Carpal Tunnel

What is Carpal Tunnel Syndrome?

CTS occurs when the median nerve, which runs from the forearm into the hand, is compressed or pinched as it passes through the wrist and carpal tunnel.

Common symptoms include numbness, tingling, and pain in the hand and fingers, sometimes radiating up the arm.

There are a few options to treat it. Splinting, less activity, medications to reduce swelling, cortisone injections, surgery…..

Carpal tunnel release is a surgery used to treat and potentially heal carpal tunnel syndrome. Healthcare providers used to think that carpal tunnel syndrome was caused only by an overuse injury or a repetitive motion done by the wrist or hand, often at work. It’s now thought that those can be partly responsible.

There are other factors also involved. They are all related to increased pressure on the median nerve as it passes through the wrist. Some people have a small carpal tunnel because the condition runs in their family (congenital predisposition). Carpal tunnel syndrome can also be caused by injury. This includes a sprain or fracture, or repetitive use of a vibrating tool. It’s also been linked to pregnancy, diabetes, thyroid disease, and rheumatoid arthritis.

The median nerve and tendons that allow your fingers to move pass through a narrow passageway in the wrist called the carpal tunnel. The carpal tunnel is formed by the wrist bones on the bottom and the transverse carpal ligament across the top (or inside) of the wrist. Swelling of the tissues within the tunnel can press on the median nerve when this part of the body is injured or tight. This causes numbness, tingling, pain, and loss of function if not treated. Symptoms usually start slowly. They may get worse over time. They tend to be worse on the thumb side of the hand. It’s not uncommon for a person to have carpal tunnel syndrome in both hands. I have it on both sides. The dominant hand is usually worse.

In this surgery, a surgeon cuts through the ligament that is pressing down on the carpal tunnel during a carpal tunnel release. This makes more room for the median nerve and tendons passing through the tunnel. It usually improves pain and function.

First, a healthcare provider performs an electromyography and nerve conduction test of the median nerve. Electromyography (EMG) and Nerve Conduction Study (NCS) are performed so the surgeon can assess the severity or if it’s a different ailment. EMG and NCS are diagnostic tests used to evaluate the function of nerves and muscles. Electrodes are placed on the skin or inserted into the muscle through a tiny needle. The electrical activity of the muscle is measured while it is at rest and while it contracts.

Here’s the torture device 😂

I’ve had tons of IV’s, two central lines, two spinal taps, scopes, a stomach tube that was placed without full anesthesia and after years of not being used, it was stuck and 5 guys had to pull it out….. I am so tired of needles and procedures! My arms are covered in scars from blown veins. This is one of the worst procedures because the needle stays in and you have to move with a needle in you. Normally, I look away and think about something else. This forces you to pay attention to the fact that there is a needle in you. But like I told the doctor, I love knowledge more than I hate pain.

The experience really depends on the person doing it. That makes a huge difference! I’ve had this test several times before. The woman who administered it this time was excellent! Medical procedures are never great but patients often mirror the tone you set. I want to thank her for being such a calming presence! I’ve been poked and prodded so much and was really dreading this! I may seem indifferent in these situations but I’m not. I saw it as something I needed to do regardless of how scared I was. Overthinking it just creates more fear and worry. I just act stoic so I don’t worry even more.

I’m definitely glad this exists. I’m going to be having this surgery soon. Search the web for tips from someone who has been through it while also using a wheelchair. Unfortunately, you’ll probably find next to nothing, like I did.

At first I figured that it was because of the pain and difficulty in writing about the experience afterwards but I’m finding out that it’s not what you would think. So I wanted to provide something to turn to for anyone else in a similar situation.

Wheelchair users are a large group of people who often come to desperately need this surgery. Our hands and shoulders weren’t meant to have such a huge burden on them every day.

The procedure is often not performed on people who use wheelchairs, for the very same reasons they really need it. The wheelchair. I wish people would stop being so scared of people in wheelchairs. I think most fear comes from a lack of knowledge.

Whenever I’m around people who don’t know me well. There’s always a palpable tension. Others assume you are just antisocial but it’s usually about not wanting to inconvenience people or make anyone feel bad.

Treating this condition in wheelchair users, in my opinion, is more important than most reasons. Two limbs take over the job of four. The two weaker limbs. It takes a toll.

The impact of doing nothing because of someone’s ability to handle it is detrimental to their future.

There are many surgeries that were perfected to go from days of hospitalization and huge scars to tiny scars and being done as an outpatient or in the doctor’s office. We are so focused on moving forward that we forget that we need to look back sometimes. If someone relies on their hands so much, please don’t see their limitations as a sign to take the safest route. See it as a reason to figure it out and help in any way you can.

Specialists get to know you for a few minutes and make drastic decisions about your care in that short time. I think that’s a bit irresponsible. I don’t expect a miracle worker or an immediate answer. Difficult situations need to be thought out.

