Carpal Tunnel Syndrome Questions & Answers

Carpal tunnel syndrome (CTS) affects as many as a third of all workers in the U.S., in particular those with jobs requiring repetitive hand movements. In today's post, Dr. Donnelly will answer several carpal tunnel syndrome questions that range from the symptoms and diagnosing of CTS, to treatment options, and the post-surgery long-term prognosis.

Symptoms & Diagnosing CTS

CTS occurs when the median nerve, which runs along with flexor tendons that bend your fingers, becomes pinched at the wrist. When the median nerve has been compressed, symptoms can include tingling, numbness, and/or general weakness in your hand or arm. The carpal tunnel syndrome questions below show how people can experience CTS in different ways.

"I assume that the stress of using a mouse with computer work will 'wear out' my dominant wrist faster than the other. Can people get CTS in both wrists or just their dominant hand?" - Brandon H., Realtor

Around 60 percent of people affected by CTS experience some symptoms on both sides. That’s called bilateral CTS. Carpal tunnel syndrome which only affects one wrist is called unilateral CTS. In cases of unilateral CTS, the dominant hand is more commonly the affected side.

“My mother-in-law had shooting pain up into her wrists and cramping hands. The symptoms were worse at night. She found relief through CTS surgery. However, she still has issues with arthritis. Is there a relationship between arthritis and CTS?” - Barb B., Small Business Owner

Not directly. If you had a lot of swelling, then you could have an issue where the symptoms of arthritis are more pronounced. But for the most part, they are separate entities. One involves nerves, and the other involves joints.

“I spend a lot of time clicking a mouse and typing for my job. Occasionally I’ll get a weird, intense shooting pain in the meat of my thumb. It only lasts for a few seconds, and it usually happens when I’m not at the keyboard. Could this be an early sign of CTS?”- James F., Web Designer

Yes, it could be. The most common signs of CTS are numbness and tingling. But shooting or electric-like pain can happen, as well. The other thing that can cause that kind of pain is something called a trigger digit, which can affect the thumb or fingers.

“I am constantly writing papers, grading student work, doing research on the computer and texting colleagues on my phone. I’m right handed, but starting to feel some aching in the palm of my left thumb. Could a new keyboard setup or hand exercises help? Is it possible to get CTS in my non-dominant hand?”- Emma F., Graduate Student

You can most certainly get carpel on the other side; it’s not dominant-hand specific. At the same time, it has not been scientifically shown to be related to most keyboard work. Everybody thinks that keyboarding can cause CTS, but that hasn’t been proven to be true. One caveat: Heavy data entry, based on key strokes per minute, can be an occupational cause. Usually, however, it’s related to heavy vibrations, such as jack hammering.

To answer the first part of your question, a different keyboard position can definitely help with hand pain. It really depends on how you're using your hands. No part of the body likes to be in the same position for a long time. If you stand up all day, for instance, your feet will hurt. It’s the same thing with hands if you do a lot of typing, or a lot of holding. People are holding cell phones longer and longer, and that’s just an unnatural position. So switching hands, altering your grip or using a different avenue to get the same thing done may be helpful.

Nonsurgical Treatment of CTS

In carpal tunnel syndome’s earliest stages, simple things can have a big impact. Taking more frequent breaks to rest your hands, cold packs or avoiding certain activities may lessen your symptoms. The carpal tunnel syndrome questions below explore these and other nonsurgical treatment options.

How can I evaluate what I can do to change or improve my hand movements to decrease the problem?”- Leslie H., Auditor

For evaluation purposes, the biggest – and simplest – thing is: If you have a position that hurts, don’t do that. Be more mindful of grips and posture. If you’re not able to change your repetitive motion, focus on changing hand pressure. For work or hobbies involving repetitive gripping, try relaxing the hand in between each action. Wearing a brace may help, too. Avoid hyper-flexed or hyper-extended positions of the wrist as these can increase pressure on the median nerve.

