All about Carpal Tunnel Syndrome and Treatment in Las Vegas

You’re working at your desk, or from home in this pandemic in Las Vegas, trying to ignore the tingling or numbness you’ve had for months in your hand and wrist. Suddenly, a sharp, piercing pain shoots through the wrist and up your arm. Just a passing cramp? More likely you have carpal tunnel syndrome, a painful progressive condition caused by compression of a key nerve in the wrist.

Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers (although not the little finger), as well as impulses to some small muscles in the hand that allow the fingers and thumb to move. The carpal tunnel – a narrow, rigid passageway of ligament and bones at the base of the hand – houses the median nerve and tendons. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed. The result may be pain, weakness, or numbness in the hand and wrist, radiating up the arm. Although painful sensations may indicate other conditions, carpal tunnel syndrome is the most common and widely known of the entrapment neuropathies in which the body’s peripheral nerves are compressed or traumatized.

Symptoms usually start gradually, with frequent burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers. Some carpal tunnel sufferers say their fingers feel useless and swollen, even though little or no swelling is apparent. The symptoms often first appear in one or both hands during the night, since many people sleep with flexed wrists. A person with carpal tunnel syndrome may wake up feeling the need to “shake out” the hand or wrist. As symptoms worsen, people might feel tingling during the day. Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In chronic and/or untreated cases, the muscles at the base of the thumb may waste away. Some people are unable to tell between hot and cold by touch.

Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. Most likely the disorder is due to a congenital predisposition – the carpal tunnel is simply smaller in some people than in others. Other contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture; overactivity of the pituitary gland; hypothyroidism; rheumatoid arthritis; mechanical problems in the wrist joint; work stress; repeated use of vibrating hand tools; fluid retention during pregnancy or menopause; or the development of a cyst or tumor in the canal. Carpal tunnel syndrome is also associated with pregnancy and diseases such as diabetes, thyroid disease, or rheumatoid arthritis. In some cases no cause can be identified.

There is little clinical data to prove whether repetitive and forceful movements of the hand and wrist during work or leisure activities can cause carpal tunnel syndrome. Repeated motions performed in the course of normal work or other daily activities can result in repetitive motion disorders such as bursitis and tendonitis. Writer’s cramp – a condition in which a lack of fine motor skill coordination and ache and pressure in the fingers, wrist, or forearm is brought on by repetitive activity – is not a symptom of carpal tunnel syndrome.

Women are three times more likely than men to develop carpal tunnel syndrome, perhaps because the carpal tunnel itself may be smaller in women than in men. The dominant hand is usually affected first and produces the most severe pain. Persons with diabetes or other metabolic disorders that directly affect the body’s nerves and make them more susceptible to compression are also at high risk. Carpal tunnel syndrome usually occurs only in adults.

The risk of developing carpal tunnel syndrome is not confined to people in a single industry or job, but is especially common in those performing assembly line work – manufacturing, sewing, finishing, cleaning, and meat, poultry, or fish packing. In fact, carpal tunnel syndrome is three times more common among assemblers than among data-entry personnel. A 2001 study by the Mayo Clinic found heavy computer use (up to 7 hours a day) did not increase a person’s risk of developing carpal tunnel syndrome.

During 1998, an estimated three of every 10,000 workers lost time from work because of carpal tunnel syndrome. Half of these workers missed more than 10 days of work. The average lifetime cost of carpal tunnel syndrome, including medical bills and lost time from work, is estimated to be about $30,000 for each injured worker.

Early diagnosis and treatment are important to avoid permanent damage to the median nerve. A physical examination of the hands, arms, shoulders, and neck can help determine if the patient’s complaints are related to daily activities or to an underlying disorder, and can rule out other painful conditions that mimic carpal tunnel syndrome. The wrist is examined for tenderness, swelling, warmth, and discoloration. Each finger should be tested for sensation, and the muscles at the base of the hand should be examined for strength and signs of atrophy. Routine laboratory tests and X-rays can reveal diabetes, arthritis, and fractures.

Physicians can use specific tests to try to produce the symptoms of carpal tunnel syndrome. In the Tinel test, the doctor taps on or presses on the median nerve in the patient’s wrist. The test is positive when tingling in the fingers or a resultant shock-like sensation occurs. The Phalen, or wrist-flexion, test involves having the patient hold his or her forearms upright by pointing the fingers down and pressing the backs of the hands together. The presence of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing numbness, is felt in the fingers within 1 minute. Doctors may also ask patients to try to make a movement that brings on symptoms.

