DEAR MAYO CLINIC: I'm a homebuilder and have begun experiencing numbness and tingling in my hands. Sometimes I drop things because I can't get a good grip. A friend suggested I might have carpal tunnel syndrome. But doesn't that mostly affect people who use computers all day? Can you explain more about the condition?

ANSWER: Working with your hands day after day can take a toll on them, causing pain, numbness and weakness. Carpal tunnel syndrome is one condition that can affect many types of occupations, including farmers, truck drivers, factory and construction workers, and others.

Carpal tunnel is a condition caused by compression of the median nerve located in the wrist. This nerve provides feeling to the thumb and the index, middle and part of the ring fingers, and also sends signals to the muscles around the base of the thumb.

Some causes of carpal tunnel syndrome include medical conditions such as arthritis, gout, diabetes, amyloidosis, infections, masses and severe wrist injuries. Other causes are environmental or workplace conditions that involve forceful and repetitive gripping, and using heavy machinery and vibrating manual tools.

The symptoms of carpal tunnel syndrome include:

• Numbness and tingling in the fingers
• Swelling and discomfort of the hands and fingers
• Weakness, especially when pinching and gripping
• Dropping things
• Waking up at night to shake out the hands
• Numbness of the fingers first thing in the morning

Diagnosing carpal tunnel syndrome

To determine if you have carpal tunnel syndrome, an orthopedic specialist will discuss the history of your symptoms and perform a physical examination of your hands and wrists.

Other tests may be performed or requested, including:

• Two-point discrimination test on your fingertips to identify which fingers have decreased sensation

• Tinel's test, which is conducted by tapping the nerve in the carpal tunnel at the wrist to see if it causes tingling in your fingers
• Durkan's test, which involves pressing a thumb over the nerve in the carpal tunnel at the wrist to see if the numbness or tingling gets worse
• X-rays of your affected hand

Treating the condition

Treatment strategies are divided into nonsurgical and surgical measures.

Nonsurgical treatments include wearing a wrist brace during the night and undergoing cortisone injections.

Surgical intervention for carpal tunnel syndrome is a carpal tunnel release. The roof of the carpal tunnel is divided, which relieves pressure on the median nerve. Surgery may be open or endoscopic.

Both open and endoscopic surgery are outpatient procedures. Endoscopic surgery is minimally invasive. It's performed in an operating room with or without light sedation. After medication is injected to numb the palm and wrist, a small incision is made near the wrist. A tiny camera is inserted through the incision into the carpal tunnel. The surgeon inspects the tunnel and then uses a blade attached to the camera to cut the transverse carpal ligament — the roof of the tunnel — to relieve nerve compression.

For the best results after surgery, be sure to consult an orthopedic hand surgeon while numbness and tingling are still intermittent rather than constant.

Preventing carpal tunnel syndrome

There are no proven strategies to prevent carpal tunnel syndrome, but you can minimize stress on the hands and wrists by:

• Reducing your force and relaxing your grip.
  If your work involves a cash register or keyboard, for instance, hit the keys softly.
• Taking short, frequent breaks.
  Gently stretch and bend hands and wrists periodically. Alternate tasks when possible. This is especially important if you use equipment that vibrates or requires you to exert a great amount of force. Even a few minutes each hour can make a difference.
• Watching your form.
  Avoid bending your wrist all the way up or down. A relaxed middle position is best.
• Improving your posture.
  Incorrect posture rolls shoulders forward, shortening the neck and shoulder muscles and compressing nerves in the neck. This can affect the wrists, fingers and hands, and can cause neck pain.
• Keeping your hands warm.
  You're more likely to develop hand pain and stiffness if you work in a cold environment. If you can't control the temperature at work, put on fingerless gloves that keep the hands and wrists warm.

