Carpal tunnel syndrome and cubital tunnel syndrome share similar symptoms, but they are distinct conditions affecting different nerves in the elbow and wrist.
If you’re experiencing pain and numbness in your fingers, you may assume you have carpal tunnel syndrome. But did you know another condition — called cubital tunnel syndrome — could also be the source of these symptoms?
Both carpal tunnel syndrome and cubital tunnel syndrome result from nerve compression; however, the damaged nerve for each is located in a different part of the body. In cubital tunnel syndrome, the ulnar nerve within the elbow becomes compressed due to injury or repeated bending of the elbow. The ulnar nerve sits inside the cubital tunnel, a passageway consisting of bone, muscle, and ligaments.
On the other hand, the compressed nerve causing carpal tunnel syndrome is the median nerve in the wrist. Repetitive motions of the hand and wrist (such as typing), fractures, and sprains are typically to blame. In addition, chronic conditions such as diabetes and arthritis are considered risk factors for carpal tunnel syndrome.
Despite some similarities — compressed nerves, hand pain, weakness when gripping objects — cubital tunnel syndrome and carpal tunnel syndrome are characterized by several differences. Knowing the symptoms for each can help you identify which condition you may have and determine the right treatment.
Carpal Tunnel vs. Cubital Tunnel
Both syndromes affect the hand and fingers, but the pain, tingling, and numbness of carpal tunnel syndrome is felt most acutely in the thumb, index finger, middle finger, and half of the ring finger. It’s also characterized by pain and burning in the hand and wrist that sometimes radiates up the forearm to the elbow.
Meanwhile, cubital tunnel syndrome is marked by numbness, pain, and tingling in the little and ring fingers as well as the inside of the hand. If you have cubital tunnel syndrome, you may notice these symptoms flare up at night when you bend your elbow for long periods as you sleep.
Diagnosing cubital tunnel syndrome or carpal tunnel syndrome begins with a physical examination. An orthopedist may also perform a nerve conduction study to assess nerve impulses in the wrist or elbow. Weak nerve activity in a certain area could indicate, for example, carpal tunnel syndrome.
Treating the Symptoms
Treatment options differ for each syndrome, although conservative therapies are recommended at first to reduce symptoms and restore function to the hand. Because cubital tunnel symptoms are more pronounced at night, you might be advised to wear a brace that straightens the elbow while you rest. Wrapping your arm in a towel to keep it straight can work as well.
If conservative treatments fail to relieve the nerve compression or muscle wasting is severe, surgery is another option. Two types of cubital tunnel surgery are currently performed: a medical epicondylectomy and an ulnar nerve transposition. In a medial epicondylectomy, the bony bump inside the elbow (the medial epicondyle) is removed. This allows the ulnar nerve to flex and straighten without pain. For an ulnar nerve transposition, the surgeon creates a new cubital tunnel and moves the ulnar nerve to the recreated tunnel.
Treating carpal tunnel syndrome non-surgically usually entails resting the hand, avoiding activities that aggravate symptoms, wearing a splint for several weeks, and applying ice to reduce swelling. Anti-inflammatories and steroids may also be prescribed. Once the pain subsides, you can practice exercises to stretch and strengthen the wrist and hand.
If these conservative treatments don’t alleviate carpal tunnel symptoms, surgery to relieve pressure on the median nerve by cutting the transverse carpal ligament may be necessary. This procedure is followed by physical therapy to strengthen the wrist.
What’s Causing Your Hand Pain?
If you’re experiencing hand and finger pain, you may be suffering from either cubital tunnel syndrome or carpal tunnel syndrome. The doctors at Comprehensive Orthopaedics can diagnose your condition and prescribe the proper treatment regimen. Whether through conservative therapy or surgery, our goal is to help our patients live pain-free. Contact us today for an appointment.
FRIDAY, March 1, 2019 (HealthDay News) — You use your hands nearly every minute of the day, so any time they hurt it’s important to find out why.
Certain conditions can affect people who do the same hand movements for hours every day. Repetitive strain injury can cause pain in muscles, nerves and tendons. Carpal tunnel syndrome swelling compresses a key nerve. The lesser known de Quervain’s tenosynovitis typically affects tendons on the inner sides of the wrist.
An autoimmune disease like rheumatoid arthritis often causes joint pain. Without treatment, it can lead to deformities in your hands. The wrist and finger joints are common targets of osteoarthritis, which occurs over time from normal wear-and-tear.
