NEWS

Carpal tunnel syndrome a pain in the hand

Mark Coddington

When it comes to the causes of and treatments for carpal tunnel syndrome, the opinions are varied as the patients.

Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the hand, becomes pressed at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers, but doesn't effect the little finger. It also sends impulses to some of the small muscles in the hand that allow the fingers and thumb to move, according to the National Institute of Neurological Disorders and Stroke.

The carpal tunnel is a narrow, rigid passageway of ligament and bones at the base of the hand. It houses the median nerve and tendons, according to the institute.

Dr. Dolf Ichtertz, who has Nebraska offices in Grand Island, Omaha, Lincoln and North Platte, said the syndrome is a grouping of symptoms including finger numbness or tingling, dropping objects, loss of dexterity or grip, and loss of sleep due to nighttime hand pain. Difficulty with fine motor skills, fear of dropping young children and hand swelling are also common, he said.

Ichtertz said the syndrome is "extremely common" and a large percentage of the patients he has treated had family members with similar problems. He estimates one out of every five or six adults develop the syndrome but the majority of them may never develop the symptoms to the point that surgery is sought.

According to the National Institute of Neurological Disorders and Stroke, carpal tunnel syndrome is often the result of the combinations of factors that increase pressure on the median nerve and the tendons in the carpal tunnel. Most likely the problem is congenital.

Ichtertz confirms that and said carpal tunnel syndrome usually occurs in people older than 30, involves both wrists and has little to do with a person's job.

The syndrome is diagnosed using nerve studies and a physical examination of the hands, arms, shoulders and neck.

According to the institute, carpal tunnel syndrome can be treated with medication, stretching and strengthening exercises, acupuncture and chiropractic care.

Dr. Chad Paisley, a chiropractor in Grand Island, Neb., said he sees a number of patients who complain of hand pain. He uses a series of stretches along the muscles in the wrist, arm, shoulder and neck to help relieve pain.

He said some of the pain he deals with is caused by repetitious movements.

Ichtertz said, in his opinion, those methods only relieve the pain temporarily. He believes surgery is the best means of correcting the problem.

He performs endoscopic carpal tunnel release, which is an out-patient surgery that uses a local anesthesia and doesn't require stitches.

Two small incisions, one just below the wrist and one mid-palm, are made, and a fiber optics scope and a hooked knife are used to cut the carpal ligament. He said the recovery time is measured in days -- not weeks.

Open release surgery is also a means of correcting carpal tunnel syndrome. It consists of making an incision up to 2 inches in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel. The procedure is generally done under local anesthesia on an outpatient basis, according to the National Institute of Neurological Disorders and Stroke.

The Grand Island Independent