If you're experiencing symptoms, consult with an orthopedic specialist to determine the best treatment to keep you on the job or get you back to work. — Dr. Kristin Karim, Orthopedic Surgery, Mayo Clinic, Albert Lea and Austin, Minnesota

The post Mayo Clinic Q and A: Work with your hands? Watch out for carpal tunnel syndrome appeared first on Mayo Clinic News Network.

"We first began investigating Mayo Clinic opioid prescribing because it was the right thing to do," says Dr. Habermann. "Mayo Clinic needed to ensure that we were doing all we could to address the prescription opioid epidemic while appropriately managing patients’ pain at the same time. Internal examination has helped us provide better, more individualized pain management solutions for our patients."

"Mayo Clinic's groundbreaking opioid research led to the development and implementation of novel postoperative prescribing guidelines that improved patient care locally, nationally, and internationally," says Tad Mabry, M.D., an orthopedic surgeon who was a member of the Midwest Surgical Quality Subcommittee at Mayo Clinic when this work first started.

"We are fortunate to have the data analytics capabilities and research expertise of the Kern Center linked directly to Quality and embedded in the Practice," he says. "All across Mayo we are tapping into the growing body of evidence and shared expertise to further refine the lessons we learned in the early days of our opioids research." Today, Dr. Mabry is chair of the Midwest Quality Subcommittee, which includes Mayo Clinic in Rochester, Minnesota, and the entire Mayo Clinic Health System.

Center-based work has helped determine Mayo's baseline prescribing habits across practices and specific surgeries. Center colleagues (center co-authors identified with bold type) led efforts to implement and validate evidence-based prescribing guidelines throughout the surgical practice.

"Mayo's opioid stewardship efforts and related research have not only been transformative for our practice," says Dr. Habermann, "They have also allowed us to contribute to more far reaching efforts through state and national health policy forums and public health initiatives."

And in turn, legislation and the national conversation bolstered Mayo's decision to implement, analyze and refine prescribing guidelines.

One late 2019 publication describes a correlation from state legislation to changes in Mayo's prescribing practices: Association of Florida House Bill 21 With Postoperative Opioid Prescribing for Acute Pain at a Single Institution. Porter SB, Glasgow AE, Yao X, Habermann EB. JAMA Surg. 2020;155(3):263–264.

Another more recent publication looks at this as well at both Mayo Clinic in Arizona and Florida: Impact of Legislation on Opioid Prescribing following Hysterectomy and Hysteroscopy in Arizona and Florida. Carrubba AR, Glasgow AE, Habermann EB, Stanton AP, Wasson MN, DeStephano CC. Gynecol Obstet Invest. 2021 Oct 12;1-9.

Mayo's opioid research started long before the COVID-19 pandemic grabbed attention in the public health arena, and, like the opioid epidemic itself, has continued throughout. In 2020, the center team co-authored approximately 27 opioid-related publications, and in 2021 there have been more than a dozen thus far. Many showcase the leadership of the Kern Center's Surgical Outcomes Research team. Following are some recent publications:

• Patient Opioid Requirements Are Often Far Less Than Their Discharge Prescription After Orthopaedic Surgery: the Results of a Prospective Multicenter Survey.

Wyles CC, Thiels CA, Hevesi M, Ubl DS, Gazelka HM, Turner NS 3rd, Trousdale RT, Pagnano MW, Mabry TM, Habermann EB. J Am Acad Orthop Surg. 2021 Apr 1;29(7):e345-e353.

"Our earlier work led to the development of prescribing guidelines for surgical practices across Mayo Clinic. However, we thought further refinement was possible," says Dr. Habermann.

In a study designed to learn how many opioids different patients actually consume for pain management, this team of investigators conducted a prospective, multicenter survey study over 10 months, with this specific investigation focusing on patients receiving one of seven common elective orthopaedic surgical procedures — total knee arthroplasty, total hip arthroplasty, lumbar fusion, lumbar laminectomy, rotator cuff repair, arthroscopic meniscectomy, and carpal tunnel release.

