Dr. Parisi Addresses Misinformation About Carpal Tunnel Syndrome
Most people know what carpal tunnel syndrome is, but its causes are widely misunderstood. Upper extremity surgeon Dr. Debra Parisi addresses misperceptions and explains how carpal tunnel is treated.
Most people know that carpal tunnel syndrome is a common upper extremity condition. They can correctly recognize and describe the symptoms: numbness and tingling in their wrist and hand. Many would also confidently identify keyboard use or typing as the cause of carpal tunnel—but is it? We asked Summit surgeon and upper extremity specialist Dr. Debra Parisi to explain how carpal tunnel syndrome develops.
What is carpal tunnel syndrome?
This condition is caused by pressure on the median nerve in the wrist. The median nerve runs from the forearm into the hand through a small enclosed space in the wrist called the carpal tunnel. This nerve controls movement and feeling in the thumb and first three fingers of the hand. Common symptoms include numbness and tingling.
“Often, patients experience these symptoms at night,” says Dr. Parisi. “The symptoms may wake people up at night. Or, they may notice them when they wake up in the morning, complaining that they need to shake their hands. They tell me they need to ‘get the blood flow back.’ To be more accurate, they are responding to pressure on the nerve. Shaking their hands gets the nerve functioning again.”
Is there a link between carpal tunnel syndrome and occupation?
“It’s a common misperception that carpal tunnel is related to jobs that require computer use,” says Dr. Parisi. “However, studies show that there’s no link between typing or keyboard use and carpal tunnel. The development of carpal tunnel is definitely linked to aging, and there’s a hereditary component to this disease. The issue involves the vascularity of the nerve.”
Who is at risk for developing carpal tunnel syndrome?
Carpal tunnel issues affect women much more commonly than men. In women, it tends to occur around menopause and can worsen as women go through menopause.
“We hypothesize that development of carpal tunnel has something to do with estrogen, which may protect the nerve prior to menopause,” says Dr. Parisi. “As we age, the small blood vessels around the median nerve deliver less blood and oxygen to the nerves. Deprived by the blood-delivered nutrients it needs, the nerve becomes much more susceptible to pressure. If there’s swelling around the nerve, nerve function is affected. In the early stages of the syndrome, the insulation around the nerve dies. If pressure continues untreated, the nerve itself can actually die.”
How is carpal tunnel syndrome treated?
“Timing matters when treating carpal tunnel, but there’s a delicate balance,” says Dr. Parisi. “Many people believe that surgery can’t help carpal tunnel. That belief is unfounded, but we don’t have to treat every case with surgery. Frequently, we can try nonoperative measures first.”
The simplest treatment is wearing braces at night while sleeping. “People have a habit of sleeping with their wrist in an awkward position which puts additional pressure on the nerve,” says Dr. Parisi. “A brace takes pressure off the nerve by keeping the wrist in a neutral position during sleep. Anti-inflammatories also help because they bring down any additional swelling in the carpal tunnel.”
If the disease has progressed past the mild stage, surgery is usually recommended. “It’s a simple, low-risk procedure,” explains Dr. Parisi. “If we take pressure off the nerve early, we can preserve function. If someone waits or delays surgery, the nerve might not recover.
“Carpal tunnel syndrome is very treatable,” she concludes. “Surgical treatment, when appropriate, is very successful and has minimal risk of complications. People can dramatically improve their lifestyle with this surgery. They stop waking up during the night, so they sleep better. During the day, they have less pain and much better function. I’m always happy to meet with anyone experiencing symptoms. Together, we can evaluate disease progression and develop a tailored treatment plan to protect the nerve and improve quality of life.”