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Johns Hopkins Health - Uncomfortably Numb
Issue No. 15
Date: January 12, 2012
Do you frequently have numbness and tingling in your hands and fingers or feel as if your hand has fallen asleep? Or do you notice your hand’s motor skills aren’t what they used to be? These symptoms might indicate carpal tunnel syndrome, or CTS, which can cause long-term damage if ignored.
An estimated 3 to 6 percent of Americans suffer from this nerve disorder, which is caused by compression of tendons and one of the wrist’s main nerves in the carpal tunnel, the passageway for nerves from the forearm to the palm of the hand. One of the most common forms of surgery in the United States is hand surgery to correct CTS.
No studies have conclusively proved that repetitive motion causes CTS. There is some evidence that hand-tool-based occupations have a stronger relationship with occurrence of CTS. People who have diabetes, are pregnant, have rheumatoid arthritis, or are more prone to swelling in general seem more likely to develop the disorder.
“Really, anybody can get it, depending on how much room they have in their carpal canal and how much volume all of the tendons and nerves occupy at any time,” says Jaimie Shores, M.D., assistant professor of plastic and reconstructive surgery at Johns Hopkins.
If you think you might be suffering from CTS, see your primary care physician, who can refer you to a neurologist for nerve testing or to a hand surgeon. Often, hand pain is not CTS but another nerve disorder, tendinitis or arthritis. If you receive a diagnosis for CTS, however, many treatment options are available. Wrist splints or a steroid injection may provide relief for people with mild disease. More severe cases may require surgery, Shores says.
“Johns Hopkins has fellowship-trained hand surgeons who specialize in hand, wrist and nerve disorders of the upper extremity [arm],” he says. Traditional open surgery involves a 1.5- to 4-inch incision, though Shores says most patients elect endoscopic surgery because incisions are smaller.
Shores says endoscopic surgery is just as effective as open surgery and patients tend to heal faster. “Some people’s hands are better suited to open surgery,” he adds, noting that people with small hands may not be eligible for an endoscopic procedure.
“That’s why having a qualified hand surgeon who knows a lot of ways of treating CTS is important,” Shores adds. “No one technique is right for absolutely every patient. And sometimes what patients think is carpal tunnel syndrome is something else entirely. But chances are, we treat that, too.”
Releasing Trigger Finger
A common nerve disorder that often appears alongside carpal tunnel syndrome is trigger finger, where swelling of the tendons of the index finger or thumb results in soreness or locking of the digit in a flexed position. The disorder usually can be treated initially through the use of nonsteroidal anti-inflammatory drugs or steroid injections, though surgery is an option for those who have severe cases, who aren’t candidates for nonsurgical treatments or who don’t experience relief from less-invasive methods.
Video: Handle with Care: Treatment of Carpal Tunnel Syndrome and Other Common Hand Conditions
Don’t ignore the symptoms of these common culprits of hand numbness. Johns Hopkins plastic and reconstructive surgeons Scott Lifchez, M.D., and Jaimie Shores, M.D., discuss diagnosis and treatment of carpal tunnel syndrome, trigger finger and other common hand conditions. Minimally invasive approaches to surgery are also discussed. Visit http://bit.ly/carpaltunnelvideo to view the video.
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