Phone surveys were conducted between 21 and 35 days postoperatively. The team wanted to document both the amount and length of time patients consumed opioid medications.

Among the 919 survey respondents, 94.3% received opioids at discharge, with a median prescription of 388 morphine milligram equivalents (MMEs). Of these, 60% of the opioids went unused, with 34.7% of patients using only a fraction of their prescription, or less than 50 MMEs.

The authors report, "These data have informed further improvement of our opioid prescription guidelines to more precisely align with anticipated procedure- and patient-specific requirements."

This paper is a continuation of findings originally described in 2018’s Results of a Prospective, Multicenter Initiative Aimed at Developing Opioid-prescribing Guidelines After Surgery led by then Surgical Outcomes fellow Cornelius Thiels, D.O., who has recently joined the staff at Mayo Clinic in Rochester.

• Variation in opioid prescribing patterns after abdominal transplant surgery.

Sussman J, Calderon E, Ubl DS, Croome KP, Taner CB, Heimbach JK, Moss A, Habermann EB, Mathur AK. Clin Transplant. 2021 Jul 23.

In this study, led by investigators at Mayo Clinic in Arizona, the researchers examined prescribing practices during 2014–2017 for 3,702 patients receiving kidney, liver or simultaneous kidney and liver transplants across the three geographically disperse transplant centers within Mayo Clinic.

At the time of this work, acute pain, including post-surgical pain, was treated by opioid prescriptions up to a maximum post-surgery or acute injury prescription of seven days, or 200 morphine milligram equivalents (MMEs). The team found that more than 80% of patients received more than 200 MME at discharge, and that prescriptions in general varied widely between sites and between types of transplant surgery.

Their findings led to individualized prescribing guidelines that have been implanted across Mayo Clinic's transplant practice. In the paper, the authors also call for creation of national opioid prescribing guidelines in transplantation. Additionally, they posit that transplant regulatory bodies could play a role in curtailing excess prescribing by mandating the creation of center-specific protocols around opioids.

• Impact of Opioid Prescribing Guidelines on Postoperative Opioid Prescriptions Following Elective Spine Surgery: Results From an Institutional Quality Improvement Initiative.

Krauss WE, Habermann EB, Goyal A, Ubl DS, Alvi MA, Whipple DC, Glasgow AE, Gazelka HM, Bydon M. Neurosurgery. 2021 Aug 16;89(3):460-470.

This study sought to evaluate the impact of departmental postoperative prescribing guidelines on opioid prescriptions following elective spine surgery. Approximately half (47.7%) of the 1,193 patients in the study were treated before the guidelines were implemented.

After guideline implementation, fewer patients received a postoperative opioid prescription. In addition, among those who received opioids, median prescriptions decreased from 300 morphine milligram equivalents (MME) to 225 MME. The 30-day refill rate also dropped slightly, indicating the changes did not adversely affect pain control.

This is the first study to evaluate a practice and procedure-specific initiative to reduce opioid prescribing following neurosurgery. The authors cite Mayo's multidisciplinary approach as the reason for successful implementation of guidelines with positive outcomes. This allows inclusion of all possible unique perspectives and ensures buy-in from all members of the care team.

• The System Is Broken: A Qualitative Assessment of Opioid Prescribing Practices After Spine Surgery

Warner NS, Finnie D, Warner DO, Hooten WM, Mauck KF, Cunningham JL, Gazelka H, Bydon M, Huddleston PM, Habermann EB. Mayo Clin Proc. 2020 Sep;95(9):1906-1915.

"We don't ever do our research in a vacuum," says Dr. Habermann. "It's not simply enough to collect numbers and report findings in peer-reviewed journals. We have a responsibility to disseminate practice transformative knowledge across Mayo Clinic and assist in implementation when appropriate."

Dissemination and implementation is not like flipping a switch. Even research conducted by expert multidisciplinary teams at Mayo Clinic doesn't automatically become part of the fabric of patient care. The Kern Center has an entire program dedicated to the science of dissemination and implementation.

