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What Kind Of Doctor Treats Carpal Tunnel

by Lyndon Langley
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What Kind Of Doctor Treats Carpal Tunnel

What Kind Of Doctor Treats Carpal Tunnel

If you have ever experienced pain or numbness in your fingers or thumb, then chances are good that you’ve suffered from carpal tunnel syndrome (CTS). It’s a condition that affects about 2 percent of adults, but because CTS involves compression of the median nerve, which runs through the wrist bone just above where the two bones meet, the symptoms can be quite severe. In fact, as many as 20 to 40 percent of people with CTS may eventually experience some type of neurological deficit. But don’t worry; there are treatments available for those who suffer from this disorder.
Carpal tunnel syndrome was first described by French surgeon Charles-Émile Reynaud in 1874. He observed what he believed were nodules on the flexor tendons of cadavers, and hypothesized they might cause tendon inflammation and pain. Since then, scientists have debated whether these nodules are really present in living patients [Source: Mayo Clinic]. Nevertheless, doctors soon realized that the pain was related to compression of the median nerve at the narrowest point of its passageway, called the carpal canal. This area is located within an arch formed by the radius and the second metacarpal bone, known as the lunate. The median nerve, along with other small nerves, branches of the radial artery and veins, and arteries also travel through the wrist joint. At this location, any swelling or tightness created by arthritis or rheumatism could potentially compress the delicate nerve tissue. As the result of pressure, the carpal canal shrinks over time, causing the surrounding tissues to become inflamed and irritated.
The carpal canal has been narrowed even further by occupational activities such as repetitive motion, forceful gripping, pushing, pulling and twisting movements, and vibration. These activities can lead to inflammation of the sheath around the median nerve, which causes swelling and irritation. When the sheath becomes too thick, it can begin to press against the nerve itself, irritating and damaging it. On top of all that, the weight of the arm can put additional strain on the median nerve, leading to chronic pain. Overuse injuries caused by repeated trauma, such as tennis elbow, golfer’s palsy, and repetitive stress injury, can also contribute to carpal tunnel problems.
While there is still much debate regarding the exact cause of CTS, sufferers should take note that the risk factors associated with the disease are age, gender, obesity, tobacco smoking, pregnancy, diabetes, high blood pressure, osteoarthritis, and previous surgery around the wrist. Additionally, certain medications, such as beta blockers, diuretics, corticosteroids, anticoagulants, antihistamines, antidepressants, and nonsteroidal antiinflammatory drugs (NSAIDs), can also increase the likelihood of developing carpal tunnel pain.
Fortunately, there are several different types of treatment options for CTS, including physical therapy, splints, braces, injections, steroidal or local anesthesia, massage therapy, acupuncture and surgical intervention. There are also several ways to relieve the pain associated with carpal tunnel syndrome, including splinting, wearing gloves during the day, resting the hands, taking NSAIDs and applying ice packs. Doctors typically recommend avoiding activity until the pain subsides. If you’re experiencing persistent discomfort after visiting your doctor, however, consider seeing a specialist.
In addition to relieving pain, treating carpal tunnel syndrome must also help prevent it from returning. To do so, sufferers need to practice safe work habits and avoid excessive exposure to harmful substances. For example, workers who perform repetitive motions for long periods of time should be encouraged to change their jobs. Similarly, nurses and physicians who regularly handle objects with sharp edges should wear protective clothing and gloves to protect themselves.
To learn more about diagnosing and treating carpal tunnel syndrome, follow the links on the next page.
Diagnosis: Diagnosis of carpal tunnel syndrome usually occurs when a patient experiences pain or weakness in his or her hand while performing certain daily tasks. A simple test known as Phalen’s sign, named after Dr. William H.Phalen, is used to determine whether a person suffers from carpal tunnel syndrome. During this procedure, the examiner holds out his or her palm, with the index finger extended upward toward the ceiling, and asks the patient to clench both fists. Next, the examiner gently squeezes each fist together, counting five seconds before releasing them. If the patient feels pain along the underside of the forearm, the test is positive. However, if the patient does not feel pain, the test is considered negative [Source: American Academy of Orthopaedic Surgeons].
Treatment: Treatment depends upon the severity of the problem, and ranges from rest to surgery. Noninvasive therapies include splints, braces and night splints. Physical therapists often prescribe exercises designed to stretch the muscles surrounding the affected areas and strengthen weaker ones. Massage therapy can also provide relief by loosening up the muscles near the carpal tunnel. Patients can also try acupuncture, heat and cold therapy, acupressure, chiropractic care, electrical stimulation and relaxation techniques. Surgery is generally reserved for patients who fail to improve with conservative measures, or whose symptoms persist beyond three months. Surgical decompression of the carpal tunnel, performed under general anesthesia, uses either open or endoscopic methods to relieve the pressure on the median nerve. Open procedures involve making a cut between the scaphoid and lunate bones, whereas endoscopic surgeries require only a small incision. Both types of procedures allow for direct visualization of the compressed median nerve. After surgery, patients are given crutches and told to keep their wrists elevated. Most patients resume normal activities within a few days, although recovery times vary depending on the specific procedure.
Complications: Rarely, complications can occur following carpal tunnel release surgery. Infection is the most frequent complication, occurring in less than 1 percent of patients. Other potential complications include permanent scarring, temporary loss of sensation, recurrent tunnel syndrome, hemorrhaging and recurrence of symptoms. Recurrent cases are more likely to happen when the surgery is done using open techniques rather than endoscopy, and in older patients.

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