Diseases, Disorders information

The other thing to remember is that carpal tunnel syndrome, like ulnar entrapment or tarsal tunnel syndrome, can be associated with certain underlying medical conditions. Diabetes is a big one. Hypothyroidism. I have picked up a few patients with hypothyroidism that were before undiagnosed. Occasionally gout, acromegaly because of changes at the specific sites, the wrist joint, pregnancy - obviously, that will resolve - synovitis at the wrist, particularly in RA, systemic sclerosis or scleroderma big time. These patients have severe problems and often don’t even respond to surgery. Amyloidosis is another one that can be very resistant. Chronic renal failure on hemodialysis they can get amyloid deposits with Beta 2 microglobulin as opposed to other types of proteins. This can also be very resistant. Again, I mention repetitive strain injury, where they will have typical carpal tunnel syndrome on history and physical.
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The treatment includes, if they have an underlying condition like thyroid disease or diabetes, treat the hypothyroidism, that will often help. Rheumatoid arthritis, treating the synovitis with an injection in the wrist or maybe systemic treatment. That may help. Antiinflammatory drugs may help. Wrist splinting will help, particularly at nighttime. Keep the wrists in good position so the patients at leas won’t wake up with the feeling that their hand is falling asleep. Cortical steroid injection into the carpal tunnel is very useful. If a patient does not respond to these things or they have significant motor involvement - really any motor involvement - I just refer them for surgical release. If I think a patient needs surgery, that’s the instance where I will get an EMG with nerve conduction study. Otherwise if I have a clinical diagnosis and I am just doing these rather simple treatments, I don’t even bother with the study. My personal thing, it’s just a waste of time and money. Very few patients enjoy having these studies done. If any of you have ever had it done - and I have as part of an experiment - it’s annoying at the least. It is uncomfortable. But before I refer a patient to a surgeon I want to document what’s going on and see how much motor involvement there is.
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This is the standard, this is a 3M splint, very similar to the Futura. It has a metal stay in the bottom of the wrist and you can take it out and wash the splint. It’s pretty hardy. The only problem is that you can’t switch it from left to right. It’s really for one hand only.