When I see a specialist, they often see a wheelchair and make snap judgements. I can see them not even thinking about anything I said. It’s very hurtful. I expect that but not from doctors. I understand it though because I was raised the same way. That’s why I think we really need to spread awareness. Because it’s not done enough, our recovery gets severely delayed. We are too busy being scared of ourselves and trying to make sense of the unknown. We were always taught to avoid people like me. Be careful! Don’t stare! It’s rude to ask questions!….. So I don’t like it but I completely understand it!

I know many people in wheelchairs. Some are a lot more capable than I am but there are also a lot of people who are less capable. Would you think that everyone who drives the same car are all the same people? Or if people have matching haircuts, they must be the same?

When I go to a new doctor, I feel like I’m spending most of the appointment trying to convince them of things or proving myself when they clearly don’t take me at my word. I understand their side, I worked for surgeons. It’s a difficult situation. They don’t know me. That doctor is responsible for you and should absolutely take that very seriously but shouldn’t let it cloud their judgement. Some let fear hold them back from helping people.

There are so many things to consider but a five minute phone call with a doctor who’s known that person for a while, might help. If they decided, together, on a better course of action, I’d respect that. Even if it differed from my thoughts.

I went through several primary doctors before finding my current doctor for a reason. In my situation, my doctor is such an important person in my life, not someone I see once a year. I needed someone I could trust fully. Someone who, without a doubt, has my best interests at heart. I love everyone there! They are like family to me!

It probably seemed very ridiculous jumping to surgery immediately and getting a second opinion. I felt like people were going to question my sanity. But in reality, I’m too cautious sometimes. I may not have expressed my thoughts to everyone but this is something that I have grappled with for over a decade.

It wasn’t a rash decision.

Although the pain is getting terrible, it’s the weakening grip strength that is worse. Remember those weird tube things filled with liquid that would keep slipping out of your hands? They are called many different things. I’ll keep it pg13 but I have a lot of thoughts That’s what it feels like when I’m grabbing things.

It feels like I’ve been trying to catch a cotton ball with a chopstick but it’s been in a small bathroom sink filled with water. As my grip weakens, that sink has grown to the size of a bathtub. It’s like soaking your hands in ice and then trying to grab something. Except I don’t need ice and it never goes away.

The way my life is set up, I have to be able to do things for myself. There are other options available to me but I really value my independence. I don’t want to give that up. Sure I struggle a lot and deal with pain I don’t have to but if giving up any independence in exchange for relief is the price I have to pay, it would be much more painful losing that.

The first doctor barely knew me and how much I truly value my independence. He suggested trying cortisone shots and reevaluating in a year. I think that might be a good preventative measure if it’s early on and you don’t need your hands for everything, but I do. Mixed with splinting and less strenuous activity, it might be helpful. But strenuous activity is a huge part of everyday life for me and I can’t do less. Plus it’s a needle in your palm!

Cortisone injections can provide temporary relief, but the effects will usually not be long-lasting, and symptoms return. Cortisone is a corticosteroid that has anti-inflammatory properties. When injected into the carpal tunnel, it reduces swelling and inflammation around the median nerve, which is compressed. This can provide temporary relief from symptoms. Cortisone injections are not a permanent solution. For carpal tunnel syndrome, the pain relief from a cortisone shot can last anywhere from a few weeks to several months, with some people experiencing relief for up to 6 months. Re-evaluating in a year sentences months of unbearable pain. Waiting can give it time to cause permanent nerve damage and surgery won’t be able to help.

I work out constantly just to compensate for everything I am unable to do already. Waiting for a year was scary to me. Who knows how capable I’ll be then? It’s unbearable pain already, could I take another year of that? There are a million things that can change my ability to handle this in a year. I’m not a gambler.

The second opinion (my first ever) was such a nice man! Ya know when you can just see people thinking and noticing everything? When I see a doctor, I try to have everything typed out the day before. Most of the information they need to know. I can see the ones who are reading a screen vs. those who actually hear me saying the words and genuinely care. 

After the first doctor said in my chart “I have some concerns about her ability to recover postoperatively given the full-time use in the wheelchair”. I was upset and mad. He didn’t even try to figure it out. I asked this new doctor to please talk to my doctor instead of just seeing my limitations. He quickly said – what limitations?-

I love that he said that! That’s when I knew I didn’t need a third opinion! You don’t become a surgeon without being very smart but few look to care for the mind too. It meant a lot to me!

I’ve been practicing doing things one handed and have been doing one handed walking exercises for years because I knew that this was inevitable.

There is so much I have to do to prepare and a ton of pre-op instructions. I use my hands for everything so this surgery is very important to me. Sure it will be really hard but it’s short term. Without this surgery, nothing will get better and I’ll have a lifetime of worsening pain and function which will lead to me having to give up things that are very important to me. I haven’t been writing much and I feel like such a horrible friend because I haven’t been able to answer messages or emails as much. I’m so sorry! This took forever to write but I felt that it was important to explain this. 

It might be awhile but I intend to write about post-op and hand therapy. I love science and learned about the surgery years ago when I knew I’d eventually need it. The recovery afterwards while in a wheelchair, that’s my biggest worry. The unknown is often scary so I’ll try to explain how everything goes.  If you have any questions, please don’t hesitate to email me!