In this study, led by Kern Health Care Delivery Scholar Nafisseh Warner, M.D., the researchers delved into some of the reasons that 'implementing' prescribing guidelines takes a much more circuitous path than flipping the proverbial switch.

Several unique themes emerged during the course of 20 one-on-one interviews with a range of primary care and surgical health care providers involved with care of patients who undergo major spinal surgery — after prescribing guidelines had been developed and 'implemented.'

Providers did not view opioid prescribing guidelines in the same way. Depending on their level of clinical experience, prescribing oversight and how many other demands on the provider's time existed, prescribing practices were likely to vary.

Universally, opioid tapering was viewed as an area in which more education and support was desired. The participants also agreed that expectation setting for both acute and chronic pain management was challenging. And finally, there was no hand-off process to transition opioid prescribing responsibilities between surgical and primary care teams.

"With Dr. Nafisseh Warner's championship, we continue to work on this problem," says Dr. Habermann. Find more publications from Dr. Warner on PubMed.

• Incidence and risk factors for prolonged postoperative opioid use following lumbar spine surgery: a cohort study.

Goyal A, Payne S, Sangaralingham LR, Jeffery MM, Naessens JM, Gazelka HM, Habermann EB, Krauss W, Spinner RJ, Bydon M. J Neurosurg Spine. 2021 Aug 6:1-9.

This publication resulted from a multi-faceted study using the OptumLabs Data Warehouse, in which the researchers sought to find ways to address a growing concern in health care of sustained postoperative opioid use after elective surgery.

An earlier publication by the same team, Variations in Postoperative Opioid Prescription Practices and Impact on Refill Prescriptions Following Lumbar Spine Surgery, published online in June in World Neurosurgery, set the stage. In it, the authors examined the records of 43,572 adult patients undergoing anterior lumbar fusion, posterior lumbar fusion, circumferential lumbar fusion, or lumbar decompression and discectomy for degenerative spine disease. They found wide variance in prescriptions between types of surgeries, as well as between patients receiving the same surgery. They also found a preponderance of prescriptions for more than 200 morphine milligram equivalents — a commonly accepted limit of opioid prescriptions for acute pain management in the seven days following severe injury or surgery.

By further analyzing the pharmacy claims for 25,587 patients who received posterior lumbar fusion or lumbar decompression and discectomy, the authors identified incidence and predictors of long-term opioid use after these elective lumbar spine surgeries.

The following were identified to be significantly associated with higher risk of long-term opioid use following posterior lumbar fusion:

• Discharge opioid prescription of greater than or equal to 500 morphine milligram equivalents (MMEs).
• Prescription of a long-acting opioid.
• Female sex, multilevel surgery or comorbidities such as depression and drug abuse.

Conversely, older patients — age 65 years or older — or people who had not been taking opioids prior to surgery, i.e. "opioid naïve," were at lower risk of progressing to long-term use.

For patients undergoing lumbar decompression and discectomy, the authors had similar findings, but also noted additional risk factors:

• Discharge opioid prescription greater than or equal to 400 MMEs.
• Prescription of tramadol alone at discharge.
• Inpatient surgery.

The Mayo Clinic Kern Center for the Science of Health Care Delivery is fully embedded in Mayo Clinic's medical Practice. Its scientists collaborate across the Practice to identify and solve challenges for patients, providers and the health care system at large.

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The post Advancements in opioids research, transformations in postsurgical prescribing appeared first on Mayo Clinic News Network.

It's not uncommon for patients to experience soreness and hypersensitivity in their hands after having carpal tunnel surgery. Dr. Van Otterloo says it's called pillar pain.

Watch: The Mayo Clinic Minute

Editor's note: Video was recorded prior to the COVID-19 pandemic.

Journalists: Broadcast-quality video (0:59) is in the downloads at the end of this post. Please "Courtesy: Mayo Clinic News Network." Read the script.