Often it is necessary to confirm the diagnosis by use of electrodiagnostic tests. In a nerve conduction study, electrodes are placed on the hand and wrist. Small electric shocks are applied and the speed with which nerves transmit impulses is measured. In electromyography, a fine needle is inserted into a muscle; electrical activity viewed on a screen can determine the severity of damage to the median nerve. Ultrasound imaging can show impaired movement of the median nerve. Magnetic resonance imaging (MRI) can show the anatomy of the wrist but to date has not been especially useful in diagnosing carpal tunnel syndrome.

Treatments for carpal tunnel syndrome should begin as early as possible, under a doctor’s direction. Underlying causes such as diabetes or arthritis should be treated first. Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms, and immobilizing the wrist in a splint to avoid further damage from twisting or bending. If there is inflammation, applying cool packs can help reduce swelling.

Non-surgical treatments

– In special circumstances, various drugs can ease the pain and swelling associated with carpal tunnel syndrome. Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and other nonprescription pain relievers, may ease symptoms that have been present for a short time or have been caused by strenuous activity. Orally administered diuretics (“water pills”) can decrease swelling. Corticosteroids (such as prednisone) or the drug lidocaine can be injected directly into the wrist or taken by mouth (in the case of prednisone) to relieve pressure on the median nerve and provide immediate, temporary relief to persons with mild or intermittent symptoms. (Caution: persons with diabetes and those who may be predisposed to diabetes should note that prolonged use of corticosteroids can make it difficult to regulate insulin levels. Corticosterioids should not be taken without a doctor’s prescription.) Additionally, some studies show that vitamin B 6 (pyridoxine) supplements may ease the symptoms of carpal tunnel syndrome.

– Stretching and strengthening exercises can be helpful in people whose symptoms have abated. These exercises may be supervised by a physical therapist, who is trained to use exercises to treat physical impairments, or an occupational therapist, who is trained in evaluating people with physical impairments and helping them build skills to improve their health and well-being.

Alternative therapies – Acupuncture and chiropractic care have benefited some patients but their effectiveness remains unproved. An exception is yoga, which has been shown to reduce pain and improve grip strength among patients with carpal tunnel syndrome.


Carpal tunnel release is one of the most common surgical procedures in the United States. Generally recommended if symptoms last for 6 months, surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve. Surgery is done under local anesthesia and does not require an overnight hospital stay. Many patients require surgery on both hands. The following are types of carpal tunnel release surgery:

Open release surgery, the traditional procedure used to correct carpal tunnel syndrome, consists of making an incision up to 2 inches in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel. The procedure is generally done under local anesthesia on an outpatient basis, unless there are unusual medical considerations.

Endoscopic surgery may allow faster functional recovery and less postoperative discomfort than traditional open release surgery. The surgeon makes two incisions (about ½ inch each) in the wrist and palm, inserts a camera attached to a tube, observes the tissue on a screen, and cuts the carpal ligament (the tissue that holds joints together). This two-portal endoscopic surgery, generally performed under local anesthesia, is effective and minimizes scarring and scar tenderness, if any. Single portal endoscopic surgery for carpal tunnel syndrome is also available and can result in less post-operative pain and a minimal scar. It generally allows individuals to resume some normal activities in a short period of time.

Although symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery can take months. Some patients may have infection, nerve damage, stiffness, and pain at the scar. Occasionally the wrist loses strength because the carpal ligament is cut. Patients should undergo physical therapy after surgery to restore wrist strength. Some patients may need to adjust job duties or even change jobs after recovery from surgery.

Recurrence of carpal tunnel syndrome following treatment is rare. The majority of patients recover completely.

How can carpal tunnel syndrome be prevented?

At the workplace, workers can do on-the-job conditioning, perform stretching exercises, take frequent rest breaks, wear splints to keep wrists straight, and use correct posture and wrist position. Wearing fingerless gloves can help keep hands warm and flexible. Workstations, tools and tool handles, and tasks can be redesigned to enable the worker’s wrist to maintain a natural position during work. Jobs can be rotated among workers. Employers can develop programs in ergonomics, the process of adapting workplace conditions and job demands to the capabilities of workers. However, research has not conclusively shown that these workplace changes prevent the occurrence of carpal tunnel syndrome.

What research is being done?

The National Institute of Neurological Disorders and Stroke (NINDS), a part of the National Institutes of Health, is the federal government’s leading supporter of biomedical research on neuropathy, including carpal tunnel syndrome. Scientists are studying the chronology of events that occur with carpal tunnel syndrome in order to better understand, treat, and prevent this ailment. By determining distinct biomechanical factors related to pain, such as specific joint angles, motions, force, and progression over time, researchers are finding new ways to limit or prevent carpal tunnel syndrome in the workplace and decrease other costly and disabling occupational illnesses.

