The doctor is in! In our Spin Doctor series, we explore hot-button questions about SCI and disability from our peers throughout the province and share answers from healthcare professionals across disciplines.
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Several peers have contacted us lately with questions about wrist pain and numbness resulting from carpal tunnel syndrome that have intensified as they age—and surgery to release it. We gleaned what we could from online sources and asked two of our peers who have also dealt with this to share their experiences.
Carpal tunnel syndrome, or CTS, is caused by pressure on the median nerve where it passes through the carpal tunnel, a narrow passageway in your hand. Symptoms can include pain, numbness, tingling and weakness in the hand and arm. In the USA, research suggests that about five percent of the general population experience CTS. But for people with SCI (particularly paraplegia), it’s a much bigger problem. Some studies say that up to 65 percent of people with paraplegia suffer from CTS. The reasons are thought to be repetitive motions of wheelchair use and frequent transfers.
Diagnosis, non-invasive treatments and surgical options
To make a diagnosis, your healthcare team will rely on a physical examination, X-rays, and nerve conduction studies to see if nerve impulses are being slowed in the carpal tunnel. Treatment may be as simple as stopping problem activities, cold packs to reduce swelling, wrist splints, use of NSAIDs such as ibuprofen, and cortisone injections.
When these treatments don’t work, carpal tunnel release (CTR) surgery is the remaining option. The goal is to relieve pressure by cutting the ligament pressing on the median nerve. This can be done in two ways—open surgery involves making an incision in your palm, while endoscopic surgery relies on tiny incisions to insert a tiny cutting tool and camera into the carpal tunnel. Both procedures have the same risks as any surgery (for example, infection), but the prospect of having their independence compromised severely during a lengthy healing period is what worries most people with SCI. However, it should be noted that there’s a fair amount of research to suggest that CTR is very effective for people with SCI.
Research study with encouraging results
In February, a study was published in the journal Nature by Swiss researchers. They analyzed 77 surgeries completed in 55 patients with SCI (the majority were paraplegics). Of the 77 surgeries, 66 resulted in total relief of symptoms.
“SCI patients with CTS respond well to surgical decompression of median nerve regardless of level and type of spinal cord lesion and risk factors,” they concluded.
We asked two of our peers, Sherry Caves and Kirsten Sharp, to tell us about their experiences with CTR surgery.
“I was encouraged for a few years by my neurologist due to my ongoing symptoms but also as I was advised by her to prevent nerve damage, as that can’t be undone,” says Caves. “Once I was agreeable and over my hesitancy, it was a straightforward process. The surgery takes approximately 10 minutes or so, and when the freezing came out, my symptoms were gone—no numbness or any symptoms pretty instantly.”
Sharp, who had endured symptoms for two decades, believes her CTR was successful, although she hasn’t had quite the same results as Caves. “The pain got to be too much, and the doctor said that I could start to lose function,” she says. “It still hurts and it’s been a year. Yes, some of the pain has decreased for sure! I really thought all the pain would go away, but obviously there are some other nerves blocked.”
Postoperative care at home
As for what to expect in the days and weeks after the surgery, both admit the procedure makes it difficult to maintain independence—but that careful planning helped.
“I was able to go home right after the procedure—I didn’t stay to get help, and my mom was able to assist,” says Sharp. “I mostly did my own transfers. For bowel and bladder, ensure you have a way to do this—for me, transferring on the toilet was as simple as changing to my spare toilet so my left hand (that I wasn’t getting surgery on) was the front facing hand for transferring. I had help, and needed someone there for a couple of weeks. I didn’t shower for two weeks, took sponge baths, and then I rented a lift for the bath. Putting pressure on my hand to get in and out of the tub was not possible. Direct pressure wasn’t possible for about six weeks. Direct pressure that felt pain-free—that likely took about seven months. So be prepared, though obviously you can get around.”
Caves shared many of the same challenges as Sharp. “The first couple of days were the ones that I had to rely on assistance to transfer,” she says. “Shifting my weight and trying to do things with only one hand was tricky on the first couple of days. But within two weeks, I was back doing most everything.”
A little planning before surgery goes a long way afterwards
- Ensure you do your routine the morning of your surgery so you have some downtime before doing it again.
- “Prior to the surgery, pay attention to all those actions that enable your independence,” Caves advises. “Think about all the movements using your hands and arms for your bathroom routine, and getting dressed. I would recommend preparing meals for a few days before you have it done.”
- As always, keep in mind that everyone’s situation is unique and that any diagnosis and treatment of CTS begins with consulting your own doctor and healthcare team.