"What that is, is you have pain kind of deep under the incision and sometimes on the sides," says Dr. Van Otterloo.

Nerves are some of the slowest healers in the body. After carpal tunnel surgery to release pressure off of a nerve, that nerve can become irritated, and can cause hypersensitivity, redness and inflammation, says Dr. Van Otterloo.

While postoperative pain does not affect the outcome of carpal tunnel surgery, it can last up to nine months. However, ultrasound therapy can speed up the recovery process.

"There's a little crystal inside our transducer head of the ultrasound machine that pulsates over 20,000 pulses per second," says Dr. Van Otterloo. "That high frequency can help to break up scar tissue that has formed after your carpel tunnel surgery. The other thing it does is that it can help to increase circulation by heating. Those sound waves will convert to heat waves. And anytime a body area is warmed, it will bring extra circulation, which is extra oxygen and nutrients to the area."

Nerves typically improve after surgery at a rate of about one inch per month. When sensation returns, it happens gradually. Dr. Van Otterloo says most patients notice benefits after three to four ultrasound therapy sessions. In general, full recovery after carpal tunnel syndrome may take up to a year.

The post Mayo Clinic Minute: Ultrasound therapy for pain following carpal tunnel surgery appeared first on Mayo Clinic News Network.

Dear Mayo Clinic: Earlier this year, I began experiencing some pain in my right hand and wrist. I am a systems engineer and have always done a fair amount of typing at work. Now with the COVID-19 pandemic, I am working at home and spending even more time on a keyboard. I'm finding the pain has increased, and I'm also having some new tingling and numbness in my hand and wrist. I heard about carpal tunnel and was wondering if I may have it. If I do have carpal tunnel, what can I do to help or reverse it?

Answer: There are various things that can cause hand and wrist discomfort. Feelings of pins and needles, or a sensation of tingling or prickling, can occur in the hands due to pressure on nerves, which are like electrical cables that in part give feeling to your fingers.

The exact area of discomfort and symptoms will guide which condition you likely have. Are your symptoms occurring all day or only at certain times? Are you having pain only while typing?

Given the situation you describe, it's most likely you are experiencing one of two common ailments that have become more common in the age of technology. The first is a type of tendonitis known as De Quervain's tenosynovitis. This is considered an overuse injury caused by repetitive hand or wrist motion. The second possibility sounds like it could be carpal tunnel syndrome. Activities such as typing or texting, golfing, and gardening can worsen these conditions.

De Quervain's tenosynovitis affects the tendons on the thumb side of your wrist. You may have swelling in this area and pain that is exacerbated when you twist your wrist, grasp or lift something heavy like a milk jug.

Carpal tunnel syndrome is a condition that can create numbness and a sensation of tingling in your fingers. It occurs when the median nerve, which is on the palm side of the hand, is compressed or irritated in some way. Symptoms typically are limited to your thumb, index finger, middle finger and thumb side of your ring finger.

If you feel tingling along the inner aspect of your forearm down to your pinky finger, carpal tunnel is not likely the cause. Rather, it may be that you are suffering from cubital tunnel, which is irritation of a nerve by your inner elbow.

Many patients with carpal tunnel report initial symptoms at night, although as the condition progresses, carpal tunnel can cause weakness of the thumb's pinching muscles and lead to difficulties performing routine tasks. Some patients have reported numbness in their hand that is exasperated, for instance, while holding a phone or driving.

If your symptoms are related to De Quervain's tenosynovitis, using ice for swelling and taking a mild pain reliever can help with discomfort.

The best treatment, though, is to reduce the activity that is most likely causing your symptoms. While that can be challenging now, especially if you notice that your pain is exasperated while you type, consider using a voice-activated dictation system or switch fingers if you text a lot. For instance, if you most often use your thumbs to text and it has become more painful, switch to using your index fingers instead.