Randomized clinical trials are being designed to evaluate the effectiveness of educational interventions in reducing the incidence of carpal tunnel syndrome and upper extremity cumulative trauma disorders. Data to be collected from a National Institute for Occupational Safety and Health-sponsored study of carpal tunnel syndrome among construction workers will provide a better understanding of the specific work factors associated with the disorder, furnish pilot data for planning future projects to study its natural history, and assist in developing strategies to prevent its occurrence among construction and other workers. Other research will discern differences between the relatively new carpal compression test (in which the examiner applies moderate pressure with both thumbs directly on the carpal tunnel and underlying median nerve, at the transverse carpal ligament) and the pressure provocative test (in which a cuff placed at the anterior of the carpal tunnel is inflated, followed by direct pressure on the median nerve) in predicting carpal tunnel syndrome. Scientists are also investigating the use of alternative therapies, such as acupuncture, to prevent and treat this disorder.

Where can I get more information?

For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network (BRAIN) at:

P.O. Box 5801
Bethesda, MD 20824
(800) 352-9424

Information also is available from the following organizations:
American Chronic Pain Association (ACPA)
P.O. Box 850
Rocklin, CA 95677-0850
[email protected]
Tel: 916-632-0922 800-533-3231
Fax: 916-652-8190
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
National Institutes of Health, DHHS
31 Center Dr., Rm. 4C02 MSC 2350
Bethesda, MD 20892-2350
[email protected]
Tel: 301-496-8190 877-22-NIAMS (226-4267)

Centers for Disease Control and Prevention (CDC)
U.S. Department of Health and Human Services
1600 Clifton Road, N.E.
Atlanta, GA 30333
[email protected]
Tel: 800-311-3435 404-639-3311/404-639-3543
Occupational Safety & Health Administration
U.S. Department of Labor
200 Constitution Avenue, NW
Washington, DC 20210
Tel: 800-321-OSHA (-6742)

Carpal Tunnel Syndrome Fact Sheet,” NINDS. Publication date November 2002.

NIH Publication No. 03-4898
Back to Carpal Tunnel Syndrome Information Page
See a list of all NINDS Disorders
Publicaciones en Español
Síndrome del Túnel Carpiano
Prepared by:
Office of Communications and Public Liaison
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892
NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.

All NINDS-prepared information is in the public domain and may be freely copied.  We Credit NINDS and the NIH.