"I perform meticulous hand movements to create my jewelry. I know I have an issue with tendonitis from repetitive motions and stress. I'm very concerned that a failed surgery could end my career. Are there hand therapies and anti-inflammatory diets that could reduce my symptoms and help me avoid surgery?"- Kenyon L., Silversmith

Unfortunately, there are not a lot of hand therapies for carpal tunnel syndrome. The one therapy that can be done is something called nerve gliding exercises, which are meant to keep the nerves mobile and prevent them from scarring in. The scientific literature has shown mixed success of nerve gliding exercises. However, nerve gliding exercise when combined with activity modifications and a brace or orthotic wear can be effective in controlling symptoms. Foods known for their anti-inflammatory properties might help, as well as over-the-counter anti-inflammatory medications.

“I’ve played guitar daily my whole life. I’ve also spent a lot of time on a mouse and keyboard doing IT work, working as a pipefitter and doing lots of carpentry through the years. All that work took a toll on my hands. My doctor helped me keep the annoying tingling in my hands under control. I wore braces at night. Finally, the damage was apparent and risked being permanent so I went for surgery. Is there anything I could have done that would have prevented me from needing surgery in the first place?”- Jude L., Professional Musician

Probably not. The thought with carpal tunnel syndrome is that once it starts, CTS usually progresses on. It can wax and wane, but CTS usually will progress to a point where something needs to be done. So, the thought that if you stopped playing guitar, would it have made a difference? Probably not. In the long run, it’s just a question of anatomy and how that can lead to pressure on that nerve.

“A big part of my art involves cutting stencils and painting with cans. Making precision cuts and pressing the valve on the cans all day causes some pretty serious hand pain. CBD lotion really helps with my pain. What role can CBD play treating symptoms and in recovery following surgery?” - Jeremy N., Muralist

There are some known inflammatory properties associated with CBD, and that’s probably what’s helping some people.

Surgical Treatment of CTS

Surgery could be appropriate if symptoms become more severe or if your hand isn’t responding to other treatments. CTS surgery involves cutting the ligament pressing on your median nerve in order to relieve pressure. There are two techniques, endoscopic and open surgery. The endoscopic option involves using a tiny camera on a telescopic-like device to see inside the carpal tunnel. Dr. Donnelly then cuts the ligament through a small incision. Open surgery, as the name suggests, involves a larger incision in your palm to reveal the ligament. The carpal tunnel syndrome questions below cover the surgical treatment option.

“My work and home life balance is very important to me. Because of my busy life, I’m concerned an invasive treatment could really impact the people who depend on me. I need to continue my life as much as I can the way it is. That said, do I run any long-term risks by avoiding surgery? And if I absolutely needed surgery, what’s the fastest way for me to get back to 100% functionality? Is that even reasonable to consider?” - Liz H., Sales Rep

In terms of long-term risks, the biggest is people who wait too long and then develop permanent damage to the nerve. If the nerve becomes severely compressed, you can get permanent sensory loss, as well as muscle weakness and even muscle loss. Both open (actually mini open) and endoscopic carpal tunnel release have a fairly short recovery. Soft dressings are worn for 4-5 days, followed by just a band-aid. Light activities are possible right away. The literature notes less palmar pain and earlier return to heavier use with the endoscopic technique.

Nevertheless, studies have shown at 6 weeks both groups have similar results, and using a mini-open approach has people returning back to work and avocations in a similar time frame to endoscopic.

"As an artist, money is always an issue. How badly can untreated CTS impair my mobility? What is the least expensive form of treatment? In the meantime, how can I avoid further damage?"- Shelley H., Artist

The easiest thing to do for early carpal tunnel syndrome is taking an over-the-counter anti-inflammatory and wearing a standard wrist brace. Particularly at night, that can help. Aside from that, steroid injections are an option, but more often than not they do not offer lasting relief.

