Below are links to articles posted in February, 2019
Carpal tunnel syndrome (CTS), which leads to pain, numbness, and tingling in the hand and arm, is a frequent occurrence among office workers. CTS occurs when a component of wrist anatomy compresses the median nerve (a major nerve in the hand that innervates the wrist).
In the vast majority of cases, carpal tunnel syndrome symptoms only worsen with time. Therefore, it is always important to seek a diagnosis and treatment plan as soon as possible. In the early stages, symptoms may be alleviated through conservative measures such as wearing a wrist splint or avoiding certain intensive activities.
That being said, if pressure on the median nerve persists, it may lead to nerve damage—and as a result—exacerbated symptoms. To prevent permanent damage, it may be necessary for some patients to undergo surgery in order to relieve this pressure.
The Anatomy of the Wrist
The carpal tunnel is an inch wide passageway that travels through the wrist. This tunnel is formed by the meeting of small wrist bones that medical experts refer to as the carpal bones. The root of this tunnel is a strong series of connective tissues known as the transverse carpal ligament. These boundaries are very rigid, meaning that the carpal tunnel has little to no flexibility when it comes to increasing its size.
The median nerve headlines the show going on in the hand. It begins as a group of nerve roots in the neck, and these roots bunch together to form a single nerve in the arm. This nerve then travels down the arm and forearm, where it passes through the carpal tunnel located in the wrist and leading down to the hand. The median nerve provides us with feeling in our fingers, as well as control over the muscles surrounding the base of the thumb.
In addition, the nine tendons that bend the fingers and thumb also pass through the carpal tunnel. Medical experts refer to these tendons as flexor tendons.
What is Carpal Tunnel Syndrome (CTS)?
Carpal tunnel syndrome (CTS) occurs when the tunnel that contains the median nerve narrows or when the tissues surrounding the flexor tendons begin to swell. Medical experts refer to these tissues as the synovium, and they may cause pressure on the median nerve when they swell in size. Under normal circumstances, these tissues lubricate the tendons, which allows for greater flexibility in our fingers.
When the synovium swells in size and applies pressure to the median nerve, it leads to pain, tingling, numbness, and weakness in the hand. Most cases of CTS arise from a variety of different factors. Generally speaking, women and the elderly are more likely to develop the condition.
The following list includes other risk factors that may lead to CTS:
- Repetitive Use: Repetitive actions of the hand and wrist over a period of time will aggravate the tendons associated with CTS. This causes swelling, which applies pressure to the median nerve.
- Pregnancy: Changes in the body’s hormone levels during pregnancy may cause swelling that increases pressure on the median nerve.
- Heredity: Genetics may also cause the development of smaller carpal tunnels, which changes the amount of space available in the wrist for the median nerve.
- Health Conditions: Other conditions such as rheumatoid arthritis, thyroid gland imbalances, and diabetes may lead to CTS.
- Position: Hand and wrist positions also have a bearing on the development of CTS. Any activity that involves heavy flexion or extension of the hand or wrist over time will irritate the tendons in the wrist.
Carpal Tunnel Syndrome Symptoms
The following list includes common symptoms of carpal tunnel syndrome:
- Sporadic shock-like symptoms that radiate to the thumb, index, middle, and ring fingers.
- Numbness, tingling, and pain in the thumb, index, middle, and ring fingers.
- Pain may also travel up the forearm and into the shoulder
- Weakness in the hand
- Poor hand grip (You may frequently drop objects)
Most of the time, the symptoms of carpal tunnel syndrome begin slowly, and usually without an isolated injury or cause. Symptoms often come and go at first, but as CTS worsens, symptoms may arise more frequently and persist for much longer.
Symptoms at night time are also very common. Many people sleep with their wrists at an angle, and this may lead to insomnia in patients with CTS. During daytime hours, symptoms often occur while holding something for a long period of time with the wrist bent at an angle, such as while holding a coffee mug. Many patients will move or shake their hands to relieve symptoms during this time.
Do I Need Surgery for CTS?
Over time, CTS will weaken your hand and wrist muscles. If symptoms persist for a prolonged period of time, your condition will worsen and muscle damage may occur.
Your doctor may suggest surgery in the following situations:
- Conservative treatments, such as braces, corticosteroids, and physical therapy have not alleviated your symptoms.
