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"I have heard that you can get carpal tunnel syndrome from typing, but my symptoms have occurred since beginning to play the guitar. Is there any relationship here?"

Our hands are unique, sophisticated tools that are very important to our everyday activities and the quality of our lives. This article reviews some of the more common conditions that can impair their function. The hand surgeons at Blue Ridge Bone & Joint are experts who have received specialty training beyond their board certified specialty training in orthopedic surgery and are available to evaluate and treat these and other problems affecting your hands.

Carpal tunnel syndrome is compression on the median nerve at the level of the wrist. The carpal tunnel is made of bones on three sides and a thick ligament which forms the roof of the canal. The contents of the carpal canal include the median nerve as well as the tendons which flex the fingers and thumb. The median nerve provides sensation to the thumb, index, middle, and a portion of the ring finger. The nerve also controls the muscles at the base of the thumb. Pressure within the carpal canal causes a delay in the transmission of impulses through the median nerve. This causes the characteristic symptoms of "tingling" and numbness in the fingertips, the hand "falling asleep", and clumsiness or fatigue with pinch or grasp. These symptoms can be associated with certain activities, can waken you at night, or can occur constantly.

Which came first, the chicken or the egg?

Similarly, it is difficult to know if carpal tunnel syndrome is due to a specific activity which causes increased pressure within the carpal tunnel, or if that activity has actually caused the narrowing of the canal. There are relatively few established causative factors which have been linked to carpal tunnel syndrome. These include obesity, thyroid disease, diabetes, and family history. The only proven occupations include repetitive use of vibratory tools such as jackhammers, and working in cold environments such as meat handlers.

If your symptoms occur during playing of the guitar, they are probably related to the prolonged flexed posture of your wrist as well as increased blood flow to the flexor compartments of the hand and wrist. These items have been shown to increase the pressure within the carpal tunnel, thus causing your tingling and hand fatigue.

Potential treatments include postural changes, stretching, bracing, anti-inflammatory medicines, injections, or surgical release. Surgery can usually be performed endoscopically with minimally invasive techniques which are less painful and have a quicker recovery time. This is performed as an outpatient with local anesthetic requires no post-op bracing, and immediate use of the hand is allowed. Prolonged, untreated carpal tunnel syndrome can lead to permanent sensory and motor loss of the hand. Therefore, if your symptoms are persistent, a thorough medical evaluation should be sought.

If conservative care of carpal tunnel syndrome fails to eliminate pain and return the patient to full activities, then Dr. Angelo Cammarata is available for consultation and expert care. He is board certified in orthopaedics and has done a fellowship in upper extremity care. He has successfully performed endoscopic carpal tunnel releases for over 15 years. He is a regional expert and referral source for hand and upper extremity problems, and has, for four consecutive years, been selected as one of America's Top Doctors by the Consumer Research Council of America.