To address the risks of waiting, one problem with chronic nerve compression is it can cause some internal scarring that the surgery doesn’t always fix. Surgery takes external pressure off, but if there is scarring inside, the damage is already done. That pain or weakness doesn’t always go away.

Aside from bracing and other non-surgical treatment, the least expensive treatment would be surgical carpal tunnel release performed wide awake with a technique referred to as WALANT (Wide Awake, Local Anesthetic, No Tourniquet). Because no sedation is involved, there are no anesthesia fees. Lastly, controlling the symptoms will likely keep the CTS in check. We are unsure if there can be damage done to the nerve without symptoms being felt, but most opinions on the matter believe that if one is symptom free (no numbness, tingling, weakness etc), there is likely no ongoing damage to the carpal tunnel nerve.

“Without my hands, my business comes to a stop. However, while I'm otherwise very strong, I'm experiencing constant weakness in my hands and fingers. How does someone in my position continue to work, but also get treatment?" - Ryan R., Small Business Owner

The biggest thing is finding out what’s causing the weakness. You can get this kind of weakness from carpal tunnel syndrome, but that usually happens later. Numbness is the first thing we see, like the feeling of your hand falling asleep. So, it depends. If the weakness is coming from CTS, then surgical treatment would be the answer. Otherwise, identifying the weakness would be the focus, then trying to correct or treat that.

Long Term Prognosis of CTS

CTS surgery has a remarkable high success rate of more than 90 percent. Many symptoms are quickly relieved, including tingling and numbness. Recovery doesn’t take long, either: The bandage covering your stitches can be removed in just a few days. The following carpal tunnel syndrome questions discuss the long term prognosis of CTS.

“I have to be very expressive on stage. How long would I have to wear a noticeable brace? Will I get my full range of motion back? If so, how long would that take?" - Evette R., Actor

Traditionally, patients wear a hand-based dressing – there’s no cast or anything firm – for five days. Then, we simply place a standard Band-Aid over the incision, which is less than an inch long. We usually anticipate 90 to 95 percent of people will have a full recovery, with nothing more than a barely noticeable scar in the palm. In a week or two, people get their range of motion back. The palm incision is usually sore for four to six weeks. Some people have pain that lasts longer, but that will resolve with time.

“As a potter, I count on having strong hands to create ceramics and to teach my art students. If I have surgery for CTS, can it come back? Is there anything one can do to keep it from happening in the first place?” - Christy B., Potter

Recurrent carpal tunnel syndrome is uncommon. Usually, we’re only seeing it 15, 20, 25 years out from the initial surgery. There’s not too much to be done, however, to keep it from coming back on that kind of timeline.

The small group of people who develop scarring around the nerve can also have their symptoms come back. That’s much more challenging to correct surgically, just because of the scar tissue. Unfortunately, there’s nothing that can be done to prevent CTS. Surgery will correct the problem, but nothing has been proven to prevent it.

Have Carpal Tunnel Syndrome Questions We Didn’t Cover?

If you still have carpal tunnel syndrome questions about the diagnosis, treatment and prognosis for carpal tunnel syndrome, request an appointment with Dr. Donnelly. Following an evaluation, we will be able to discuss CTS and what can be done to relieve your pain.

About Dr. Brandon P. Donnelly, MD

Dr. Brandon P. Donnelly is a board certified orthopedic surgeon with Pontchartrain Orthopedics & Sports Medicine. Dr. Donnelly completed his hand and microsurgery fellowship at the prestigious Philadelphia Hand to Shoulder Center. Dr. Donnelly treats all ages of patients in the greater New Orleans area for hand, wrist, and elbow conditions.

This site is not intended to and does not provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual. Through this website and links to other websites, Brandon P. Donnelly, MD provides general information for educational purposes only. The content provided in this website and links, is not a substitute for medical care or treatment. You should not use this information in place of a consultation or the advice of your healthcare provider. Brandon P. Donnelly, MD is not liable or responsible for any advice, course of treatment, diagnosis or any other information, services or product you obtain through this site.