Treatment might start with an over-the-counter or prescription NSAID to temporarily relieve pain, but their long-term use has been linked to side effects such as liver or kidney damage and elevated heart attack risk.
Stronger medications may be needed to stop a degenerative disease like rheumatoid arthritis. Corticosteroid injections are an occasional option to reduce inflammation. Heat can ease stiffness while a cold pack can relieve soreness. If you have a chronic condition, an occupational therapist can teach you how to limit stress on joints when using your hands. During a flare, he or she might suggest a splint to stabilize your hand.
Sometimes surgery is needed. Dupuytren’s contracture, a thickening under the skin on the palm of the hand, can develop into firm lumps that cause fingers to bend inward. Unless lumps are removed early, it may be impossible to straighten fingers later on. If other options don’t help carpal tunnel and de Quervain’s, surgery might be the answer.
Many conditions worsen without appropriate treatment, so don’t delay in seeing your doctor or a hand specialist.
Tendonitis can affect anybody, from office workers to athletes. Here’s how to keep your symptoms under control.
Tendonitis is a common problem, affecting athletes, office workers, and musicians alike. Indeed, it can affect almost any part of the body, though it’s most common in the tendons of the shoulders, elbows, wrists, and knees. Some of the most frequent types include patellar tendinitis (or “jumper’s knee”), lateral epicondylitis in the elbow (or “tennis elbow”), and Achilles tendinitis.
As common as it is, however, tendonitis can be a debilitating condition, creating chronic pain and greatly restricting the patient’s range of motion. Fortunately, some basic knowledge of its common causes and symptoms can help you seek relief from this condition.
CAUSES AND SYMPTOMS OF TENDONITIS
Tendons are strands of elastic fibrous tissue that connect muscles to bones, providing stability to the joints and enabling a free range of motion. Any tendon in the body can become inflamed or irritated, causing pain, tenderness, and swelling in the affected tissue.
The most common cause of tendonitis is prolonged stress or gradual wear caused by repetitive movements, though it can also be caused by sudden trauma. As a result, most people develop tendonitis while performing their jobs, enjoying hobbies that rely on a specific joint, or playing sports A typist, for example, is most likely to have tendonitis in the wrist, while weightlifters may suffer from biceps tendinitis. Aging also increases the likelihood of developing tendonitis, since tendons become less flexible with age.
TREATMENT FOR TENDONITIS
The severity of tendonitis can vary greatly depending on the specific cause of the inflammation and the particular tendon affected. Most cases of tendonitis, however, can be successfully treated without surgery. Some of the most common courses of treatment include:
Resting the affected area
Avoiding activities that cause flare-ups or increased pain
Taking over the counter anti-inflammatories like Advil or Aleve
If your tendonitis does not respond to these conservative treatments, the inflamed tendon may need to be repaired with a minimally invasive surgery. During the procedure, your surgeon will mend any tears in the tendon and remove any permanently damaged tissue.
Since tendonitis is an injury that often results from overuse, the best treatment in many cases is simply to refrain from using the joint in question. Some effective preventative measures include stretching before exercise, wearing protective braces, using proper technique when lifting, and always maintaining correct posture.
Whether you suffer from tennis elbow or jumper’s knee, our team at New York Bone and Joint can help. With decades of combined experience in treating injured tendons, our specialists are able to provide comprehensive assistance at every stage of the process, from identifying the source of the problem to crafting a personalized treatment plan. If you worry that you may have tendonitis, contact us today to schedule a consultation.
FRIDAY, June 23, 2017 (HealthDay News) — People who spend lots of time on their smartphones may be scrolling, tapping and swiping their way to carpal tunnel syndrome, a painful wrist and hand disorder.
A small study found a link between extended use of smartphones and other hand-held electronic devices and a greater likelihood for experiencing the telltale wrist and hand pain of the syndrome.
But the researchers did not prove that heavy smartphone use caused carpal tunnel syndrome, and one hand surgeon said very few people in the real world use their smartphones as much as the heavy users in the study did.
Study author Peter White said the findings suggest “caution may be warranted when using hand-held electronic devices, in order to minimize the chance of developing carpal tunnel syndrome.”
White is an assistant professor in the department of health technology and informatics at Hong Kong Polytechnic University.
The carpal tunnel is a narrow and hard pathway of bone and ligament found at the base of the hand, according to the U.S. National Institute of Neurological Disorders and Stroke. It contains tendons, which enable finger-bending, as well as the so-called “median nerve,” which runs from the forearm to the palm and provides feeling to some fingers.
