By Boyd W. Haynes III, MD

If your patient is a woman with numbness in her hands, she is three times more likely to have Carpal Tunnel Syndrome (CTS) than her male counterpart. Some common symptoms of CTS are: Numbness, pain, burning or tingling in the thumb, index and middle fingers and palm; discomfort which awakens individuals from sleep, where shaking of the hand provides relief. It is believed that a combination of factors causes CTS, such as genetic predisposition, stress, overuse, rheumatic arthritis, previous injury to the wrist and other issues.

Some conditions that might increase a woman’s chances of developing CTS are:

Pregnancy ­— CTS is a frequent complication of pregnancy, with a prevalence reported as high as 62 percent. Hormonal changes during pregnancy and build-up of fluid can cause CTS. Most doctors treat the condition with wrist splints, rest, or cortisone injections, rather than surgery. CTS almost always dissipates following childbirth.

Menopause – Hormonal changes during menopause can put women at greater risk of getting CTS. In some postmenopausal women, the wrist structures become enlarged and can press on the medial nerve.

Breast Cancer – Some women who have a mastectomy get lymphedema, localized fluid retention and tissue swelling. Although rare, some of these women will get CTS due to pressure on the medial nerve from this swelling.

An Orthopaedic Specialist will ask your patient about her symptoms, do a physical examination of the fingers, palm and wrist, looking for swelling, discoloration or other obvious signs of trauma. Two tests are commonly ordered to confirm the diagnosis and to ascertain the severity of the condition; a nerve conduction study or electromyography. While highly reliable and informative, these tests are slightly uncomfortable for the patient.

All studies show that once a female patient gets CTS, her symptoms may be managed, but nothing will reverse the condition or cure it except for surgical intervention. CTS can permanently damage the medial nerve of the hand, causing irreparable damage, resulting in lifelong numbness. Even so, most people choose to try and manage the symptoms (at first) with anti-inflammatory medications, splints or bracing for the wrist and hand, or cortisone injections.

There are two that can be used to remedy CTS. The first surgical approach is the open approach, which has been used for many years with good outcomes. It is performed as outpatient surgery and requires a two-inch incision in the palm.

I prefer the endoscopic approach, that involves using a scope to see the ligament which needs to be released and performing the surgery through a surgical cannula. This approach has also been used for many years and the results are excellent, totally relieving symptoms. It too is performed as outpatient surgery, but the incision is much smaller (¼ inch) and the recovery time is quite minimal.

The long-term results of both the open and endoscopic surgeries are the same at three months, but the endoscopic technique will get the patient back to their activities and work two to three times faster than the open surgery.

Boyd Haynes, MD is a Fellowship-trained, Board-certified Orthopaedic Specialist who currently practices at Orthopaedic and Spine Center in Newport News, VA. Dr. Haynes has a fellowship in Sports Medicine and specializes in total joint replacement and endoscopic carpal tunnel repair. For more information on Dr. Haynes or OSC, please go to www.osc-ortho.com.