Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

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.

Provider photo for Alexandra McSpadden

Alexandra McSpadden, PA-C

Plastic Surgery

Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.

My Offices

Santa Rosa Medical Center
Appt/Advice: 707-566-5288

See all office information »

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Overview

Carpal tunnel syndrome causes painful numbness and tingling in the fingers. The carpal tunnel is a passageway in your wrist that contains the median nerve. This nerve extends from the forearm into the hand. It controls sensation to most of the fingers, including the:

  • Thumb
  • Index and middle fingers
  • Inside half of the ring finger that is next to the middle finger

Anything that puts pressure on the median nerve may cause symptoms of carpal tunnel syndrome.

Treatments include:

  • Avoiding activities that keep the wrist in the same position for too long
  • Avoiding activities that put too much pressure on the wrist
  • Wrist splints
  • Physical therapy
  • Cortisone injection
  • Surgery

Symptoms

Symptoms of carpal tunnel syndrome vary. They include:

  • Numbness, tingling, electric shock-like sensation, and pain in most of the fingers.
  • Pain that can also be felt in the entire palm and can sometimes radiate into the arm.
  • Pain at night that can disturb sleep.
  • Muscle weakness or clumsiness of the hand.

The symptoms often occur when you are involved in activities that require frequent or persistent flexing or extending of the wrists.

Other daily tasks that are repetitive can also bring on the symptoms. These may include cooking, driving, or holding a book. However, for some people, there is no specific activity that triggers symptoms.

Shaking the hand to make symptoms better, especially at night, is commonly seen in patients with carpal tunnel syndrome.

Diagnosis

We will ask you about your medical history and symptoms. Then we will examine you. The exam may include the following tests:

  • Carpal compression test. We apply direct pressure over the carpal tunnel to see if this reproduces the symptoms in the hand.
  • Phalen maneuver. You flex your wrist for 30 to 60 seconds to see if this causes numbness, tingling, or pain.
  • Muscle strength test. We ask you to try and straighten the thumb while someone else holds it back.
  • Nerve conduction study. We place electrodes on the skin and pass small electric shocks through the median nerve. This shows us if the nerve is transmitting electrical impulses at normal speed and strength.

Additional tests

Imaging studies typically do not help us to diagnose carpal tunnel syndrome. If your symptoms may be caused by something other than overuse of the wrist, we may order additional tests, including blood work.

Causes

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. There are many risk factors that are associated with this increase in pressure. 

Health and family history risk factors include:

  • Obesity.
  • Family history of carpal tunnel syndrome.
  • Diabetes.
  • Hypothyroidism, or low thyroid function. The median nerve may be more susceptible to increased pressure in people with hypothyroidism.
  • Pregnancy. Swelling and fluid retention can increase pressure on the median nerve.
  • Wrist fracture.
  • Women are more at risk.
  • Rheumatoid arthritis and other connective tissue disorders.

Work and Lifestyle Factors

The work you do and your use of body mechanics may make symptoms worse. Here are some examples:

  • Flexing the wrists while sleeping, reading, or driving.
  • Clenching the steering wheel while driving.
  • Repetitive activities. Repetitive flexing of the wrists causes the tendons to swell and press on the median nerve.

Certain occupations or activities may increase the risk that you will develop carpal tunnel syndrome. Examples of activities include:

  • Repetitive forceful gripping
  • Awkward wrist positions
  • Working with equipment that causes vibration

Construction work, nursing, and jobs that require typing and mouse use on the computer are in this category of occupations. The debate continues about any association between repetitive computer keyboard work and carpal tunnel syndrome.

Prevention

Learn about the activities that increase your risk of developing carpal tunnel syndrome. Take steps to manage them. If you already have wrist problems, limiting these activities may help control your symptoms. 

Avoid repetitive hand motions with a bent wrist. Keep your wrist straight when you are:

  • Using the computer, typing, or using the mouse
  • Writing
  • Driving
  • Using scissors, power tools, pliers, screwdrivers, or other tools
  • Playing the piano
  • Knitting, crocheting, or sewing
Additional References:

Protecting Your Wrist

You can follow these guidelines to protect your wrist:

  • 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.
  • Check the ergonomics of your work area. Adjusting your work area can improve your wrist position and posture. Use online resources, such as the Smartmoves interactive program, to help make sure your computer or laptop is set up properly. Ask for an evaluation of your work station by an ergonomic specialist at work.
  • Avoid leaning or sleeping on your hands. Keep your wrists straight while you sleep.
  • Wear a wrist splint. Wearing a wrist splint at night or during the day can help.
Additional References:

Treatment

Nonsurgical treatments are effective for most people. We will discuss the preventive measures and treatments that are most appropriate for you. Sometimes we recommend a combination of treatments.

Wrist splints and ice

  • We can recommend wrist splints and talk to you about using them during sleep.
  • We’ll tell you how to use wrist splints while you are participating in activities that require you to flex your wrist.
  • Icing your wrist up to 3 times each day, for 10 to 15 minutes each time, can be helpful. This is particularly important right before you go to bed. We can show you how to use ice effectively.

Reducing Inflammation

Anti-inflammatory pain relief

Over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may treat the tendinitis that is causing carpal tunnel syndrome. Read the directions carefully so that you take the correct dosage.

OTC NSAIDs are not appropriate for everyone. They can interact with other medicines. They can also cause problems for people with some medical conditions. Talk to us about these medications if:

  • You have a complex medical condition.
  • You are pregnant or trying to get pregnant.
  • You have been taking OTC NSAIDs and they do not relieve your symptoms. We can recommend alternatives.

Corticosteroid injections

  • Occasionally, we may prescribe corticosteroid injections.
  • Corticosteroids, such as cortisone, decrease inflammation.
  • We use these injections to treat, or diagnose, your condition.

Surgical Treatment

Carpal tunnel release surgery

If other treatments do not relieve your symptoms, we may recommend carpal tunnel release surgery. During surgery, we cut ligaments or tissue that are 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 1 of 2 ways:

  • Open incision. We make a small cut in the palm of your hand to access the carpal tunnel area.
  • Endoscopy. We make 1 or 2 small incisions in the wrist and/or palm. We then insert an endoscope into the incision. An endoscope is a lighted tube with a camera and surgical instruments attached. This helps us see the structures in the wrist and treat the problem.

These are outpatient surgeries that require only local anesthetic. We use medications to help you relax during the procedure.

Your Care with Me

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 usually arrange for you to attend a carpal tunnel syndrome group class. 

During the class, you will receive information about carpal tunnel symptoms, how to prevent them, and treatment options, ranging from conservative treatments to surgery. After the presentation, one of my colleagues will assess your nerve function by performing a nerve conduction study test. Based on the results of that test, you may be scheduled to see a surgeon.

If you come to see me, during your office visit, we will discuss your medical and family history and I will examine your wrist. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a 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.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing an emergency, call 911 or go to the nearest Emergency Room.

Coordinating Your Care

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.

If you come to an office visit

At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 

  • At the end of your visit, you may receive a document called the "After Visit Summary" that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
  • To help you prepare for your visit, please see additional details under Office Visit. 
If I prescribe medications

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:

  • Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
  • Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.
If lab testing or imaging is needed

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 I refer you to another specialty colleague

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.

If surgery or a procedure is a treatment option

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.

Convenient Resources for You

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:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Related Health Tools:

Podcasts
Prepare for Your Procedure

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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.

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