Feel free to read the transcription below to the video above

everybody’s actually by the game


redactor you’re in sport soccers talking


to you today about carpal tunnel


syndrome this is a study that we’ve


covered multiple times but I still get a


lot of questions about it and a lot of


requests to do videos about it


specifically how you impact the gaming


community how it impacts people do a lot


of typing or texting or keyboarding our


mouse use is really extreme so today I’d


like to go over the basics of carpal


tunnel what it is again the anatomy of


carpal tunnel as well as how its treated


and how its treated surgically and


non-surgically so for myself as no big


surgery I see a lot of gamers of course


from all over the world a lot of


athletes who develop carpal tunnel


syndrome and I want to give you some


basics today about it how to prevent it


hopefully and more importantly how to


prevent any type of surgical


intervention so let’s begin so what is


carpal tunnel carpal tunnel is


impingement of the median nerve under


the TCL the transverse carpal ligament


so if you think about the layers here of


the hand over this area there’s skin and


then there’s fat and then there’s


something comes the palmar aponeurosis


and then other that there are some


vessels and the next thing is the


transverse carpal ligament and the


transverse carpal ligament is the median


nerve so when there’s a problem like


carpal tunnel someone will come in and


they’ll have the following problem


they’ll have numbness and tingling and


their thumb index finger middle finger


half of the ring finger they’ll have a


decrease in dexterity decrease in stress


don’t have pain that wakes them up at


night in their hands we have to shake


their hands out they will have


difficulty driving difficulty playing


sports just difficulty in life they’ll


also come in and say well definitely I’m


dropping all the cups and plates in my


home because I have no strength in my


hands so if you have those problems of


course it can be associated with carpal


tunnel syndrome now the issue here is


well how


treat it who commonly has it what it


commonly affects women and it commonly


affects people and their late s are


early to mid s however what I see now


in the gaming community it affects


people I’ve seen as young as years


old and as old as so and the person I


have done surgery on for carpal tunnel


oldest was I think he was ninety nine


and a half actually so it can affect a


wide demographic so if you have those


problems as population you have carpal


tunnel so it’s important that you talk


to your healthcare professional yeah a


lot of tests that we can do the first


thing that is most important for any


position of course will be to get your


history and to do a physical exam


because once we do that we can see if


there really are these issues that you


think are bothering you how we can help


you now the other tests we can get a


test called an EMG nerve conduction


study whereby they will place needles


and certain specific points of your


upper Trinity to check your nerves


specifically the median nerve also will


often check the median nerve as well as


the alternative we do this because


there’s something that we’ll talk about


another time is cubital tunnel syndrome


which is the ulnar nerve is affected


here at the elbow but for now carpal


tunnel now the other thing that we will


get is an ultrasound sometime because an


ultrasound can tell us if there is a


Gailey insist or some type of mass


that’s impinging on the median nerve


here at the carpal tunnel now with that


said if we do all of those tests and


it’s positive that you do have carpal


tunnel and there can be a wide variety


sometimes it can be from to 


percent of the tests especially the EMG


can be negative when the person still


has carpal tunnel so I want you to know


that if you have a negative test it


doesn’t mean you don’t have carpal


tunnel it just simply means that it


wasn’t picked up by that test and all it


depends on the sensitivity of the test


as well as the operator the EMG you know


who performed the tests did they do it


really well they do it properly so a lot


of variables there now


let’s talk about how do we treat carpal


tunnel well we can initially treat it


with a change in what you’re doing for


example if you’re gaming for eighteen or


twenty three hours a day


well maybe game less that’s important


maybe game differently maybe there’s a


different Mouse make sure that your


setup is ergonomically balanced you want


to maybe change the mouse setting to


maybe be less less sensitive maybe add a


mid-range change your keyboard to make


sure it’s ergonomically balanced make


sure that you’re sitting properly while


you’re gaming that you’re your posture


is appropriate that you’re not leaning


your shoulders down you’re not dipping


your neck down on your game you’re not


in this type of position when you’re


when you hold a controller for example


that you’re your chest is upright your


shoulders are square your head is up


your neck is relaxed other things that


you want to correct of course is your


work if you work at a desk that’s not


balanced if you’re doing an extreme


amount of keyboarding every day these


things may have to be collected or your


mouth may need it for a mouse you may


have to change that to a trackball


it depends on what works for your body


especially if you’re having problems and


want to do things quickly to prevent the


progression of carpal tunnel now if


those tests are conclusive that you have


if the test else that you have instead


of symptoms these are the ways that we


treat carpal tunnel number one we will


ask them to change their work habits


whatever you’re doing


number two we will treat you an embrace


for a short period of time because if


you use a brace for a long period of


time and actually make the entire


Trinity much weaker because you’re not


using your hands and your fingers and


your wrists properly so you use a brace


for a short period of time of course the


big thing I use in my practice is


acupuncture I love acupuncture is really


a underutilized and underappreciated


mode of healing so I love acupuncture so


I saw up in my practice with acupuncture


as well as diet I asked the patient I’m


taking care of


I’ll ask him about their diet do they


have a lot of psyllium in their diet a


lot of fried foods a lot of sugar a lot


of light rice a lot of white bread you


know things that really don’t have a lot


of great nutritional value


so we talked about that we also talked


about the need to exercise we have to


exercise exercise like gaming exercise


the lifestyle Gaming is a lifestyle so I


want you to really consider doing that


also it’s so very very important so if


acupuncture has not been effective the


next thing I do in my practice physical


therapy you’ll see an occupational


therapist or physical therapist for


maybe three to four weeks see if that


gives some benefit now if none of that


helps then the next thing we can talk


