Please note: this is revised version of  the story  ////  this version was filed at 6 pm, Monday, October 9

Carpal Tunnel Syndrome: A Multi-Factorial Disorder That Can Be Treated

By Andrew Gorosko

DANBURY — It is estimated that at some point during their lives, about 50 percent of the general population will experience some of the symptoms of carpal tunnel syndrome (CTS), according to Dr John G. Lunt, a hand surgeon with The Hand Center of Western Connecticut in Danbury.

During the course of their lives, an estimated 4 to 5 percent of the general population will seek out medical help for the disorder, the doctor adds. 

“Life causes carpal tunnel syndrome,” Dr Lunt said.

“It’s really a multifactorial disorder,” he said, explaining that the pinched nerve condition stems from a variety of causes. The malady is a painful or numb condition of the wrist and hand.

CTS research indicates the condition is more common among typists, cashiers, meatpackers and carpenters, or, in effect, among workers with repetitive hand motions, than among the general population, the doctor said. Women are twice as likely as men to experience CTS.

The most typical time women first report the problem to doctors is when they are 49 or 50. Men most typically first report the disorder at age 52.

As a hand surgeon, many of the patients whom Dr Lunt treats have CTS. The hand surgeon estimates that about one-third of the people whom he sees have the condition.

Often people will endure the symptoms of CTS for a long time before seeking medical help, Dr Lunt said. The condition’s onset is insidious, emerging slowly across time. People often experience CTS symptoms for 6 to 12 months before seeking help.

Pinched Nerve

CTS essentially is a pinched nerve lying within the “carpal tunnel,” Dr Lunt said.

“This tunnel is much like a bottleneck at the base of your palm that acts as a passageway for the nine tendons that bend the fingers and a large nerve,” known as the median nerve, he said. “When the pressure rises in the tunnel, it compresses the nerve, which leads to any of a number of symptoms,” according to Dr Lunt.

These symptoms include numbness and tingling in the fingers, but usually not the little finger; pain on the palm side of the wrist; weakness of the grip; a lack of coordination, as manifested by the dropping of objects; sensitivity to cold, and a swollen sensation in the fingers. CTS symptoms may awaken people from sleep.

Repetitive motions, such as typing, contribute to CTS, but repetitive motions are only part of the cause, Dr Lunt said stressing that the origin of CTS is multifactorial.

CTS may be an acute or chronic condition, he noted. Exposure to high vibration is a high risk factor for CTS, as is repetitive activity performed without rest periods.

Treatments Available

Initial treatments for CTS may involve having patients wear hand splints, if the symptoms present themselves only at night, Dr Lunt said. A second level of treatment involves injections of cortisone into the affected area. A third level of treatment involves endoscopic surgery, in which miniature, remotely operated tools are inserted into the hand to perform the operation. Open hand surgery is performed if endoscopic surgery is not technically possible, or if there is trauma, Dr Lunt said.

Cortisone injections are a very effective, safe and reliable treatment for relieving the inflammation associated with CTS, typically providing the patient with relief for six to 12 twelve months, he said. Cortisone injections, in some cases, may be curative of CTS, Dr Lunt said. The injections typically take several days to a week to alleviate inflammation.

If, after two cortisone injections, the symptoms persist, it may be time for a patient to have hand surgery to achieve a permanent solution, he said.

In such endoscopic surgery, a surgeon inserts a miniature, remotely controlled cutting blade into the body.  A miniature television camera is aimed at the blade to guide the surgeon’s cutting actions. Because minimal cutting is done in endoscopic surgery, healing is rapid.

The surgical procedure, known as “carpal tunnel release,” involves cutting the transverse carpal ligament, a very strong ligament that lies across the arch of the carpal bones and forms the roof of the carpal tunnel.

Such surgery increases the volume of the carpal tunnel by about 20 percent, relieving fluid pressure on the median nerve and alleviating the inflammation. “Surgery is almost always a permanent solution,” Dr Lunt said.

Of the patients with CTS who visit his medical practice, only about 20 percent require surgery, he said.

The healing period after surgery ranges from only few days to up to six weeks, in the case of someone who has a job operating high-vibration equipment, such as a jackhammer, the doctor said.

Beyond providing specific treatments for CTS and other disorders of the hand and upper extremities, Dr Lunt provides medical counseling to his patients, explaining the implications of their conditions and the measures which can be taken to achieve improvement.