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Options for treating carpal tunnel syndrome

Lois Dover, Wisconsin Rapids, painting after carpal tunnel treatment

​​​​​​​​​​It starts with tingling or numbness in fingers and thumb, progressing to pain. If left untreated, it can cause weakness so bad you can't open a bottle or a jar.

"It" is carpal tunnel syndrome, a common problem often associated with repeated use of wrists and hands. The carpal tunnel is a narrow passageway of ligament and bones at the base of your hand. It contains tendons and the median nerve which provides feeling and sensation in the thumb and first three fingers of your hand.

Sometimes the tendons can become irritated, causing swelling that narrows the tunnel compressing the median nerve. This causes tingling, numbness and ultimately, sharp pain in the wrist.

"Pain can become so bad my patients just assume they'll need surgery," said John McDonough, D.O., an orthopedic surgeon at Marshfield Clinic Wisconsin Rapids Orthopedic Center. "But there are many other ways to treat carpal tunnel syndrome before surgery."

To diagnose carpal tunnel syndrome an orthopedic surgeon will first get a thorough medical history. Steven Sanford, M.D., an orthopedic surgeon specializing in hand and upper extremity surgery at Marshfield Center, said he'll ask when symptoms were first noticed, did they get worse, did anything seem to trigger them and pain level. He'll do a physical exam, and if there is still doubt about the cause, he can order a test that measures electrical activity in the nerves.

"When the diagnosis is made, the first treatment is often simple rest. Many patients need nothing further," Dr. Sanford said. "Some may benefit from wearing a splint, especially at night or when doing repetitive motions, to keep the wrist from bending and creating more pressure on the median nerve." Oral medications may help ease pain, while steroid injections fight inflammation.

Some patients do become candidates for surgery. Even then, there's a choice. The traditional surgical approach is an open incision through the palm. A newer alternative is endoscopy, which involves routing a tiny instrument through a smaller incision in the wrist.

Drs. McDonough and Sanford have had specialized training in endoscopy and prefer it to the open approach. Other orthopedic surgeons aren't so sure. Research shows that both types are equally effective over time.

Lois Dover, 57, of Wisconsin Rapids, underwent both techniques in her wrists. Dr. McDonough performed endoscopic surgery on her right wrist in November, 2012. It healed, but then her left wrist flared. She had trouble with her painting and woodworking hobbies. Because of an abnormal muscle in the wrist, the doctor chose the traditional open incision.

"I just asked Dr. McDonough to keep my wrists well enough so I could continue to paint," she said. "The scoped wrist seemed to heal faster but I have no complaints about either."

​Dr. Sanford said each patient handles pain and recovery differently. "Generally, I prefer using the endoscopic approach, unless there's a good reason not to. My patients tend to be a little more comfortable and are able to do more shortly after the endoscopic surgery," he said. "But I also believe there's probably not much difference in the long run."