Carpal Tunnel Questions Answered: Q&A with Orthopedic Surgeon Dr. James Barger

Carpal tunnel syndrome is characterized by symptoms such as pain, tingling, and numbness in the hand, impacting millions globally. Dr. James Barger, an orthopedic surgeon specializing in upper extremities and shoulders, regularly aids patients in managing these symptoms. In this Q&A session, he explores the symptoms, causes, and treatment options he suggests for carpal tunnel syndrome in his patients.

What is carpal tunnel syndrome?

Dr. Barger: Carpal tunnel syndrome is the most common form of "compressive neuropathy," where continuous pressure on the median nerve in the wrist leads to dysfunction. The carpal tunnel is a narrow passageway in the wrist, comprised of bones and a ligament, and when pressure increases within it, it affects the median nerve.

What are the symptoms of carpal tunnel syndrome and what does it feel like?

Dr. Barger:  Symptoms typically include numbness and tingling in the thumb, index, middle, and half of the ring finger closest to the thumb. Left untreated, it can progress to constant numbness, weakness, and muscle atrophy in the thumb. Early stages often manifest as nighttime discomfort and may flare up during activities like driving or holding a phone.
 

What causes carpal tunnel syndrome?

Dr. Barger:  Increased pressure within the carpal tunnel is the primary cause. This pressure often arises from low-grade inflammation around the flexor tendons that run through the tunnel alongside the median nerve. This inflammation reduces space and impairs blood flow to the nerve.
This increased pressure can result from various factors, including:

• Anatomy: Individuals with smaller carpal tunnels may be more prone to developing carpal tunnel syndrome. Some people are born with a narrower carpal tunnel, while others may develop it due to injury or inflammation.
• Repetitive hand and wrist movements: Activities or occupations that involve repetitive hand and wrist movements, such as typing, assembly line work, or using vibrating tools, can contribute to carpal tunnel syndrome.
• Hand and wrist position: Prolonged or frequent use of the hand and wrist in awkward or flexed positions can compress the median nerve and contribute to carpal tunnel syndrome. This is often seen in activities like prolonged typing with improper wrist positioning.
• Medical conditions: Certain medical conditions, such as diabetes, rheumatoid arthritis, thyroid disorders, and pregnancy, can increase the risk of developing carpal tunnel syndrome.
• Trauma or injury: Wrist injuries, such as fractures or sprains, can cause swelling and inflammation within the carpal tunnel, leading to compression of the median nerve.
• Hormonal changes: Hormonal fluctuations, such as those occurring during pregnancy or menopause, can affect the balance of fluids in the body and increase the risk of developing carpal tunnel syndrome.
• Obesity: Being overweight or obese can increase the risk of carpal tunnel syndrome, possibly due to increased pressure on the wrist and median nerve.

When should someone see a doctor for carpal tunnel syndrome?

Dr. Barger:  If numbness and tingling persist despite using a nighttime splint, it's advisable to seek medical attention. Prompt evaluation is warranted if numbness becomes constant or if there's noticeable weakness in the thumb muscles.
 

Are there non-surgical treatments for carpal tunnel syndrome?

Dr. Barger:  Wearing wrist splints at night to maintain a neutral wrist position is the initial treatment. Steroid injections can also help reduce inflammation around the flexor tendons and alleviate pressure on the nerve.
 

Does carpal tunnel syndrome require surgery?

Dr. Barger:  Surgery becomes necessary when symptoms persist despite splinting. The surgical procedure involves cutting the ligament to increase space within the carpal tunnel. This can be done through an incision in the palm or endoscopically through a small incision in the wrist. Endoscopic release often leads to quicker recovery, though long-term outcomes are comparable.

Carpal tunnel syndrome presents a significant challenge for many, impacting daily activities and quality of life. Dr. Barger's insights highlight the importance of early recognition and intervention to prevent progression. Whether through non-surgical methods like splinting and steroid injections or surgical options when necessary, managing this condition effectively is crucial for restoring functionality and relieving discomfort. With proactive care and timely medical attention, individuals can navigate through this condition with greater ease and comfort, ensuring optimal hand and wrist health for years to come.
 
 

Dr. James Barger, an orthopedic surgeon with specialties in upper extremities and shoulders, is now accepting new patients at Foundation Orthopedics.