A few weeks ago a new patient came to my office and was complaining that her hands were feeling numb and cramping during the night. This has been going on for the last few months and has been getting worse. Associated with the numbness has been some slight to moderate pain radiating into her thumb and index and middle finger. She was concerned that she might be having a slight stroke. She has tried taking some Aleve but it did not help her problem very much. I listen to her symptoms and they sounded as if she has carpal tunnel syndrome. I examined her wrist and found that she had considerable tenderness over her median nerve at her wrist and when I tapped on the nerve it created an electric tingling sensation into her fingers. This is called a positive Tinel’s sign. When I applied pressure to the nerve her fingers also got numb and tingly and this is called a digital compression sign. Finally when I had her flexor wrist and hold them in that position for a while her fingers also got numb And this is called a positive Phalen’s sign. These 3 tests confirm that she does have carpal tunnel syndrome. I advised her that she has to wear a wrist brace when she sleeps to avoid allowing her wrist to get into the flex position which aggravates and pinches the nerve. I provided her with a cortisone injection into her carpal canal to alleviate some of the inflammation and swelling of the irritated median nerve. The patient has returned and her condition has significantly improved. Now she has only an occasional tingling but no pain. I have advised her to keep wearing The wrist brace when she sleeps for another 6 weeks at least. If her symptoms return we might repeat the cortisone injection or proceed to perform minor surgery on her wrist to take the pressure off of the median nerve. I told her that if the pressure remains on the nerve and causes significant symptoms and she waits too long for the surgery to be performed then she may not have a full recovery. Right now she is happy to continue with conservative treatment.
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