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otherSeptember 3, 2013

If you often feel the need to "shake out" the tingling, numbness or pain in your hands and wrists, it may be time to have a conversation with your doctor about carpal tunnel syndrome. Dr. Kyle Colle, a neurosurgeon at Regional Brain and Spine in Cape Girardeau, says no one is immune to the symptoms, but they are more common in people who do a lot of repetitive motions with their hands, such as typists, mechanics and factory workers...

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If you often feel the need to "shake out" the tingling, numbness or pain in your hands and wrists, it may be time to have a conversation with your doctor about carpal tunnel syndrome.

Dr. Kyle Colle, a neurosurgeon at Regional Brain and Spine in Cape Girardeau, says no one is immune to the symptoms, but they are more common in people who do a lot of repetitive motions with their hands, such as typists, mechanics and factory workers.

"It's very common because of the technical world we live in, and it's becoming even more common as more people use computers ... for hours and hours a day," he says.

Dr. Brandon Scott, a neurosurgeon at Cape Spine & Neurosurgery, says about one of 20 people in the U.S. suffer the effects of carpal tunnel syndrome, and it's more common in women than in men. In addition to repetitive motion, carpal tunnel can be caused by obesity, oral contraceptives, hypothyroidism, arthritis, diabetes, pre-diabetes and trauma.

Here's how carpal tunnel happens, in a nutshell: We all have a transverse carpal ligament in our wrist. Repetitive motion over time causes the ligament to thicken, placing pressure on the median nerve that travels through the carpal tunnel in the wrist. The compression or entrapment of that nerve causes numbness, tingling and achiness, mainly in the hand and middle and index fingers, though the feeling can extend up to the arm and shoulder. Nocturnal paresthesia is one telltale sign of carpal tunnel syndrome -- you may wake up at night with numbness or "pins and needles" in your hands. Carpal tunnel syndrome is progressive and can lead to pain, muscle atrophy, loss of grip and problems using the hand.

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Colle and Scott say making ergonomic adjustments and trying to limit repetitive motions can help prevent or delay symptoms. Try to take breaks throughout the day and stretch your hands and wrists.

If you do develop carpal tunnel syndrome, braces or splints from the drugstore can help. Chiropractic care, physical and occupational therapy or injection therapy are also options. If conservative methods don't seem to help, Colle and Scott say carpal tunnel release surgery is the way to go. Carpal tunnel syndrome is a "structural problem," Colle explains, and surgery will correct the problem for good.

"It is recommended when there is static (constant, not just intermittent) numbness, muscle weakness or atrophy, and when night-splinting no longer controls intermittent symptoms," says Scott. "This is a very simple outpatient surgery that has a significantly high success rate."

Open and endoscopic procedures are available for the surgery, which involves cutting the transversal carpal ligament from the inside out in order to relieve pressure on the median nerve, says Colle. The surgery uses local anesthesia and takes only 20 to 30 minutes, and most patients wear a splint for a week after the surgery. Recovery time is a little quicker with endoscopic surgery, which is less invasive, says Colle. If patients still feel symptoms after a month, Colle will send them for occupational therapy.

Before being considered for surgery, patients must have an electrodiagnostic study to confirm that their symptoms are indeed carpal tunnel syndrome, says Colle. Electromyography, a sort of needle sensory study, examines the nerves from the neck down to the hand to confirm that the nerve entrapment is in the wrist. Patients also need to know that the biggest risk with carpal tunnel surgery is damage to the nerve, which could be disabling.

"Nothing in medicine is 100 percent," says Colle, but there's a very good chance that carpal tunnel surgery will be successful.

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