- You find it progressively harder to grasp objects than you once did.
- Your symptoms have persisted without getting better for at least 6 months.
There are two types of procedures that doctors commonly use for carpal tunnel release surgery: open surgery and endoscopy. Either way, your doctor will cut ligaments around the carpal tunnel to release pressure from the median nerve. This, in turn, will help to relieve symptoms. After your doctor has completed the surgery, the ligament heals back together and also allows for more room surrounding the median nerve.
Open surgery involves a larger incision that may be as long as 2 inches, extending from the wrist to the palm. Endoscopic surgery works a little differently, by utilizing several smaller incisions and a tiny camera to help guide your surgeon through the procedure. This, of course, is a much easier procedure to heal from than open surgery. That being said, not all CTS cases are viable for endoscopic surgery. You will need to talk with your doctor to find out which procedure is best for your specific needs.
CTS Surgery: The Recovery Process
Some relief may occur on the same day as surgery, but the entire healing process takes a little bit longer than that. Patients should expect to experience pain and swelling immediately after their procedure. Your doctor will prescribe you medications that will alleviate any tenderness that you may experience. Soreness may last anywhere from a few weeks to a few months after your surgery.
Your wound dressing will stay on for at least 1-2 weeks, depending upon your case. During this time, your doctor will likely give you a list of appropriate exercises to perform in order to keep your fingers from becoming too stiff. That being said, you should still be careful to avoid too much strain while completing these exercises. Over time, you will be able to return to normal activities, such as driving, writing, and grabbing objects. This improvement typically becomes apparent by 6-8 weeks out, but full functionality may not return until the 10-12 week mark.
If you have any of the symptoms mentioned above, please contact us at (855) 853-6542. At Orthopedic Laser and Spine Surgery, we pride ourselves on our ability to provide the highest level of care and treatment to our patients in need. At OLSS, you can rest assured that you will be put on a treatment plan that is tailored to address your specific needs. Don’t hesitate, contact us today!
A herniated or slipped disc is the result of a disc moving out of place and applying pressure on nearby nerves or nerve roots. This is a very common problem because this injury often occurs during a variety of everyday events. Engaging in repetitive movements, improper lifting, or even carrying around excess abdominal weight can all result in a lumbar herniated disc.
In addition, as time goes by, we become much more susceptible to disc-related injuries. Our discs begin to break down, dry out, and tear. Furthermore, certain genetic factors may also make a person more susceptible to disc degeneration and a resulting herniated disc.
In the body, you have two sciatic nerves. These are the largest nerves in your entire body. They originate in the spine and extend all the way down the leg to the foot. You might already see where this is going. Herniated discs may put pressure on adjacent nerves, leading to neurological symptoms and pain. In the lumbar spine, the sciatic nerve just happens to be an adjacent nerve. So, when a herniated disc occurs at this point on the spine, it may lead to sciatica.
Lumbar Herniated Disc & Sciatica Symptoms
It is not uncommon for a herniated lumbar disc to put stress upon or inflame nearby nerves, leading to pain radiating along the length of the nerve. In fact, the most common cause of sciatica is a lumbar herniated disc.
These are some general characteristics of how a lumbar herniated disc may feel:
- Leg Pain: The leg pain associated with sciatica and lumbar herniated discs is much worse than the accompanying lower back pain. If the pain radiates along the sciatic nerve, then doctors call this condition sciatica.
- Variable List of Symptoms: A lot of factors determine the symptoms associated with both lumbar herniated discs and sciatica. This list includes the severity of the herniation, as well as other symptoms present in the back, buttock front/back of the thigh, calves, foot, and toes. Typically, however, the symptoms just affect one side of the body.
- Nerve Pain: Nerve pain from both conditions is very noticeable. Patients describe this kind of pain as searing, sharp, radiating, or piercing.
- Foot Drop: Foot drop is a condition that occurs when the patient has difficulty lifting the foot when walking, or perhaps when they stand on the ball of their foot. This is a neurological symptom that may occur with either condition.
- Neurological Symptoms: “Pins-and-needles” sensations, weakness, and tingling are all associated with both conditions.
- Quick Onset: Symptoms of lumbar herniated discs usually have a quick onset, but there are some cases in which symptoms develop gradually.
