After a carpal tunnel diagnosis, several steps come before hand surgery

November 21, 2018 Providence Health Team

After spending much of their adult lives performing a repetitive task that leads to carpal tunnel syndrome, some people may be surprised to learn what part the time of day could play in easing their painful symptoms.

That would be nighttime, when the person is asleep.

Nighttime is an opportune time to find non-surgical solutions to relieve pain, says William T. Page, MD, an orthopedic hand surgeon with Providence Orthopedics in Spokane, Washington.

“The first thing we do for almost everybody,” says Dr. Page, “is to recommend nighttime wrist immobilization splints. What that does is keep your wrists in a good extended position so you're not sleeping on it curled up like so many people do.”

Nighttime wrist splinting, perhaps for up to six weeks, is one of the ways to moderate the symptoms of carpal tunnel syndrome, possibly avoiding the need for hand surgery. Other approaches to treatment begin after the symptoms are diagnosed as carpal tunnel and not a close cousin, arthritis.

“The biggest difference between carpal tunnel syndrome and wrist arthritis,” Dr. Page says, “is really in the symptoms that they present with. The most common presenting symptom with carpal tunnel syndrome is numbness and tingling that specifically involves the thumb, index, long, and occasionally ring fingers.”

Carpal tunnel syndrome, Dr. Page explains, is the compression of a nerve, and arthritis is the degeneration of a joint.

“So, while they can both present with wrist pain,” he says, “it's far more common to have numbness and tingling as the primary complaint with carpal tunnel, as opposed to pain and stiffness.”

The hand numbness associated with carpal tunnel can be traced to the median nerve, which “runs across the central palm of your wrist and, when you're resting on it for hours at a time,” Dr. Page says, “it leads to the numbness and tingling because it's decreasing the blood to the median nerve.”

One of the first treatments Dr. Page may suggest involves paying attention to wrist position during the day. This conscious activity modification means being mindful of how you’re holding your wrist and avoiding prolonged static positions, particularly those that put pressure on the palm of the hand, Dr. Page says.

If progress isn’t made using activity modification, wrist splints may be prescribed for use at night, during the day, or both. 

The goal with all of these approaches is to increase blood flow to the hand. “Carpal tunnel syndrome, by definition,” Dr. Page says, “means that the median nerve is not getting enough blood.”

If a patient’s symptoms show insufficient improvement with initial treatments, steroid injections may be tried in the affected area. It’s often a temporary fix, perhaps for patients like teachers who may be able to have an extended stretch during the summer to show improvement. Or perhaps the steroid injection may be used for a patient “who has borderline carpal tunnel,” Dr. Page says, “or for whom we can't necessarily rule it in or out specifically.”

After trying non-operative therapies, a patient with carpal tunnel may consider hand surgery. For the majority of patients, this would mean surgery on both hands, since both hands are usually affected. The procedure is called “carpal tunnel release.”

“It’s a very quick, very simple operation that's done as on an outpatient basis,” Dr. Page says of the procedure, which typically lasts around 10 minutes. 

Patients are encouraged to resume daily activities as soon as possible, while keeping the stitches dry for two weeks. 

"Eating, drinking, buttoning clothes, dressing hair and doing makeup is fine right of the gate and in fact encouraged,” Dr. Page says. “We want you moving your fingers immediately.”

To avoid developing symptoms of carpal tunnel syndrome, people should start paying earlier attention to improper hand placement. On that score, Dr. Page is attempting to practice what he preaches.

The dedicated bicyclist makes it a point to move his hands to different positions on the handlebars during his frequent recreational rides.

His handlebar-positioning advice can apply to someone resting their wrists at a keyboard.

“Rather than sitting in one position for hours on end,” Dr. Page says, “you should vary both your position and your grip, particularly if you're starting to notice any numbness and tingling.”

For expert orthopedic care, find a Providence provider near you in our online directory, or visit:

WA: Providence Orthopedics - Spokane; Providence Orthopedics; Swedish Orthopedic Institute

OR: Providence Orthopedic Institute

CA: Providence Orthopedic ServicesSt. Joseph Health Medical Group; St. Joseph & St. Jude Heritage Medical Group

AK: Providence Orthopedic Services

MT: Providence Orthopedics

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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

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