Wrist pain operation -Both hands


Carpal tunnel syndrome used to be rare, a disease relegated to heavy typewriter and pen-and-ink users, such as writers and secretaries. But in the past few decades, with computers, smartphones, tablets and video game consoles permeating every aspect of our existence, it has become far more common, and frequently plagues office workers, heavy video game users, and anyone else who spends a long time in front of a keyboard or console.

 

What causes carpal tunnel syndrome?

This affliction is caused by pressure on your median nerve, a nerve that runs through your wrist along with several tendons through a space called the carpal tunnel and controls sensation in every finger but the smallest one. When swelling or other pressure restricts the carpal tunnel, the nerve undergoes pressure and its functions are affected, causing numbness, tingling and weakness in your hand.

 

There are several things that could cause the carpal tunnel to constrict, but the #1 cause is repetitive hand motions - making the same hand or wrist movements again and again, such as when you are typing or playing a video game. This is even more likely when your hand is lower than your wrist, due to an improper ergonomic position.

 

Illnesses like rheumatoid arthritis, diabetes and hypothyroidism can also cause symptoms that affect the carpal tunnel, and swelling and oedema due to pregnancy can be another cause.

 

What does it feel like?

As very few people have jobs and hobbies that do not put them at risk for carpal tunnel syndrome, here are a few symptoms that will allow you to recognise it.

 

?       Shooting pain between your hand and elbow

?       Tingling, numbness or pain in your wrist or fingers

?       Discomfort in all fingers but the little finger and half the ring finger

?       Symptoms initially appearing at night, after a day’s work

 

Many people initially dismiss the symptoms as shaking your hand and stretching your wrist can temporarily alleviate the discomfort. However, carpal tunnel is not a condition that improves with negligence and requires that you visit a doctor as soon as possible.

 

Your doctor will ask for a complete medical history, as they need to know whether you suffer from arthritis, hypothyroidism, or diabetes, and may get you tested for those and other conditions if you haven’t had a recent check-up. Any recent injuries must be gone over in detail, and the strength and sensation in your upper body (neck, shoulders, arms and hands) will be checked.

 

Most often, it will be found that factors in your daily routine or working position are the culprits. You will need to change your habits and form a more ergonomic workspace on the advice of your doctor.

 

Treatment of mild symptoms

Along with lifestyle changes, your doctor may prescribe NSAIDS (non-steroidal anti-inflammatory drugs) to reduce the swelling, and prescribe a set of stretches and exercises to be carried out periodically. You may need to take longer breaks or temporarily stop activities that make your symptoms worse. Applying ice periodically or wearing a wrist splint may also alleviate your symptoms.

 

If your carpal tunnel syndrome is caused by any of the abovementioned health issues, your doctor will treat the problem directly through prescription meds or other means. As hypothyroidism, diabetes and arthritis can be serious problems, diagnosis and treatment will help you in many other ways as well.

 

Surgical options

One principal of carpal tunnel surgery is that as the tunnel is narrowing itself and constricting the nerve, it needs to be made bigger. This is most simply done by cutting through the transverse carpal ligament. The surgery accomplishing this is called carpal tunnel release surgery, which can be of two types - open and endoscopic. Surgeons have come up with several creative alternative ideas for surgeries, but none of these techniques have been tested extensively enough and are all considered experimental.

 

Open carpal tunnel release surgery

This follows the standard open surgery format. The patient is typically put under a local anaesthetic, an incision is made in the skin, the surgeon corrects the problem and then sutures up the incision. In open CTRS, the incision will be of about two inches. As always, open surgery requires a longer recovery period and leaves a bigger scar than a keyhole or endoscopic surgery. However, the chance of other complications may be lessened.

 

Mini open release surgeries, where the surgeon makes a smaller incision than during standard open release surgery, allow a direct view to the ligament during surgery and may minimise risk of damage to the nerve. It also heals more quickly and will leave a smaller scar.

 

Endoscopic carpal tunnel release surgery

During endoscopic carpal tunnel release, two half-inch incisions are made - one on the palm, the other on the wrist. A tiny camera on the end of a tube is inserted through one incision, allowing the surgeon to see what they are doing as they insert their instruments through the other incision and cut the carpal ligament.

 

This surgery involves smaller incisions and quicker recovery time, but may not always be the best option. Your doctor will be able to help you choose.



The sooner you see your doctor and start carrying out simple home treatments like this on their recommendation, the less likely it is you will need surgery.


When do you need surgery?

Surgery is a last resort, and occurs only when your symptoms are so severe that you are prevented from working and carrying out other activities for several weeks despite undergoing treatment. In fact, actress Brooke Shields suffered carpal tunnel for years before she finally had surgery.

 

Severe symptoms of carpal tunnel syndrome can really restrict daily activities. Numbness and a loss of sensation in the fingers and thumb can cause weakness and a lack of coordination, making it hard to pick up objects, type, and generally carry out day to day functions. Jessica Alba in fact woke up with severe numbness in her arm, and thought she was having a stroke! Pain can also become so severe that it disturbs your sleep, or distracts you as you attempt to work and carry out other tasks. You will be asked to carry out a nerve test, and if there is damage or a risk of damage to the median nerve, surgery will become a more urgent matter.



Pre-surgery

Undergo required tests and consultation

Please carry your medical history and case sheets

Hospital admission should be planned depending upon the medical condition

 

Post-surgery

After the surgery, the doctors may monitor you for a few hours and then send you home the same day. Make sure you have someone to drive you home, as driving yourself is not an option!

Your wrist will be bandaged and splinted up to prevent movement for at least a week or two. You will have some pain after the surgery, for which your doctor will provide oral painkillers. As with some other limb surgeries, you may be advised to sleep with your hand elevated to lessen swelling.

 

When your splint is removed, you will be made to move your fingers and hand to prevent stiffness. They may be quite stiff and painful! Your doctor will probably provide a physical therapist to help you improve your range of motion with exercises and stretches, strengthening your hand and wrist and helping it to heal.

 

If you are feverish or experiencing redness, bleeding, swelling or discharge from your surgical incision, rush to your doctor. Increased pain can also be a red flag.

 

Recovery period can vary, as can the length of time you need to wear a splint. Make sure you go over activity restrictions, recovery times and your time off work in detail with your doctor before and after the surgery. You could recovery in a few days, or slowly over a few weeks.

 

Ensure it doesn’t recur

Once you’ve recovered from surgery, you need to make sure you change the causal factors in your life so that the problem doesn’t come back!

 

Redesign your work space to be more ergonomic, especially making sure that your wrists are kept in a neutral position as you type.

Follow basic health guidelines - maintain a healthy weight, exercise and stay flexible, don’t smoke.

If your carpal tunnel syndrome was caused by a long-term health problem, focus on keeping it under control.

 

Of course, if you are not suffering from carpal tunnel or are in the home treatment stage - following the advice above could help you avoid surgery for good.



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