- Movement Pain:Sitting, standing, leaning forward, coughing, sitting for prolonged periods of time. All of these become painful with sciatica and lumbar herniated discs.
- Lower Back Pain:Lower back pain is sometimes present, but not with all cases. Aside from lower back pain, both conditions may result in stiffness, muscle spasms, and throbbing.
Rarer Symptoms of Sciatica & Lower Herniated Discs
Loss of bladder/bowel control, numbness in the saddle region, lower back pain, and weakness in the extremities are all signs of a condition known as cauda equina syndrome. This syndrome is quite rare, but if you believe you have it then you should seek medical attention immediately.
The stress and swelling of the nerves at the end of the spine may lead to paralysis and other lifelong impairments if you do not seek treatment immediately. Always, always seek out medical attention promptly if you believe you have cauda equina syndrome.
Causes & Risk Factors of Lumbar Herniated Discs with Sciatica
Lumbar herniated disc and sciatic pain may have a sudden onset, but usually, the condition comes on more gradually. Spinal discs have high water content, which helps these discs stay flexible to absorb the daily shock that the spine undergoes. Over time, these structures dry out, which leaves the disc’s tough outer shell more brittle and susceptible to cracking or tearing.
Less common causes of herniated discs include traumatic injuries, which could involve anything from a car accident to a fall. An injury may put so much pressure on the discs in the lower back that they herniate.
Here are some common risk factors for developing sciatica and lumbar herniated discs:
- Gender: Men are at twice the risk for developing lumbar herniated discs, which also increases their chance of developing sciatica that much more.
- Age: The most common age group for developing lumbar herniated discs is ages 35-50. After age 80, the condition usually does not cause symptoms.
- Physically demanding or repetitive work: Jobs that require heavy lifting or other such physical labor will put patients at a greater risk of developing lumbar herniated discs, and thereby sciatica. This is especially true for twisting actions.
- Obesity: When the spine has to support more weight, it is put under more stress. This only makes sense. Obese patients are 12 times more likely to have the same disc herniate twice. Doctors call this phenomenon recurrent disc herniation.
- Family History: People with a family history of disc herniation are much more likely to have their discs herniate than others.
- Smoking: Nicotine limits the blood flow to the discs, which exacerbates disc herniation and dampens healing. Degenerated discs are much more likely to tear and crack, leading to herniation.
Lumbar Disc Herniation & Sciatica Treatment
Most doctors will exhaust conservative options before considering surgery. Most cases of lumbar disc herniation resolve themselves within six weeks, so doctors urge patients to try more conservative options first. This does not work for everyone, however.
Here is a list of conservative options that many patients use to achieve herniated disc relief:
- Medications: Usually consists of muscle relaxants and NSAIDs. This is also great for sciatica patients.
- Ice Application: Good for initial inflammation and muscle spasms that occur with lumbar herniated discs. This will also help with muscle spasms associated with sciatica.
- Heat Therapy: After the first 48 hours, heat may also help reduce muscle spasms that occur with both conditions.
- Physical Therapy: Certain stretching exercises are great for treating both conditions. Your doctor will be able to give you information pertaining to your specific needs.
- Epidural Injections: In cases where normal medications are not enough, your doctor may recommend steroid injections. The effects of this treatment, however, vary.
Two minimally invasive procedures are typically used for sciatica and lumbar herniated discs. Most commonly, this includes a microdiscectomy or an endoscopic microdiscectomy. These procedures relieve the pressure on the nerve root and allow for a better healing environment.
Typically, the doctor removes only a small portion of the disc that is pressing against the nerve. The majority of the disc is left alone, structurally speaking. The doctor will use small incisions in a microdiscectomy.
For an endoscopic microdiscectomy, the doctor also uses endoscopic guidance. That really is the main difference. The doctor inserts the implements through a tiny tube to minimize damage to surrounding tissues. A small camera is also inserted through the tube to allow guidance for the performing surgeon.
Both surgeries are minimally invasive and performed on an outpatient basis.
If you are experiencing symptoms of either lumbar disc herniation or sciatica, please contact our spine doctors at (855) 853-6542. Our team is passionate about finding an individualized care plan that will work for you. Contact us today!