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Carpal tunnel is a very common problem that has been studied extensively. If you ask any hand surgeon what they see the most of, and what the most common surgery they do is, the answers are very likely to be carpal tunnel syndrome and carpal tunnel release respectively. Typing a lot incorrectly can give you carpal tunnel syndrome, as can any activity that includes repetitive wrist motions with elements of direct wrist compression. If you type correctly, there should be minimal stress on your carpal tunnel and a much lower chance of you getting carpal tunnel syndrome. But before getting into that, I think it’s worth explaining what the carpal tunnel is.

What is the carpal tunnel?

Your wrist bones are also called carpal bones, and there are eight of them in each of your wrists. Some of these bones form a concave surface (kind of like a small half pipe). Now imagine being in this half pipe of wrist bones but someone put a roof directly on top. Well, at this point it’s more like a tunnel. This is more or less what the carpal tunnel is. All of your tendons that flex your fingers, and a major nerve (the median nerve) that supplies some of the muscles and much of the sensation to your hand, need to travel through this tunnel in order to make it to the hand. Now imagine all these tendons and nerves are traveling through this tunnel, but that the roof started to cave in. Now all of the tendons and nerves are smushed against each other and the nerve is starting to complain. 

How do I know if I have carpal tunnel syndrome?

Carpal tunnel syndrome is when the main nerve that travels through the carpal tunnel to the hand is compressed and irritated. This causes numbness and tingling in the whole hand except for the pinky finger and half of the ring finger. It the nerve is compressed for a long time, some of the muscles that move the thumb will start to atrophy. If you wake up at night and have to shake out your hands, or you can’t feel the tips of your fingers then you might have carpal tunnel syndrome. In some cases, your doctor will do nerve conduction studies that can definitely tell you if you have carpal tunnel syndrome or not. Most of the time, this test is used to determine how bad the compression is, rather than to arrive at a diagnosis.

What can I do about my carpal tunnel syndrome?

The size of the carpal tunnel is largest when your wrist is neutral, and gets smaller when you flex or extend your wrist. This is not so much of a problem, until you go to sleep and curl your wrists in. Buying an over the counter carpal tunnel brace to be worn at night is a good way to get your wrist to calm down. When you type on a keyboard, you want to make sure that your wrists are in a neutral position and comfortably floating above the keys. Do not type while resting your wrist on the wrist rest. The wrist rests should only be used to rest your wrist when you are not typing. Physical therapy for nerve gliding can also be helpful in some cases. Some doctors will give a steroid injection into the carpal tunnel. While this may give some relief, it usually only provides lasting relief about 20% of the time. Lastly, if all else fails, your orthopedic doctor can do a carpal tunnel release which essentially cuts the roof open of the carpal tunnel (transverse carpal ligament). As far as surgeries go, this is one of the best ones out there in terms of how good it works, and how minimally invasive it is.

I hope I was able to answer all of your questions. If you have any that I didn’t answer, feel free to contact me.

-Written by Dr. Daniel Paull

The short answer is that neuropathy is when a nerve is irritated and isn’t working right which can cause numbness, tingling, weakness, or even pain. The term neuropathy doesn’t tell you what is causing the nerve to be irritated, only that something is bothering it. The most common type of neuropathy is diabetic neuropathy, meaning that the nerves get irritated due to the consequences of diabetes. But, there are many different types of neuropathy, which can present in all sorts of ways. Before going too much more into neuropathy, it’s worth talking a little more about how a nerve works, and what it does.

What is a nerve, and how does it work?

If you were to cut someone open and take a look at one of their nerves, it would almost look and feel like a piece of spaghetti, with the smallest nerves being microscopic sized spaghetti that you can’t see, and the largest ones having a diameter of about the size of a nickel. Nerves are really just fancy electrical wires that do different things. Some nerves power muscles, others provide sensation so you know when you’re touching something, while some control things such as your heart beating and how much you sweat. With the most common types of neuropathy, it’s mostly the sensory nerves that are affected. A diabetic with bad diabetic neuropathy won’t even know if they have a thumbtack stuck in their foot because they can’t feel it. 

What causes neuropathy?

There are many many reasons why someone can have neuropathy; autoimmune diseases, specific types of infections, trauma, kidney disease, liver disease, genetic disorders, tumors, medication, chronic nerve compression (carpal tunnel), industrial chemicals, heavy metals, alcoholism, vitamin deficiencies… In other words, nerves are delicate, and there are many many different reasons that a nerve can be irritated. 

What can I do about my neuropathy?

The most important thing you can do is to see a doctor who spends time with you, and can give you an accurate diagnosis. Once you have this, then you can start a treatment plan to deal with your neuropathy on a personal level. The treatment you need for your neuropathy may be different than what someone else may need. Some recommend a healthy diet and exercise. While a healthy diet and exercise are always a good idea, you still need an accurate diagnosis and treatment plan to attack the root cause of your neuropathy.

I hope I was able to answer some of your questions about neuropathy. If you still have more questions, I encourage you to contact me.

-Written by Dr. Daniel Paull

If you shoulder hurts, you may have torn your rotator cuff. But there are also a lot of other things that can cause your shoulder to hurt such as bursitis, or neck pain that travels to the shoulder. If you are having trouble lifting your arm up, then your rotator cuff may be torn. But there are some people who have pain when they lift their arms who don’t have rotator cuff tears. I know it all sounds confusing, and I’m going to try to explain it.

What is a rotator cuff?

In each shoulder you have a rotator cuff, which is a collection of 4 smaller muscles that originate on your shoulder blade and then attach onto your shoulder. If you feel the back of your shoulder blade, you can feel some of your rotator cuff muscles. By the time they connect to your shoulder they aren’t muscles so much anymore, rather they are tendons. When someone tears their rotator cuff, they tear one of these tendons that attach to the shoulder. The shoulder joint itself is not  like a ball and socket (like the hip), and more like a golf ball on a golf tee. The rotator cuff is responsible for keeping that golf ball on the golf tee. When you tear your rotator cuff, it interferes with this process which can cause inflammation and in some cases pain.

What happens when you tear your rotator cuff?

The answer to this question depends on how bad the tear is. If the tear is all the way through (full thickness tear), it can cause the shoulder to move funny and overtime lead to arthritis. Sometimes the tear is only part way which can cause pain, but may not lead to anything bad down the road. Strangely enough, there are some people with rotator cuff tears who don’t have any pain! This means that there are likely a lot of people who have torn rotator cuffs and don’t even know it. Fortunately, the rotator cuff is not a ticking time bomb and if it doesn’t hurt then the best thing to do is to leave it alone.

How do I know if my rotator cuff is torn?

If you have weakness and pain lifting your arm up after you did “something” to it, then you may have torn it. Some people may have pain now, but tore their rotator cuff a long time ago and didn’t even know it. The best way to know if your rotator cuff is torn is to get an MRI which can directly see the rotator cuff, and see if it’s torn. But as I said, even if you do happen to have a tear, it may not be the source of your pain. You might have a partial rotator cuff tear, but bad bursitis, and it’s actually the bursitis that’s giving you grief! The only way to know for sure is to get an evaluation by an orthopedic doctor, or someone who is trained in the shoulder. Whoever you end up seeing, just make sure they take the time to listen to you, and that they are treating you and not just what the MRI shows.

I hope I was able to give you some good information and help you on your path to recovery. If there are any questions you have that I didn’t answer, I encourage you to contact me.

-Written by Dr. Daniel Paull