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Carpal tunnel flare ups can last days, weeks, or they can be permanent, in fact. Patients can come in (usually they have had it for quite some time - weeks to months) and that's what brings them into the doctor's office. Usually once you have it, it's a consistent problem until you see a medical professional. It's rare for it to come on a one time basis and then just go away.
Carpal tunnel flare ups can last days, weeks, or they can be permanent, in fact. Patients can come in (usually they have had it for quite some time - weeks to months) and that's what brings them into the doctor's office. Usually once you have it, it's a consistent problem until you see a medical professional. It's rare for it to come on a one time basis and then just go away.
Carpal tunnel symptoms can be transient and can resolve on their own or with mild treatment or more often they can be gradually progressive until the condition is treated surgically and carpal tunnel release is performed. Intermittent symptoms that resolve on their own are usually the result of an episode, over use of the hand, or trauma to the hand and wrist, such as a fall on the risk that causes swelling or sometimes a medical condition. The most common being pregnancy, which is often a precipitant of carpal tunnel symptoms. When those conditions resolve, fortunately the symptoms often go away. If the symptoms persist and are progressive, then medical attention is indicated and people should seek out their doctor to ask about referral to a hand surgeon.
The symptoms of carpal tunnel can be as varied as the patient, but clearly it must involve something in the hand and the wrist. Sometimes it can actually be painful. Sometimes it can just be numbness. Sometimes it can be a sense of clumsiness. "Can't write those numbers in the checkbook like I used to." "My handwriting isn't the same." My hand doesn't it feel right." Typically patients present with those symptoms at night because they're not moving their hand well and the median nerve - that special nerve that's in there with the tendons - isn't getting enough blood flow and so it starts acting out.
The first thing people usually experience when they start having carpal tunnel symptoms is numbness. The numbness is often first noticed when people are sound asleep at night. It's not uncommon for people to wake up once or twice a night with their fingers asleep. The fingers that are affected by carpal tunnel syndrome are the thumb index, middle and ring finger. Initially the symptoms can be mild and short lived, but as the condition progresses, those symptoms become more continuous so that people can start waking up several times a night. This is obviously distressing and is usually the first thing that leads people to seek medical attention for their problem. As carpal tunnel symptoms progress, they often then start to affect people with activities during the day. Repetitive and forceful activities or the things that are usually the most concerning for people as they can elicit increasing symptoms with use. As carpal tunnel symptoms progress from mild into more moderate compression, the numbness can then be associated with pain and even weakness as the symptoms of the nerve compression begin to be manifested in other ways. Eventually patients do seek medical care because the symptoms are typically not tolerated for very long before people become worried about it, and that's natural.
Having Carpal Tunnel Syndrome doesn't mean that symptoms will always be present. Especially early in the condition, symptoms are often intermittent. Most often we hear people start to complain of Carpal Tunnel Syndrome with symptoms only at night when they're sleeping. As the condition becomes more severe, the symptoms usually become more continuous. It's also not uncommon for people to have symptoms primarily with certain activities, typing for long periods of time, or repetitive forceful activities such as occupational exposure, construction workers, assembly line workers, and the like. So continuous symptoms are not always present, and not having continuous symptoms doesn't mean that you don't have carpal tunnel syndrome.
Typically, carpal tunnel presents with nocturnal symptoms - meaning symptoms at night. Oftentimes patients wake up in the middle of the night and have to shake their hands out because they're numb. Other times when the symptoms can be bothersome is working at a computer, driving, anything where your risks are flexed or extended. Because risk flexion diminishes the space available for the median nerve in the palm. And so anything like this *Demonstrates* or like this *Demonstrates*, sleeping like this *Demonstrates*, for instance, can irritate the media nerve and causes numbness and tingling in the fingers. Carpal tunnel symptoms can come and go but generally, even if they do come and go, patients present because it's bothersome to them and it affects their quality of life and their ability to work. If you're feeling numbness and tingling in the thumb, index finger, middle finger, and ring finger, particularly at night or when performing activities of daily living, such as driving or working at your computer, then that would be a time to consider going in to see a hand specialist to assess for carpal tunnel syndrome.
Recurrent carpal tunnel syndrome is fortunately rare. Usually after a transverse carpal ligament release, after a carpal tunnel release, patients get better and they never have a recurrence. In the rare circumstances when they do, generally I try to avoid surgery because the fact of the matter is that the data shows that in a revision carpal tunnel release the outcomes are not as good as with a primary carpal tunnel release. So generally if we can avoid going back in and having to operate a second time, that's optimal. Generally the treatment would be: perhaps some hand therapy, perhaps a cortisone injection, maybe splinting for a period of time. If I'm concerned, I'd get a new nerve study to assess to see if there is still slowing of the median nerve at the carpal tunnel because it is possible that there could be an incomplete release of the transverse carpal ligament. That would be the most common cause of persistent symptoms after carpal tunnel release.
There are other conditions that can mimic the symptoms of carpal tunnel syndrome fairly closely. Things like nerve compression in the neck or in the shoulder can produce numbness, tingling, and even pain in a similar distribution to the carpal tunnel. Therefore, assuming that symptoms are the result of carpal tunnel syndrome is not the best policy. If you have these symptoms, if they're troubling and if they persist, it's important to seek out medical attention and an accurate diagnosis to be certain that you know what the condition is, because that will lead to proper treatment.
At some point, as the condition progresses, symptoms become more profound. Patients will no longer just experience intermittent numbness, but they start to have more pain and become weak as the motor portion of the nerve becomes affected. At that point, people traditionally seek out medical attention because it starts to affect their daily life on a really profound basis. As carpal tunnel symptoms progress from mild to more profound symptoms, the nerve compression is starting to affect the nerve itself. Initially, it's only the environment that the nerve is in that's producing mild symptoms. As that compression persists, the nerve can actually start to become damaged. When that happens, the symptoms go from being very tolerable and mild to becoming much more profound. People start to become weak. They drop objects, they have trouble buttoning buttons or turning keys because the muscles at the base of the thumb become weak. When that happens, it's no longer a matter of simply managing the symptoms. When people start to lose function and their numbness and pain becomes severe, they require medical treatment.
The typical presentation of carpal tunnel is numbness and tingling in the thumb, index finger, middle finger, and ring finger. It generally does not present with pain. In fact, oftentimes I see patients who present complaining of hand pain and they think that they have carpal tunnel syndrome. Carpal tunnel syndrome typically does not present with pain (although it can) but classically the presentation of carpal tunnel is numbness and tingling in the thumb, index, middle, and ring fingers. The numbness and tingling can be in any of those fingers. Typically it is all of the fingers, but sometimes patients will present with isolated numbness in the middle finger or index finger, but generally it's the thumb, index, middle, and ring finger.
Board Certified Orthopedic Surgeon
Completed fellowships at Brown University and UCLA
Specialties include sports medicine, trauma, and hand surgery
Board Certified Orthopedic Surgeon
Completed fellowships at Brown University and UCLA
Specialties include sports medicine, trauma, and hand surgery
Certified by the American Board of Neurological Surgery
Chief of Neurosurgery at St. Joseph’s Hospital
Former Chief of Surgery at Tucson Medical Center
Board Certified Orthopedic Surgeon
Completed fellowships at Brown University and UCLA
Specialties include sports medicine, trauma, and hand surgery
Board Certified Orthopedic Surgeon
Completed fellowships at Brown University and UCLA
Specialties include sports medicine, trauma, and hand surgery
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