Bloomington / Normal, IL

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Release the Pressure Carpal: Tunnel Syndrome


By Alexander Germanis

Whether washing the car or watering the lawn, anyone who has used a garden hose knows how easily a little bit of pressure on the hose can begin to restrict the flow of water; and if the hose is completely kinked, the water ceases to flow at all.

Unfortunately, a similar “kinking” is all too familiar an issue in the human carpus or wrist. The end result is what is known as carpal tunnel syndrome.

The carpal tunnel “is literally a tunnel in the wrist that’s made of bones,” explains McLean County Orthopedics hand and wrist surgeon, Dr. Jerry Oakey. “There’s a ligament that runs across the top that confines the tendons that move your fingers, as well as the nerve that tells your body what’s going on in your thumb, index, middle and half of the ring finger. That nerve conveys the signals from your brain to tell the muscle at the base of your thumb what to do.”

The nerve in the wrist, known as the median nerve, can be compressed, most often due to inflammation of that transverse carpal ligament or of the flexor tendons. Once compressed, the nerve, like the kinked hose, is then unable to perform its function unimpeded, usually resulting first in a numbness in the hand and/or the fingers.

According to Dr. Oakey, the numbness is often the first symptom that presents itself, but it is not the only possible symptom pointing to carpal tunnel syndrome. “Nerves are funny creatures,” he says, “so there’s not only numbness, but hands can feel cold or feel like they’re burning.

Some people have pain in the palm of their wrist and not all the way to fingers. It’s not always textbook.”

The early symptoms often show themselves “in the morning,” Dr. Oakey continues. “It’s usually worse [then] because when we sleep we tend to compress the nerves. But driving, holding an iPad, or a newspaper — any sort of manual gripping activity can really aggravate it.”

Once these early symptoms show, there are a few courses of action. Employing a wrist brace at night is often the first move. “If the symptoms do improve, that’s a good sign,” says the doctor. The bracing is then continued for a further three months.

Non-steroidal, anti-inflammatory, over-the-counter drugs (NSAIDs) like Aleve or Ibuprofen can also reduce the symptoms when used for about a month.

But carpal tunnel syndrome is not as easily diagnosed as some people may think. “Often people come in complaining of pain in their thumb and think it’s carpal tunnel,” Dr. Oakey shares. “But that’s usually a sign of thumb arthritis.” To help with the diagnosis of carpal tunnel syndrome, physicians like Dr. Oakey utilize an Electromyogram (EMG) with nerve conduction velocity.

Typically, should the electric test suggest the nerve is not conducting properly or as quickly, that might indicate carpal tunnel syndrome. But, Dr. Oakey insists, the actual diagnosis of carpal tunnel still must be made through the physical exam because “not everyone conducts electricity normally; ‘normal’ is defined by a bell curve.” Nevertheless, the results of the EMG can steer the doctor to determine “where to go from there.”

Once diagnosed, the course of action depends on the severity of the condition. “If it’s mild, we may continue with some bracing,” says the doctor. “If it’s more moderate, we can attempt steroid injections. They tend to work but not last. But they’re specifically useful when not everything lines up—maybe the physical exam does not line up with the electrical studies and you need sort of a tie breaker to help predict what it’s like if they were to require surgery to release the carpal tunnel, which is probably the most common surgical procedures that orthopedic surgeons do.”

However, “steroid injections are often the first line of treatment for carpal tunnel during pregnancy,” Dr. Oakey informs. “Specifically in that last trimester and immediately after the child is born, there’s a lot of retained fluid in the body that can absolutely choke off that nerve.”

Although carpal tunnel syndrome cannot always be completely avoided, there are things one can do to lessen the severity of its onset: “a good ergonomic posture in the workplace when you’re typing,” suggests Dr. Oakey, “stretching frequently throughout your workday can be beneficial, and take anti-inflammatories if you start to notice the symptoms.”

If those symptoms persist, however, it is time to see a physician, who can then figure out the best way to release the pressure or “unkink the hose” and get you back to functionally normally once more.

For more information or to schedule an appointment, you may contact Dr. Oakey at McLean County Orthopedics,, 309-663-6461. He treats all general orthopedic conditions, but focuses on hand, wrist, and elbow conditions for which he is fellowship-trained and board-certified. Dr. Oakey is known as the specialist for dealing with complex hand and wrist cases in Central Illinois.

Photo credit: nebari/iStock