Relief for Carpal Tunnel Syndrome

You’ve got to hand it to your hands; they do a lot. So when they hurt too much to do their job, don’t hesitate to seek relief, says Erica Taylor, MD, a hand surgeon at Duke Orthopaedics Heritage.

Carpal tunnel syndrome is one of the most common conditions Dr. Taylor treats. And although she’s a surgeon, this condition may also respond to nonsurgical treatments, which she also provides. 

Carpal tunnel syndrome occurs when the nerve that runs from the forearm into the palm of the hand becomes squeezed at the wrist. This nerve, called the median nerve, controls sensations to the palm side of the thumb and fingers. The carpal tunnel is a narrow, rigid passageway of ligament and bones at the base of the hand that houses the median nerve and tendons. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and compresses the median nerve. The result may be pain, weakness, or numbness in the hand and wrist that radiates up the forearm.

Between 2 and 6% of the general population suffer from carpal tunnel syndrome, Dr. Taylor says. While the condition historically has been associated with secretarial work, it isn’t necessarily job-related.

“There are many other underlying factors that can contribute to the development of carpal tunnel syndrome and its symptoms,” she says. Symptoms can be worsened by repetitive movements, but physiology plays a big role. Hormonal changes, pregnancy, a thyroid condition, diabetes, and other conditions have also been associated with carpal tunnel syndrome.

The first step, Dr. Taylor says, is to determine the cause of the pain, tingling, weakness, or numbness that are often the first clues to carpal tunnel syndrome. “People are likely to notice these symptoms when they’re driving or blow-drying their hair—the vibration sensations can be very irritating,” she says. “They also commonly report symptoms at night—with hand pain that may make it difficult to get a good night’s sleep.”

Diagnosis will likely involve a physical exam, medical history, nerve studies, and possibly lab tests to evaluate for any underlying conditions.

When diagnosed early, mild cases may be treated with activity modification and possibly nighttime splinting. Cortisone injections are sometimes used if other therapies do not provide relief. Outpatient surgery is an option when other treatments aren’t effective or if the symptoms are severe.

Cathy Jimenez Ernst, a fiber artist and former hairstylist from Gibsonville, North Carolina knew something was wrong when she began to have what she described as “lots of numbness and pins and needles” in her hands—mild in her right hand and moderate in her dominant left hand. “It would wake me up at night,” she says. “I wasn’t able to do certain things for my work, and I constantly dropped items.”

After trying remedies including splints, ice packs, and heat for several years, the artist had an outpatient procedure known as carpal tunnel release on her dominant hand. She had full use of her hand within two weeks of the surgery, and had a subtle scar. “The decision to have surgery was the best decision I’ve ever made,” she says.

Following carpal tunnel release, patients are usually able to return fully to normal activities within a few weeks. It may be several months before they get all the strength back in the affected hand.

As the daughter of an NFL great, Hall of Famer Charley Taylor of the Washington Football Team, Taylor has a particular interest in treating sports injuries. She also treats fractures, arthritis, tendon lacerations, and a hereditary condition known as Dupuytren’s contracture.

No matter what condition she’s treating, “the hand therapists at the Duke outpatient rehabilitation centers in Raleigh and Wake Forest are an integral part of the treatment team. We work hand in hand,” she says, laughing at the pun. “Approximately 50% of my patients are engaged with an occupational therapist.” Those visits can be as simple as a one-time session where the therapist coaches the patient on exercises to do at home. On the other hand, a patient may need six or eight weeks of occupational therapy.