I also would recommend that you perform an ergonomics check of your at-home workspace. Your posture can affect how you function and develop some of these symptoms. Second, look at the position of your wrist. If you are sitting or standing at an awkward height, your wrist could be in a significantly flexed position that puts pressure on the nerves and tendons, and increases your risk for issues and symptoms.

To help alleviate your carpal tunnel like symptoms at night, try an over-the-counter splint with a metal reinforcement on the palm side. This splint will stop you from flexing your wrist and reduce irritation on the nerve.

If your symptoms progress, talk with your health care provider about next steps to confirm your diagnosis and the potential for other nonsurgical treatments, such as hand therapy or an injection. ­― Dr. Sanjeev Kakar, Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

The post Mayo Clinic Q and A: Repetitive motion injuries during COVID-19 appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. ― Human bodies constantly produce thousands of perfectly folded proteins, but some proteins get misfolded. An excess of these misfolded proteins can overwhelm the body's ability to remove them. When that happens, the rogue proteins bind together and form a substance called amyloid. Webs of amyloid can deposit in any tissue or organ, but some types affect the heart.

Martha Grogan, M.D., a Mayo Clinic cardiologist and director of the Cardiac Amyloid Clinic at Mayo Clinic in Rochester, says the treatment approach depends on two important factors: early diagnosis and knowing which type of amyloid a person has.

Three types of amyloid can affect the human heart:

• Light chain amyloid
  This type progresses quickly and has the worst prognosis. It is produced in the bone marrow and can be deposited in any tissue or organ. This type of amyloid causes organ failure or neurological damage. Treatment may include chemotherapy or stem cell transplant with a patient's own cells.

• Wild type transthyretin amyloid
  This type originates in the liver and becomes unstable. It typically shows up in men over age 60. Carpal tunnel syndrome or spinal stenosis is common, often occurring six to 10 years before wild type transthyretin is diagnosed. New medication options are available to stabilize protein or prevent protein folding.

• Hereditary type transthyretin amyloid
  This type originates in the liver. It is caused by mutations of the transthyretin gene. A single copy of the gene variation is enough to cause the condition. Effects vary. Not everyone with the gene variation gets amyloidosis. This type is rare, except in black Americans. Treatment can include a liver or heart transplant. New medication options are available to prevent the protein from being produced, or to stabilize protein and prevent misfolding.

Each type causes irreversible thickening of the heart muscle and can lead to congestive heart failure. But each of these cardiac amyloid types has distinct differences. For example, people of African or Caribbean descent are at increased risk of hereditary type transthyretin amyloid.

Dr. Grogan says amyloidosis is tricky to diagnose because layers of amyloid build up over time. At first, there are no symptoms. Later, the symptoms often imitate other conditions. A health care provider may suspect cardiac amyloidosis if a patient's echocardiogram or MRI shows certain heart characteristics, such as thickened walls, abnormal strain and restricted filling of blood. A patient may have unexplained heart failure, stroke or atrial arrhythmia that can be traced back to amyloid. Kidney disease, an unexplained rise in lipids and signs of neural damage also may be present.

"When cardiac amyloid is suspected, the first thing is to find out what type it is because that will guide treatment. There is no medication available at this time that has been proven to take amyloid out of the heart, but we can stop more amyloid from being produced by treating the underlying protein problem," says Dr. Grogan.

Using a tissue biopsy taken from the fat, bone marrow, kidney or heart, a pathologist uses a technique called mass spectrometryto examine the tissue and determine the type of amyloid. If light chain amyloid is ruled out by blood and urine tests, then a biopsy is not always needed. In this setting, a pyrophosphate scan may be used to see if transthyretin amyloid is present in the heart. If the patient has transthyretin type, the next step is genetic testing to see if there is an inherited variation that is causing the amyloid.

"The hereditary form of transthyretin amyloid is generally rare. However, we know that approximately 4% of the black population in the U.S. carries the gene. Not all of these people develop amyloidosis, but this is a huge population at risk," says Dr. Grogan.