Carpal tunnel syndrome can gradually develop following repeated pressure to the point where the median nerve passes into the hand and meets the wrist.
A common cause, said White, are work conditions that call for “repetitive, forceful or awkward hand movements, for example, when typing.” And the result is often pain (sometimes extending up the arm), numbness, finger tingling and weakened grip strength.
To explore whether smartphone use might up the carpal tunnel syndrome risk, White and his associates followed up on their prior investigation involving 500 Hong Kong University students.
Those students fell into two camps: intensive users of hand-held electronic devices (meaning five or more hours of use per day) and non-intensive users (less than five hours per day). Hand-held devices included mobile phones, tablet computers and game consoles.
More than half (54 percent) of the intensive group reported musculoskeletal pain and/or discomfort, compared with 12 percent among the less intensive group.
The new study looked at 48 students from the first study. Half were intensive users who spent (on average) more than nine hours a day using their devices. Those in the other group spent just under three hours a day on their devices.
The participants answered questionnaires on electronic device habits and any pain or discomfort in their neck, shoulder, back, elbow or wrist/hand region.
Ultrasounds and physical exams on the wrist region were also done.
Muscle pain was found to be more common among intensive users.
The researchers also found that intensive electronics users had “significantly” more discomfort, and more severe discomfort, in their wrist and hand.
The more time a person spent using a hand-held electronic device, the more intense and long-lasting their wrist and hand pain was.
To explain why, the researchers pointed to device design, which requires the repeated use of fingers to click, swipe, scroll, tap and press. The result is an enlargement and flattening of the median nerve, alongside bulging of a key ligament.
To minimize risk, White advises keeping the wrist as straight as possible when using devices.
He added, “One should try to minimize repetitive movements of one’s fingers and thumb when using hand-held electronic devices, especially for single-hand use. It is also important to take regular rest periods, so as to avoid continuous intensive use, so as to allow recovery time and to prevent prolonged stress.”
But hand surgeon Dr. Dori Cage questioned how much of a risk smartphone use really poses.
“The strong correlation of carpal tunnel syndrome with smartphone use is surprising, as I have not seen that in my practice,” said Cage, an American Academy of Orthopaedic Surgeons spokesperson.
Cage, who’s with San Diego Hand Specialists, also suggested that “it is unlikely that the general population would have [the] degree of phone use” seen among the intensive users in the study.
“This is likely an issue affecting only a small percentage of cellphone users,” she said.
The study was published June 21 in the journal Muscle and Nerve.
Carpal tunnel release is a surgery used to treat and potentially heal the painful condition known as carpal tunnel syndrome. Doctors used to think that carpal tunnel syndrome was caused by an overuse injury or a repetitive motion performed by the wrist or hand, often at work. They now know that it’s most likely a congenital predisposition (something that runs in families) – some people simply have smaller carpal tunnels than others. Carpal tunnel syndrome can also be caused by injury, such as a sprain or fracture, or repetitive use of a vibrating tool. It’s also been linked to pregnancy, diabetes, thyroid disease, and rheumatoid arthritis.
The median nerve and tendons that allow your fingers to move pass through a narrow passageway in the wrist called the carpal tunnel. The carpal tunnel is formed by the wrist bones on the bottom and the transverse carpal ligament across the top (or inside) of the wrist. When this part of the body is injured or tight, swelling of the tissues within the tunnel can press on the median nerve. This causes numbness and tingling of the hand, pain, and loss of function if not treated. Symptoms usually start slowly, and may get worse over time. They tend to be worse on the thumb side of the hand.
During a carpal tunnel release, a surgeon cuts through the ligament that is pressing down on the carpal tunnel. This makes more room for the median nerve and tendons passing through the tunnel, and usually improves pain and function.
Why might I need carpal tunnel surgery?
A diagnosis of carpal tunnel syndrome is about the only reason to have a carpal tunnel surgery. And even then, your doctor will likely want you to try nonsurgical treatments first. These may include over-the-counter pain medicines, physical therapy, changes to the equipment you use at work, wrist splints, or shots of steroids in the wrist to help relieve swelling and pain.
The reasons that a doctor would recommend a carpal tunnel release surgery may include:
The nonsurgical interventions for carpal tunnel syndrome don’t relieve the pain.
The doctor performs an electromyography test of the median nerve and determines that you have carpal tunnel syndrome.
The muscles of the hands or wrists are weak and actually getting smaller because of the severe pinching of the median nerve.
