One
recent patient I had was a pleasant old lady who had a condition called carpal
tunnel syndrome. Since I can’t think of
a more boring orthopedic topic to cover right now, I decided to tackle this and
see if I can offer something unique on the subject.
My
patient was a 70-year old lady who has been suffering from pins and needles
sensation on her right hand.
Her
name is Lola Phoebe. Actually, her real name was Lola Pebang. But she told
me she took a vacation in America, when she came back after 2 weeks, she was
now called Lola Phoebe.
Anyway,
she has taken pain medications and vitamin B complex, as prescribed by an
extended family member, specifically, a friend of her sister’s neighbor’s niece’s
classmate (whew). She did not improve and told me she had episodes of dropping
objects from her right hand because of pain and occasionally being awakened at
night due to pain. Her symptoms gradually worsened until the pain and numbness
became more often. How often? Everytime
she breathes.
On
examination, her hand has some evidence of atrophy or thinning around the ball
of the thumb muscles, and symptoms isolated to the first 3 fingers of the hand.
Thus, the clinical impression of carpal tunnel syndrome was made.
So
now, what then is a carpal tunnel syndrome?
The
carpal tunnel is the canal-like passageway on the palm side of the wrist
through which several tendons and a pencil-sized nerve, called the median
nerve, pass through on their way to the hand from the forearm. The canal is
bordered by some of the bones of the wrist and the strong ligament the binds
the bones together, called the transverse carpal ligament. This ligament forms the roof of the tunnel.
When
the transverse carpal ligament thickens (parang
kinalyo), the canal decreases in size, compressing the median nerve that
leads to the occurrence of signs and symptoms such as those experienced by my
patient. These symptoms are collectively referred to as carpal tunnel syndrome.
Carpal
tunnel syndrome (CTS) is a relatively common painful ailment that affects women
more than men. People with CTS usually complain of pain in the hand associated
with numbness and tingling over the thumb, index finger, middle finger and part
of the ring finger. The pain may radiate into the forearm and occasionally into
the shoulder and neck. It is aggravated by activity and may awaken the patient
at night. If nothing is done to relieve the nerve compression, the signs and
symptoms may progress and atrophy or thinning of the muscles at the ball of the
thumb may ensue.
Carpal
tunnel syndrome can be secondary to conditions in the wrist such as
inflammation of any of the tendons (tendinitis) that pass through the tunnel,
fractures and tumors. Sometimes, it is one of the manifestations of a disease
like rheumatoid arthritis, diabetes mellitus and thyroid disease. It is also
associated with pregnancy and menopause.
Most
CTS patients have a history of holding jobs that require them to do repetitive
motions with the hands and wrists for long periods of time. Hence, it is common
in factory workers, seamstresses, housekeepers, even surgeons!
Theoretically,
people like you who extensively use computers to read my blog J should be prone to CTS.
The only definitive cure for CTS is surgery. It is a minor outpatient procedure where after the operation, the
pain usually subsides within a few days and never recurs. Muscle strength also
returns gradually except when the nerve has already been severely damaged.
However,
surgery, for most cases, is the last recourse for CTS. You should try non-surgical treatment first, which should include elevating the hand whenever
possible, splinting of the arm and hand, or physical therapy. If the above
measures do not work, you could ask your orthopedic surgeon to inject your
wrist with a steroid solution. But if conservative treatment fails, then consider
surgery.
So what did I
do with my patient? She refused surgery
for fear of dying during surgery (how morbid). So I injected steroid into the carpal tunnel
and so far, she is doing well. She is also
undergoing physical therapy right now.
As to how long this will help, nobody knows. If you, however, want more definitive solution,
then surgery should be considered. Remember, the problem is a compressed nerve.
Therefore, the solution is to decompress the nerve.
That’s it for
now. Til the next blog post…..
