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Doctor says carpal tunnel syndrome usually not work related

Think of your hands and all you do with them. Now, think of experiencing pain in your hand every day. That’s what it’s like to have carpal tunnel syndrome.

Dr. Jonathan Sorelle is a Las Vegas-based hand surgeon who does more than 2,000 surgeries a year, most of them for carpal tunnel. He spoke to roughly 50 people Jan. 26 at a Sun City Summerlin program.

It used to be thought that repetitive use, such as using a keyboard, was a cause of carpal tunnel syndrome, but this theory is no longer considered valid, according to Sorelle.

“It’s not usually work-related, as we’ve all been taught from that famous article that came out in the ’60s,” Sorelle said. “We know now that’s really not true. We have a large (body of research) that really disputes that.”

A classic symptom, Sorelle said, is waking up with a numb hand. Symptoms include finger numbness, tingling and pain in the hand. Some people report an electric shock-like feeling. Sometimes, weird sensations and pain travel up the arm.

Sorelle said inflection or extension movement increases pressure in the carpal tunnel, and symptoms can worsen over time.

The diagnosis comes from having a physical exam and, possibly, electromyography (EMG), a nerve conduction test. Sometimes the EMG reveals that the pinched nerve is actually in the neck. He said if the two outside fingers (pinkie and ring) are the ones affected, it’s likely not carpal tunnel but a neck nerve.

Robbie Hughes was at the program for information.

“A couple years ago, I got my hands caught in a sliding glass door,” Hughes said. “I was working in a restaurant, and there was no way I could carry a tray without losing the feeling in two of my fingers (little finger and ring finger of her left hand). I rubbed them and rubbed them, and nothing helped. Now I’m noticing if I hold my hand like this, they start to go to sleep again.”

Another attendee, Deanna Johns, broke her left hand while ice skating in her 20s and said it was coming back to haunt her. But she was hesitant to look to surgery.

“I’m waiting for them to do something that doesn’t hurt, that doesn’t cost money or lay you up for (an extended time),” Johns said.

Carpal tunnel syndrome is caused by tissue swelling. Are there any exercises to avoid it?

“We’ve done prospective randomized control studies, good research that shows that injections or medications taken orally or topically, physical therapy, really at five years, are going to be 98 percent ineffective,” Sorelle said. “So, typically, we say release (surgery) is the way to go, which is 99 percent effective.”

The carpal tunnel is a narrow structure in the wrist, much like a tunnel. The bottom and sides are made up of the wrist (carpal) bones. The transverse carpal ligament, a band of connective tissue, makes up the top. The tunnel is the pathway for the median nerve, which travels from the forearm into the hand and for tendons that control hand movement.

According to the American Academy of Orthopaedic Surgeons, heredity plays an important part in whether people will get carpal tunnel syndrome, as some peoples’s tunnels are smaller, a trait that can be passed on. More women than men get carpal tunnel, likely from hormone changes from pregnancy. The syndrome also appears more frequently in older people. Whether one has a chronic medical condition such as gout, diabetes, rheumatoid arthritis and thyroid gland imbalance also can play a role.

Sorelle said postoperative patients start to notice improvement up to a year after surgery.

“People say, ‘I had carpal tunnel surgery, and it didn’t work,’ ” he said. “Well, it’s because you waited too long … your nerve is permanently damaged.”

The surgery requires an incision that is about the size of the opening of a ballpoint pen.

“This is not plastic surgery, and Medicare is smart enough to know that when people cannot use their hands very well, and they start needing people to come in (to their homes) and helping them, they figured out that, yeah, they’ll pay for this procedure,” Sorelle said.

Contact Summerlin Area View reporter Jan Hogan at jhogan@viewnews.com or 702-387-2949.

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