggest that mouse use and not the use of a keyboard may be the problem.
But there has not been enough consistent, high-quality evidence to show that extensive computer use is a risk factor for carpal tunnel syndrome.
Discussing his qualifications, Dr. Blackburn notes that “a board-certified and fellowship-trained surgeon is at the top of the field.
“Fellowship training, during which you learn from experts in the specialty, takes place for one full year after residency and is an optional process that’s very important,” he added.
Alan R. Blackburn, MD, received his undergraduate and medical degrees from the University of Georgia, completed his residency at Augusta University-Medical Center of Georgia and his fellowship at University of Pittsburgh Medical Center. He is a member of American Academy of Orthopaedic Surgeons, American Society for Surgery of the Hand and American Association for Hand Surgery. Dr. Blackburn is accepting new patients at South Florida Orthopedics and Sports Medicine, which is in Tradition at 9401 SW Discovery Way, Port St. Lucie. The phone number is 772-288-2400.
