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Ask Dr. Rick – March 2011

March 9, 2011

CARPAL TUNNEL SYNDROME

Carpal tunnel syndrome is a very common problem that is often seen with overuse and stress to the wrist. The common patient complaints that accompany carpal tunnel syndrome are tingling and numbness in the thumb and the two fingers next to the thumb, which often causes the athlete to wake up in pain at night. It can be seen in athletes who repetitively lift weights, do push-ups or have substantial stress to their hands and wrists. It can also be seen in people who have idiopathic carpal tunnel syndrome, which means that there is no defined reason for the nerve compression.

Carpal tunnel syndrome is the compression of the median nerve in the wrists. Evaluation for carpal tunnel syndrome includes an x-ray and a test called an EMG, which is a nerve conduction velocity test that measures the speed of the nerve as it crosses the wrist. If the nerve is compressed at the wrist, the speed with which the nerve crosses the wrist is decreased and the impulses to the muscles in the hands are decreased.

Initial treatment for carpal tunnel syndrome includes night splints, which put the wrist at rest while one sleeps, and possible vitamin B supplementation. Care and treatment for carpal tunnel syndrome can include an injection into the area where the median nerve crosses the wrist, and the athlete may have to do activities that stress the wrist.

If conservative care fails, surgical treatment for carpal tunnel syndrome is very successful and entails releasing the transverse carpal ligament, which is the structure that pinches the nerve in the wrist. This is done on an outpatient basis, and return to normal activities occurs in approximately two weeks. Post-surgical physical therapy should be completed for two to three weeks after the surgery, and athletes can expect to return to normal activities and regain their strength in four to six weeks.

Ask Dr. Rick


“Dear Dr. Rick, During the winter, I commonly have aching in my right elbow. I injured my right elbow approximately 13 years ago and had surgery after a fracture. For the first ten years, I had no problems with my elbow, but for the past two to three years, it has become very achy and stiff in the winter. Could this possibly be arthritis, or is being able to predict the cold weather and changes in the weather an old wives’ tale?”
– Allison C., Town &amp Country, MO

Allison, posttraumatic arthritis, which is arthritis after an injury or fracture, is a very common problem and is directly related to the severity of the injury. I would recommend a very gentle stretching program. I would also recommend a topical anti-inflammatory throughout the winter months, and that you possibly sleep with a light cotton sleeve over your elbow. This arthritis will progressively get worse over time, and if you continue to be symptomatic, you should see your physician for more definitive treatment.
I don’t believe it is an old wives’ tale, and you will be very good at predicting the weather due to barometric changes inside your joint. This is a very good question, and I appreciate your interest.


“Dear Dr. Rick, My neck pops when I rotate to the right, creating a noise and a sensation in my neck that sometimes goes to my fingers. Is this a problem?”
– Rick A., Ladue, MO

Rick, popping of the low back, cervical spine, ankles, fingers, etc. releases nitrogen in the joint is a common phenomenon. I would not recommend trying to actively pop your neck or lower back, but when it happens, it is not a problem and you are not creating any damage. This is a common occurrence, and I believe many of our readers will appreciate hearing that they are not the only ones with this problem. Thank you very much.

Dr. Rick’s medical tip for March: If you are experiencing any type of pain in your lower lumbar spine while sleeping or in the morning, check the firmness of your mattress.

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