Carpal tunnel can be more than just a pain in the wrist

If you’ve got pain or numbness in the wrist and Google your symptoms, one of the first conditions that may pop up is carpal tunnel syndrome. This injury is one that Dr. Neal Lintecum, an orthopedic surgeon at OrthoKansas, is seeing more and more often.

Neal Lintecum, MD

“Sports have decreased due to the COVID pandemic, so the number of high-energy injuries we see have decreased,” he said. “It’s the repetitive, low-energy injuries from work, people spending time on their laptops and in Zoom meetings that we’re seeing more of.”

What is carpal tunnel syndrome?

The “carpal tunnel” is a narrow passageway that runs from the base of the hand through the wrist. Several tendons and the median nerve, which controls our sense of touch in the palm and fine movement in the thumb, pass through the carpal tunnel.

When any of those tendons become irritated or other swelling encroaches on the space within the tunnel, the median nerve can become compressed. This may cause symptoms ranging from tingling and numbness in the fingers to pain that radiates up the arm.

People who engage in activities with their hands for long periods of time, such as those who use a computer frequently, are at greater risk for developing carpal tunnel syndrome. Your chances of developing carpal tunnel increase if you’re pregnant or have an illness such as hypothyroidism, rheumatoid arthritis and diabetes.

“If you’re having numbness that’s keeping you awake at night or you’re having difficulty with fine motor tasks like buttoning buttons, tying shoes, or if you dropped your coffee cup five times in the last three months, you should probably have that checked out,” Dr. Lintecum said.

What can I do to find relief?

There are a number of steps you can take to provide temporary relief from carpal tunnel symptoms.

• Take frequent breaks from activities that cause numbness and pain.
• Ice your wrist once or twice each hour for 10 to 15 minutes at a time and repeat as needed.
• Take non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil or Aleve. These can help relieve pain and reduce swelling. Your doctor may also suggest you get a corticosteroid injection in the wrist to relieve pain.
• Wear a wrist splint at night. This will help take pressure off your median nerve.

“Therapy is also a great option, one that can get you relief and can often times save you from needing surgery,” Dr. Lintecum said. “There are lots of times where a good hand therapist or physical therapist can get you fixed up, saving you from bigger problems, improving your function and relieving your symptoms without having to involve surgery.”

Sometimes surgery is necessary

If your symptoms continue to persist, the next step may be surgery. Many people have fears that they’ll have to take an extended leave from work or daily activities, but Dr. Lintecum says that’s no longer the case.

“We do the vast majority of our carpal tunnel surgeries endoscopically,” he said. “I tell patients that I’ve had farmers go throw hay bales the next day. There’s no weight limit. Keeping the incision clean and dry for three days is the only restriction. We can get people back to their exercise or work pretty quickly.”

Bilateral carpal tunnel may be a warning sign

One relatively new finding is that people with bilateral carpal tunnel syndrome, or carpal tunnel in both wrists, may be at increased risk for cardiac amyloidosis.

“Bilateral carpal tunnel is a marker for amyloidosis, where the body produces abnormal proteins deposited in different organs,” said Dr. Michael Zabel, a cardiologist with Cardiovascular Specialists of Lawrence. “The proteins act like scar tissue and make that organ stiffer than normal. You can get proteins that build up and cause heart arrhythmias like slow heartbeat that causes people to faint or blackout. In more serious cases, it can cause heart failure.”

The team at OrthoKansas works closely with Cardiovascular Specialists of Lawrence to identify patients who may be at risk for this disease.

“Sometimes bilateral carpal tunnel is the first sign of amyloidosis. We’ll do a biopsy and if a patient does have the condition, we’ll send them to a cardiologist to determine if they need a work-up or further treatment. It can be a life-saving diagnosis if it’s caught early enough,” Dr. Lintecum said.

Medication is one treatment option for patients with cardiac amyloidosis. Dr. Zabel said that two medications have been approved by the Food and Drug Administration over the past three years.

“These medications don’t prevent the disease but they do appear to be quite effective at lowering the risk of complications,” he said. “A few patients need more than medication – a pacemaker, for example – but many just need a pill.”

When should I see a doctor?

Dr. Lintecum advises that if you’re concerned about symptoms you’re experiencing, including functional limitation or pain that keeps you from sleeping, make an appointment with either your primary care physician or call OrthoKansas for an evaluation.

“We’ve got experts at OrthoKansas that are trained as well as anyone in the country and are board-certified in their specialties and subspecialties,” he said. “We’ve got outstanding therapy to address any need you may have. We have the facilities to provide you care and imaging capabilities and expertise that are unmatched in the state. Come in and let us help you with your musculoskeletal care.”

Related story:

Eight signs you could have carpal tunnel syndrome
February 25, 2018