Are you having back pain with any of the following?
We understand that you are experiencing one or more of the health issues that might be impacting your back pain.
We recommend that you discuss these health issues with your doctor before proceeding with this program.
Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.
Carpal tunnel syndrome is pain or numbness in the hand, wrist, or arm that is caused by pinching of a nerve in the wrist.
The carpal tunnel is a narrow passageway in your wrist, composed of bone and ligaments. The median nerve and tendons pass through the tunnel. The median nerve controls sensation to the thumb, index, and middle fingers as well as the half of the ring finger that is next to the middle finger. The nerve also controls some of the muscles that move your fingers. Anything that causes pressure on the median nerve may cause the symptoms of carpal tunnel syndrome.
Usually, we are able to diagnose carpal tunnel syndrome by evaluating your medical history and the results of a physical exam. Sometimes we may need to refer you for a nerve conduction test to confirm the diagnosis.
We may recommend surgery if these treatments do not help or if your symptoms are severe.
Symptoms of carpal tunnel syndrome vary and may include:
The symptoms often occur when you are involved in activities that require frequent or persistent flexing or extending of the wrists.
Other simple daily tasks that are repetitive can also bring on the symptoms. These may include cooking, driving, or holding a book. Shaking the hand may return normal feeling. Try to keep your wrists straight and avoid leaning on them.
We use a range of diagnostic tools to evaluate your wrist. Initially, we will ask you to describe your symptoms and go through a comprehensive physical examination. The exam will include some or all of the following:
X-rays or other imaging studies do not help us to diagnose carpal tunnel syndrome. If we suspect that your symptoms are caused by something other than overuse of the wrist, we may order additional tests, including blood work.
Carpal tunnel syndrome is caused by increased pressure on the median nerve as it passes through the tight space in the wrist. This can be due to compression or inflammation. Often it is not possible to identify what causes the pressure on the median nerve to increase. However, there are many factors, including your medical and family history, that may be associated with this increase in pressure. These include:
The kind of work you do, your behaviors, and your use of body mechanics may also exacerbate these symptoms. Here are some examples:
We recommend that you understand the activities that increase your risk of developing carpal tunnel syndrome and take steps to manage them. If you already have carpal tunnel syndrome, limiting these activities may help control your symptoms. For example:
Avoid repetitive hand motions with a bent wrist. Keep your wrist straight when you are involved in the following activities:
Take frequent breaks if you must repeat hand motions. Rest your hand for at least 5 minutes every hour. Stretch your fingers and thumb and change your grip.
Type softly on your keyboard. A gel pad may help to cushion your wrist and keep it in the right position.
Be careful with your posture. Keep your shoulders straight.
Consult an ergonomic specialist. If you are uncomfortable, ask for an ergonomic evaluation at work, if one is available to you. An ergonomic specialist may be able to improve the configuration of your workstation and improve your wrist position and posture.
Avoid sleeping on your hands. Try to keep your wrists straight while you sleep. Wearing wrist splints while sleeping may help.
Wear a wrist splint at night if you are having symptoms. You may also wear the wrist splint during the day to decrease symptoms.
Nonsurgical treatments can be effective for people with carpal tunnel syndrome. We will discuss the preventive measures and treatments that are most appropriate for you. Sometimes we recommend a combination of treatments that may include the following:
Good posture and ergonomics
Avoid poor posture or overuse of the wrist. We can talk to you about using good ergonomics; for example, when you are using a computer workstation.
Wrist splints and ice
Anti-inflammatory pain relief
Carpal tunnel release surgery
If more conservative treatments do not relieve your symptoms, we may recommend carpal tunnel release surgery. During surgery, we cut ligaments or tissue that is pressing on the median nerve. Most commonly, we cut the transverse carpal ligament that lies directly over the median nerve. We perform the surgery in one of two ways:
These are outpatient surgeries that require only local anesthetic. We will also offer you medications to help you relax during the procedure.
If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms. If specialty care is needed, your personal physician will arrange an appointment for you in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.
During your office visit, we will discuss your medical and family history and I will examine your hand, arm and wrist. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options and develop a treatment plan that is right for you.
If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.
For general medical advice, our Appointment and Advice line is available 24 hours a day, 7 days a week.
If you have urgent concerns or issues while my office is closed, you can call the Appointment and Advice line. You will be connected with a nurse who can give you immediate advice.
If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.
Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.
Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.
When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.
We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.
If refills are needed in the future, you can:
For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.
If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.
I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.
If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.
As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.
My Doctor Online is available at any time that is most convenient for you. From my home page you can:
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.