To interview Dr. Grogan, contact newsbureau@mayo.edu.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news and An Inside Look at Mayo Clinic for more information about Mayo.

Media contact:

• Terri Malloy, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

The post Expert Alert: Cardiac amyloidosis masquerades as other conditions; 1 type affects more black Americans appeared first on Mayo Clinic News Network.

In this Mayo Clinic Radio Health Minute, Dr. Sanj Kakar discusses several treatment options are available to relieve tingling and numbness, and restore wrist and hand function.

To listen click the link below.

Symptoms and solutions for carpal tunnel syndrome

The post Symptoms and solutions for carpal tunnel syndrome: Mayo Clinic Radio Health Minute appeared first on Mayo Clinic News Network.

Several treatment options are available to relieve tingling and numbness, and restore wrist and hand function.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (0:58) is in the downloads at the end of the post. Please "Courtesy: Mayo Clinic News Network." Read the script.

A pathway within the structure of palm side of the hand creates the problem.

"This is the carpal tunnel ligament," says orthopedic surgeon Dr. Sanj Kakar while pointing to a model of the inner workings of a human hand. "The median nerve is this yellow structure."

Carpal tunnel syndrome is simply pressure on that nerve. A majority of the times, doctors don’t know why, but sometimes it can be due to a mass or thickening of the tissues in the carpal canal.

"And patients will generally complain of numbness and tingling," says Dr. Kakar. "It mainly happens at nighttime."

Dr. Kakar says if symptoms are ignored, carpal tunnel can lead to difficulties doing what were routine tasks, due to clumsiness of the fingers.

"Women have difficulty doing their bra," he adds. "Men have difficulty doing the top button of their shirt."

Dr. Kakar says, for some patients, wearing a wrist brace at night can ease symptoms. A steroid injection may help – although the effect can wear off over time. The next step is a short surgery to open the tunnel and relieve the pressure.

"All we are doing is literally opening up this band," says Dr. Kakar, referencing a computer animation of a carpal tunnel surgery."

"The actual procedure takes five to 10 minutes," explains Dr. Kakar. "And it’s amazing the number of times you see patients who say, 'I didn’t realize that’s all it took.'"

The post Mayo Clinic Minute: What is carpal tunnel syndrome? appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: Three months ago, I had surgery on my left wrist to treat carpal tunnel syndrome. Since then, I am in much more pain than before surgery, and two of my fingers are completely numb. I cannot even button a button, and tying my shoes is a chore. What would cause the pain to worsen after surgery? Could another surgery remedy the problem, or is this my new normal?

ANSWER: Your condition as it stands now shouldn’t be considered a new normal. It’s possible your symptoms are part of the recovery from surgery, and they may improve with time. It would be a good idea, however, to meet with your surgeon now, so he or she can reassess your condition and decide if you need additional tests or treatment.

Carpal tunnel syndrome is caused by compression of the median nerve within the carpal tunnel — a narrow passageway on the palm side of your wrist. The median nerve runs from your forearm through the carpal tunnel and into your hand. It controls the sensations you feel on the palm side of your thumb and fingers, except the little finger. Carpal tunnel syndrome often causes numbness and tingling in the hand and arm. Surgery to treat it involves relieving pressure on the median nerve by cutting the ligament that crosses over it.

Research shows that symptoms improve for more than 90% of patients following carpal tunnel surgery. However, the number who experience complete relief of symptoms after surgery may be only 50%. Patients whose symptoms are severe before surgery show the most improvement afterward, but this group also tends to have the most residual symptoms after the procedure.

At three months following carpal tunnel surgery, your numbness and pain still could be byproducts of the procedure. Many people find the incision causes pain and irritation as it heals. In addition, a condition called ‘pillar pain,’ which is a localized reaction to the surgery, can lead to discomfort. Both generally improve over several months.