about of course is revisiting their work


side of their gaming area to make sure


that everything is ergonomically


balanced and working properly for their


body their body type for their height


then if none of that helps then we can


talk about something more invasive the


more basic thing of course would be an


injection to the wrist so we’ll inject


the carpal tunnel with the steroid now


I’m not big on any medication but


sometimes course we have to use it to


help the patient to get better so we do


and we’ll do an injection I in my


practice I use kilowog and sometimes


I’ll use a diplomate doll but more often


can unlock and we’ll do injects with


that and marcaine if they have relief


from that great now I’ll tell you my


practice the statistics that I have are


the following


% of people get better from two weeks


to two to five years and then the


symptoms return about thirty percent of


people I get injection in my practice


again I’m not talking about the


literature in general from from other


places other studies of the hospital my


my practice the doctor leave my client


that has no experience food there we see


six or seven people get better from two


weeks to two to five years then they’re


still come back about % of people that


I have want one injection the pain


numbers continue and decrease Griffith


goes away and they never come back again


which is great when we call them back to


say hey I’m not having problems I don’t


need to see which is fantastic then %


of people it has no effect at all and


then we have to talk about more invasive


things like surgery now but I do tell


everyone always try to avoid surgical


surgery always does we’ll do one of


three things make you better make you


worse or no change so you talk about a


.% chance of getting better so I


always say if you can oblige


for anything trying to avoid that now


with that said I want to go over some


basic exercises for carpal tunnel


syndrome these can be done in your


office at your gaming site in your car


that they’re just simple to do so again


get a gliding exercise we talked about


them before but I added a twist to those


so you can do them this way with the


hand open you can do them with the fist


close this way if you want to reverse it


so Ken this way Tim that way can with


the hand open ten with the hand open


going the opposite direction then you


can do these these are flappers up and


down up and down up and down and then


the up you want to really hold to really


stretch out your your form stretch out


the extensors of your of your hands go


up and hold like that I’m going to hold


this for about thirty seconds really


really easy I don’t want you to hold it


flex for thirty Seconds I watched for


carpal tunnel specifically I want you to


hold it up for thirty seconds just like


that with the elbow straight which your


neck relaxed with your shoulders square


all right very very simple then the


other things that you can do of course


are just shaking out your hand shaking


out your wrist just like this for our


thirty Seconds to shake them out you can


do this every hour for about a minute


it’s really easy to shake up your wrist


we can check them out and go around this


way shake them out go around that way


really simple so would that say carpal


tunnel is one of the most common


entities that I treat in my practice not


only in the gaming community but with


people do a lot of repetitive motion so


I hope this video helps you please


subscribe below and follow me and like


me on all my social media platforms I


want to remind everyone of course that


you can join me every first Saturday of


the month on twitch TV right interact


with gamers from all over the world


escape your questions ourselves our


fitness health and lifestyle remember


gaming is a lifestyle this dr. levo I’ll


see you soon

 Thanks to CC license and Dr. C for sharing this valuable info.  Feel free to read the transcription below… 


my name is Doug Carlin I’m an orthopedic


hand surgeon and I work at the Caroline


Surgery Center


I’ve board-certified an orthopaedic


surgery with a certificate of added


qualification and hand surgery once we


have the diagnosis established I can


recommend treatment options treatment


options can range from postural changes


particularly at night so that would


include wearing a splint at night that


keeps the wrist more still if that’s


unsuccessful the next treatment options


can include an injection into the carpal


tunnel which is a cortisone injection


which can reduce the swelling around the


nerve and potentially give you relief


once you’ve crossed the threshold into


having persistent or constant symptoms


surgery is the best option to avoid


further damage to the nerve the role of


surgery is to relieve the pressure on


the nerve to allow the body to heal the


nerve and improve your your symptoms the


surgery is done as an outpatient




it’s a approximately minute long


surgery done with mostly local


anesthetic and a light sedation with


very low complication rate there’s two


ways to do the surgery I do what’s


called a mini open carpal tunnel release


which is a small incision here that’s


often less than two centimeters long i


incise the skin I go down through the


what’s called the subcutaneous tissues


to the transverse carpal ligament which


runs this direction and the transverse


carpal ligament is divided in the same


line as the skin incision which allows


the carpal tunnel to open up and become


larger to reduce the pressure on the


nerve once that’s accomplished three


stitches are placed in the skin in this


area and a light bandage is placed from


from here to here


in your hand on your hand that stays on


for a total of three days your fingers


are free to move to do most household


type chores writing typing feeding


yourself is all possible after surgery


very little discomfort after surgery you


have three stitches in the palm of your


hand we send you home with a small light


bandage that stays on for three days


your fingers are free to move




essential tasks such as feeding yourself


writing typing putting on clothes are


all able to be performed immediately


after surgery there’s some mild soreness


but it’s not a particularly painful


procedure typically the surgery is long


lasting and we don’t see recurrences of


carpal tunnel there’s no particular


exercises that need to be done after the


surgery to prevent it from recurring the


majority of patients can return to work


the day following surgery a typical


result following surgery is that the


tingling that you feel in your hand what


I call the hot symptoms the burning type


symptoms or tingling type symptoms


resolved immediately it’s a common


response after surgery for a patient to


come back and say I should have done


this much sooner


the percentage of what a patient would


consider a good or an excellent result


from carpal tunnel surgery is very high


and most literature will quote a success


rate of over % it’s one of the more


successful procedures that we do in


orthopedic surgery