Free Community Seminar on Nerve Compression Disorders

Do You Experience Tingling, Numbness, Weakness or Pain, in Your Hand, Wrist or Arm?

Chances are you know someone who has had carpal tunnel syndrome – a medical condition that initially produces tingling or numbness in the hand and can progress over time to piercing pain that shoots through the wrist and up the arm. The cause of this fairly common affliction is nerve compression, sometimes referred to as a “pinched nerve.”

“Carpal tunnel syndrome results from pressure on the median nerve, which runs from the forearm into the hand through the ‘carpal tunnel,’ a narrow passage of ligaments and bones,” explains Prasad Kilaru, MD, director of the Hand Program at Washington Hospital. “The nerve provides sensation to the thumb, index finger, middle finger and half of the ring finger. When swelling narrows the tunnel and compresses the nerve, the result may be pain, tingling, numbness or weakness in the hand and wrist, radiating up the arm.”

While carpal tunnel syndrome is the most common and best-known nerve compression disorder of the arms, compression of other nerves in the arm can produce similar symptoms in other locations in the hands and arms. For example, cubital tunnel syndrome is caused by increased pressure on the ulnar nerve, which passes close to the skin’s surface in the area of the elbow commonly known as the "funny bone." A third condition, radial tunnel syndrome, is caused by increased pressure on the radial nerve, which runs past the bones and muscles of the forearm and elbow.

To help people in the community learn more about nerve compression disorders of the arm, Washington Hospital is sponsoring a free Health & Wellness seminar on Tuesday, April 26, from 1 to 3 p.m. in the Conrad E. Anderson, MD, Auditorium in the Washington West Building at 2500 Mowry Ave. in Fremont. At the seminar, Dr. Kilaru will discuss the causes, symptoms and medical treatments available for carpal tunnel, cubital tunnel and radial tunnel syndromes. He also will explain surgical techniques for treating the three disorders.

“Carpal tunnel syndrome usually starts off with the fingers ‘falling asleep’ and then progressing to pain,” Dr. Kilaru notes. “Left untreated, the pain can become severe enough to wake the person up at night. With further progression, the nerve may die, so it is important to treat the disorder early.

“Compression of the ulnar nerve can produce tingling in the pinkie finger and the ring finger, as well as pain and numbness in the hand, radiating up to the elbow,” he adds. “Compression of the radial nerve can cause piercing or stabbing pain at the outer aspect of the forearm or back of the hand, especially when you try to straighten your wrist or fingers. Radial tunnel syndrome usually does not cause numbness or tingling because the nerve mostly affects the muscles.”

According to the National Institutes of Health, carpal tunnel syndrome may be caused by a variety of factors, including the fact that the carpal tunnel is smaller in some people than in others – which may be why women are three times more likely than men to develop carpal tunnel syndrome. The dominant hand is often affected first and produces the most severe pain. Repetitive and forceful movements of the hand during work or leisure activities may increase the risk of developing carpal tunnel syndrome.

Cubital tunnel syndrome is more likely to develop if you repeatedly lean on your elbow, especially on a hard surface, or if you bend your elbow for sustained periods, such as while talking on a cell phone. The risk for this disorder also increases for people, such as baseball pitchers, who participate in intense physical activity that puts pressure on the ulnar nerve. Causes of radial tunnel syndrome can include repetitive motions such as typing and especially mouse use, injury, noncancerous fatty tumors, bone tumors and inflammation of surrounding tissues.

“People with diabetes and kidney problems are at higher risk for developing nerve compression disorders,” says Dr. Kilaru. “Both of those health problems can cause nerve damage, and water retention associated with poor kidney function can put extra pressure on the nerves. We do see more cases of nerve compression in people who are involved with manual labor or who perform repetitive motions at work, including those who work with computers or who work on assembly lines.”

Initial treatment for any of these conditions usually involves the use of nonsteroidal anti-inflammatory medications such as ibuprofen or naproxen. In addition, physicians may recommend the use of wrist braces, protective elbow pads or splints to avoid undue pressure on the nerves.

“If those treatments don’t work, more aggressive treatments may be required,” Dr. Kilaru says. “Some physicians may suggest steroid injections, but I believe surgery is more effective and results in better outcomes. For all three conditions, the general concept is to relieve pressure on the nerve. To treat carpal tunnel syndrome, we can perform a quick, outpatient surgery performed endoscopically or through a small open incision, with either a local or general anesthetic, depending on the patient’s preference and general medical condition. Procedures for the other two conditions are always performed as open surgeries, but the incisions are still quite small – only two to three inches.”

Dr. Kilaru notes that most patients are able to return to their normal daily activities within three to six weeks following surgery for nerve compression disorders. Physical therapy may be recommended to help patients recover strength and range of motion.

“Complete recovery does depend on the extent of damage to the nerve,” he cautions. “If the nerve is badly damaged, it may take up to a year or even longer for the nerve to fully recover. In cases of severe nerve damage, the nerve may never recover its original level of function, which is why it is important to seek treatment for nerve compression disorders early.”

To register for the seminar on April 26, visit www.whhs.com and click on the tab at the top of the page for “Events.”