Hand and Wrist
Dr. Raymund Chung, specializing in hand and microvascular surgery, is trained to diagnose and treat all problems associated with the hand wrist and forearm. His patients are seen for carpal tunnel syndrome, tennis elbow, wrist pain, sports injuries of the hand and wrist, fractures of the hnd, wrist, and forearm, and trigger finger.
Dr Chung has a well-earned reputation regionally for excellent results. We have provided some additional information below about carpal tunnel - which is very common in our patient population.
Carpal tunnel syndrome may make it difficult or painful to perform certain activities, and it also will typically get worse over time without treatment. Early diagnosis and treatment is important to avoid permanent damage.
Dr. Raymond Chung is our carpal tunnel specialist at Orthopedic Specialty Clinic. He has over 20 years of experience with carpal tunnel surgery, and is fellowship trained in hand and microvascular surgery. When a patient has carpal tunnel syndrome, Dr. Chung recommends an individualized treatment plan based on the patient’s needs and backed by current medical research.
What Are the Causes & Symptoms of Carpal Tunnel Syndrome?
Though people often refer to this condition as simply “carpal tunnel,” the carpal tunnel is actually a part of your anatomy. It is a small, narrow tunnel in the wrist formed by the wrist bones and a ligament called the transverse carpal ligament. The median nerve, which supplies feeling in the thumb, index, middle, and half of the ring fingers and also controls the muscles at the base of the thumb, runs through the carpal tunnel. The tendons that bend the fingers and thumb also pass through the carpal tunnel.
Carpal tunnel syndrome occurs when the carpal tunnel becomes inflamed or narrowed, putting pressure on the median nerve. The classic “textbook” symptoms of carpal tunnel syndrome are numbness and tingling in the thumb, index, and long fingers, but in some cases, patients may feel pain or a burning sensation. Some patients also report that the hand feels swollen, even if there is no visible swelling present. As carpal tunnel syndrome progresses, patients may lose grip strength or have weakness in the hands.
The precise cause of carpal tunnel syndrome is often unknown. Repetitive hand and wrist motions may play a role in the development of carpal tunnel syndrome. Heredity and health conditions like diabetes, rheumatoid arthritis, and thyroid gland imbalance may also increase a patient’s risk of developing carpal tunnel syndrome.
Treating Carpal Tunnel Syndrome
Dr. Chung takes a history and examines each patient to confirm a diagnosis of carpal tunnel syndrome. Nerve testing, although not necessary to make the diagnosis, may be performed to confirm the diagnosis, especially in situations when the symptoms are not classic and when other factors may be involved.
Dr. Chung bases his recommended treatment plan on the intensity and duration of the patient’s symptoms. Milder cases of carpal tunnel may be treated with nonsurgical methods, while more severe or persistent cases may require surgery.
Unless carpal tunnel symptoms are very severe, Dr. Chung will typically recommend nonsurgical treatments as a first course of action. There are many “home remedies” for carpal tunnel syndrome; while most are not harmful, there is also no scientific proof that they are helpful. Dr. Chung bases his treatment recommendations on the latest scientific evidence.
Nonsurgical treatment for carpal tunnel syndrome typically involves night splinting, which keeps your wrist straight while you are asleep to reduce pressure on the median nerve. Dr. Chung may also recommend taking vitamin B6 supplements, light exercise, and smoking cessation which can possibly help symptoms and overall nerve health. Corticosteroid injections may also be useful as a treatment or diagnostic tool for carpal tunnel syndrome.
Over time, carpal tunnel syndrome can lead to permanent nerve damage. If a patient’s symptoms are severe or persist with nonsurgical treatment, Dr. Chung may recommend surgery to help avoid or limit permanent nerve damage.
The surgical procedure is called carpal tunnel release surgery. During this procedure, Dr. Chung divides the transverse carpal ligament to make more space in the carpal tunnel. This reduces pressure on the median nerve, which may help to relieve symptoms.
Dr. Chung performs carpal tunnel surgery in an outpatient surgery center using a small incision made over the ligament. Typically, the surgery is performed under a regional block performed by the anesthesiologist. Minimally invasive surgical techniques help reduce pain in recovery, and patients often do not need to take much pain medication after surgery.
Recovering After Carpal Tunnel Surgery
Patients return home the day of surgery, and most patients don’t have a lot of pain in recovery. The hand will be bandaged for the first 5 days, and patients return to Dr. Chung’s office to have their stitches removed after 10 days.
Most patients do not require formal hand therapy, though patients who have a higher amount of pain or stiffness may benefit from working with a hand therapist. Recovery is progressive as patients regain strength in the hand. For the first week, patients may use the hand for light activities like typing. It may take as long as 4 weeks for patients to perform activities that involve gripping and/or twisting, like wringing out a dishrag or turning a doorknob with that hand. Most patients regain normal function within 8 weeks of surgery.
Most patients are able to resume all normal activities once they have fully recovered. If there is any pre-existing permanent nerve damage, the patient’s symptoms may not resolve completely, but are typically improved. Other factors such as diabetes or neck issues may also result incomplete symptom resolution. In rare cases (1-2%), carpal tunnel syndrome may recur after surgery, but the majority of patients have long-term improvement of symptoms.
Carpal Tunnel Treatment & Surgery in Fredericksburg, VA
Dr. Raymond Chung, our carpal tunnel specialist, is fellowship trained in hand surgery and has over 20 years of experience in treating carpal tunnel syndrome. Dr. Chung recommends treatment options based on the patient’s individual needs taking into account the duration as well as the severity of symptoms. If you would like to schedule an appointment with Dr. Chung, please call our office at (540) 361-1830 or request an appointment via our online form.