The symptoms of carpal tunnel syndrome have lasted 6 months or longer with no relief.
What are the risks of carpal tunnel surgery?
As with most surgeries, carpal tunnel release is not without its risks. Your wrist will be made numb and you may be given medicine to make you sleepy and not feel pain (called local anesthesia) for the procedure. In some cases general anesthesia is used, this when drugs are used to put you into a deep sleep during surgery. Anesthesia poses risks for some people. Other potential risks of a carpal tunnel release surgery include:
Injury to the median nerve or nerves that branch out from it
Injuries to nearby blood vessels
A sensitive scar
The recovery from carpal tunnel surgery takes time – anywhere from several weeks to several months. If the nerve has been compressed for a long period of time, recovery may take even longer. Recovery involves splinting your wrist and getting physical therapy to strengthen and heal the wrist and hand.
There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your doctor before the procedure.
How do I get ready for carpal tunnel surgery?
Tell your doctor about all medicines you are currently taking, including over-the-counter drugs, vitamins, herbs, and supplements. You will probably need to stop taking any medicines that make it harder for the blood to clot, such as ibuprofen, aspirin, or naproxen.
If you’re a smoker, try to quit before to the surgery. Smoking can delay healing.
You may need to get blood tests or an electrocardiogram (ECG) before surgery.
You will usually be asked not to eat or drink anything for 6 to 12 hours before the surgery.
Based on your medical condition, your doctor may request other specific preparations.
What happens during carpal tunnel surgery?
Carpal tunnel release is usually an outpatient procedure, which means that you can go home the same day as the surgery if all goes well. There are 2 types of carpal tunnel release surgery. The traditional method is the open release, in which the surgeon cuts open the wrist to do the surgery.
The other method is endoscopic carpal tunnel release, in which a thin, flexible tube that contains a camera is put into the wrist through a tiny incision (cut). The camera guides the doctor as the surgery is done with thin tools put into the wrist through another small cut.
In either case, here is the general sequence of events in a carpal tunnel release surgery:
You will usually be asked to remove your clothing, or at least your shirt, and put on a hospital gown.
Typically, local anesthetic is used for this procedure to numb the hand and wrist.
In an open release surgery, the surgeon cuts about a 2-inch incision on the wrist. Then he or she uses common surgical instruments to cut the carpal ligament and enlarge the carpal tunnel.
In an endoscopic carpal tunnel release, the doctor makes 2, half-inch incisions. One is on the wrist, and one is on the palm. Then he or she inserts a camera attached to a narrow tube into one incision. The camera guides your doctor as he or she inserts the instruments and cuts the carpal ligament through the other incision.
The surgeon will stitch up the incision or incisions.
Your hand and wrist will be placed in a splint or bandaged heavily to keep you from moving your wrist.
Once the surgery is done, you’ll be monitored for a short time, and then allowed to go home. Only in rare cases or complications is an overnight stay needed for a carpal tunnel release surgery.
What happens after carpal tunnel surgery?
Your wrist will likely be in a heavy bandage or a splint for 1 to 2 weeks. Doctors usually schedule another appointment to remove the bandage or splint. During this time, you may be encouraged to move your fingers to help prevent stiffness.
You’ll probably have pain in your hand and wrist after surgery. It’s usually controlled with pain medicines taken by mouth. The surgeon may also have you keep the affected hand elevated while sleeping at night to help decrease swelling.
Once the splint is removed, you will likely begin a physical therapy program. The physical therapist will teach you motion exercises to improve the movement of your wrist and hand. These exercises will speed healing and strengthen the area. You may still need to sometimes use a splint or brace for a month or so after surgery.
The recovery period can take anywhere from a few days to a few months. In the meantime, you may need to adjust job duties or even take time off from work while you heal. Your doctor will talk to you about activity restrictions you should follow after surgery.
Let your doctor know about any of the following:
Redness, swelling, bleeding, or other drainage from the incision
Increased pain around the incision
These problems may need to be treated. Talk to your doctor about what you should expect and what problems mean you need to see your doctor right away.
Before you agree to the test or the procedure make sure you know:
The name of the test or procedure
The reason you are having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What the possible side effects or complications are
When and where you are to have the test or procedure
Who will do the test or procedure and what that person’s qualifications are
What would happen if you did not have the test or procedure
Any alternative tests or procedures to think about
When and how will you get the results
Who to call after the test or procedure if you have questions or problems
How much will you have to pay for the test or procedure