Working with a hand therapist can be particularly useful during this uncomfortable period of recovery. The therapist can follow your progress by measuring the strength and sensation in your fingers, hand and arm, as well as provide advice about how to make your hand and arm more comfortable.

It’s helpful to note, too, that nerves typically improve after surgery at a rate of about 1 inch per month. When sensation returns, it happens gradually. In general, full recovery after carpal tunnel syndrome may take up to a year.

Whether your pain and numbness are part of the healing process or whether they signal the need for more intervention depends somewhat on how your current symptoms compare to the symptoms you had before surgery. For example, you mention that two of your fingers are completely numb. If the numbness is significantly worse than it was before surgery, or if it’s affecting different parts of your hand, then closer assessment is appropriate at this time.

It is a possibility that another problem is playing a role here. Various diseases, such as inflammatory arthritis, can first appear as carpal tunnel syndrome before it becomes evident that another process actually is triggering the condition. An ultrasound may reveal a new or additional diagnosis at the wrist. The scan also can help your surgeon determine if decompression of the median nerve is complete. If not, then another procedure may be useful.

In some cases, numbness following carpal tunnel surgery happens due to a problem farther up the arm, or in the shoulder, neck or brain. If your surgeon suspects that could be the case for you, you may be referred to another specialist, such as a neurologist, for further assessment. — Dr. Mary Jurisson, Physical Medicine and Rehabilitation, and Dr. Nicholas Pulos, Orthopedic Surgery — both of Mayo Clinic, Rochester, Minnesota

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Related Articles

• Mayo Clinic Minute: Symptoms, solutions for carpal tunnel syndrome published 9/25/17
• Mayo Clinic Q and A: Carpal tunnel syndrome may require surgery published 5/20/17

The post Mayo Clinic Q and A: Recovery after surgery for carpal tunnel syndrome — what’s normal and what’s not appeared first on Mayo Clinic News Network.

Treatment for a brachial plexus injury depends on several factors, including the type and severity of the injury, the length of time since the injury, and other existing conditions. Nerves that have only been stretched may recover without further treatment; whereas, other injuries may require physical therapy. The most severe injuries can require nerve graft or nerve transfer surgery.

On the next Mayo Clinic Radio program, Dr. Alexander Shin, an orthopedic surgeon at Mayo Clinic, will discuss diagnosis and treatment of brachial plexus injuries. Dr. Shin also will talk about carpal tunnel syndrome. Also on the program, Dr. Naima Covassin, a cardiovascular disease researcher at Mayo Clinic, will share the findings of a recent Mayo Clinic study showing how eating breakfast regularly can help control weight gain. And Dr. Heather Fields, an internal medicine specialist at Mayo Clinic, will explain the dangers of eating too much red meat.

To hear the program, find an affiliate in your area.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio: Brachial plexus injury appeared first on Mayo Clinic News Network.

Treatment for a brachial plexus injury depends on several factors, including the type and severity of the injury, the length of time since the injury, and other existing conditions. Nerves that have only been stretched may recover without further treatment; whereas, other injuries may require physical therapy. The most severe injuries can require nerve graft or nerve transfer surgery.

On the next Mayo Clinic Radio program, Dr. Alexander Shin, an orthopedic surgeon at Mayo Clinic, will discuss diagnosis and treatment of brachial plexus injuries. Dr. Shin also will talk about carpal tunnel syndrome. Also on the program, Dr. Naima Covassin, a cardiovascular disease researcher at Mayo Clinic, will share the findings of a recent Mayo Clinic study showing how eating breakfast regularly can help control weight gain. And Dr. Heather Fields, an internal medicine specialist at Mayo Clinic, will explain the dangers of eating too much red meat.

To hear the program, find an affiliate in your area.

Miss the show?  Here's your Mayo Clinic Radio podcast.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio: Brachial plexus injury / carpal tunnel syndrome / importance of eating breakfast / dangers of too much red meat appeared first on Mayo Clinic News Network.