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Southern Ocean County Hospital would like to thank everyone who e-mailed questions for this edition of Ask-The-Expert and would like to especially thank Dr. Frederick Ballet for taking part in the program.

March : Carpal Tunnel Syndrome

Dr. Ballet's answers are informational only and should not be used as a diagnosis or for treatment. Please talk to your physician about official diagnosis of your condition and treatment.

Question 1
I have bilateral carpel tunnel syndrome and have bilateral thoracic outlet documented by 2 EMG's. I had carpel tunnel surgery done on my non dominant side in 2001. I had immediate relief of my symptoms on both sides which I was told may happen. For about three years now, I get a shocky pain in my palmar surface of my hand and wrist that had surgery and it radiates into my thumb,index finger and middle finger. I have also had the same symptoms in my other non surgical side. Sometimes I can not even grip a pen and write for about 15-30 minutes. I get this when I use my hands to push off a chair to get up. Could that mean that the surgery has failed? Thank you for the opportunity to present my quetion. I try not to bother my surgeon for intermittent discomfort which is self limiting.

The symptoms you are describing are not necessarily related to your prior carpal tunnel release. The fact that you experienced relief of your symptoms soon after the surgery speaks favorably for that being the initial problem. Before I would attribute your symptoms to a recurrent carpal tunnel syndrome I would recommend that you be evaluated for other causes of numbness. You have a history of Thoracic Outlet Syndrome, this may be contributing to your symptoms but oftentimes that numbness complaint is in a different distribution. A pinched nerve in the neck (cervical radiculopathy) could present as numbness such as you described. A pinched nerve at the forearm level is another possibility. Numbness could be a side effect of certain medications and certain medical conditions could also lower one’s threshold for developing a nerve pressure problem in the extremities (compression neuropathy). I would suggest you consult with your treating physician to rule out these and other possibilities. A full medical exam and diagnostics tests such as an EMG/NCS (electromyogram, nerve conduction study), MRI, and routine radiographs should be considered.

Question 2
I thought I had carpel tunnel and when I asked my doctor about it he sail it was the RA that was bother me. Is there a way to tell if it is one or the other?

Carpal Tunnel Syndrome (CTS) is a nerve pressure problem at the wrist level involving a main nerve in the hand (median nerve). A person with CTS may experience numbness, tingling, pain, and paresthesias in the median nerve distribution (thumb, index, middle, and part of the ring fingers). In addition one may experience weakness in the thumb. Classically a patient may wake from sleep with their hands numb, necessitating shaking the hands for relief. Certain activities such as typing, driving, speaking on the telephone-any activity with the wrist in a fixed flexed position may aggravate the symptoms. Most of the time CTS is an idiopathic problem but certain medical conditions can lower the threshold for developing this condition, a few examples being diabetes, thyroid dysfunction, pregnancy, obesity, or rheumatoid arthritis. It is common to see CTS in patients with rheumatoid arthritis, the etiology being inflammation around the tendons that travel through the carpal canal, placing pressure on the median nerve within. An evaluation for CTS consists of obtaining an appropriate history, physical exam and a diagnostic test called an EMG/NCS to check the functional status of the median nerve.