Carpal Tunnel Syndrome

Hello, my name is Alex Kish and I am a new orthopaedic surgeon with OSS Health based in the Hanover office on Eisenhower Drive.

My practice focuses on taking care of upper extremity injuries or problems from the shoulder down to the fingertips. As a hand surgeon, I am excited to join OSS Health and help the greater Hanover area with their upper extremity needs.

A common complaint hand surgeons see in their office is numbness and tingling, as well as pain developing in the thumb, index finger, and middle finger. This is usually related to compression of the median nerve at the wrist, referred to as “carpal tunnel syndrome.” This condition affects over 3 million people in the United States each year. My aim is to alleviate these symptoms with various modes of treatment. Signs that may point toward carpal tunnel are:

Night Pain: One of the first signs of carpal tunnel is pain in the fingers that wakes you at night. This is due to your wrists being in a flexed position that causes increased pressure on the nerve as you sleep. This can be troublesome and lead to disturbed sleep and fatigue during the day.

Numbness/Tingling/Shock like sensations: As pressure on your median nerve in the wrist prolongs, the blood supply decreases leading to the sensation of numb fingers, tingling, and shock like sensations. Some patients will describe the tips of the thumb, index finger, or middle finger having a “sandpaper” feeling. It typically starts at the tips of the fingers but can involve the entire finger as time goes on.

Weakness: The longer pressure builds on the nerve, issues may arise with weakness in the thumb muscles with pinching or grasping activity, and some patients will notice their hand appears flat as the muscles in the thumb lose their mass.

There are various treatment options to address numbness and tingling in your fingers. First line treatment consists of over-the-counter antiinflammatory medications (NSAIDs) to decrease inflammation, and a splint to wear on your wrist at night to prevent them from flexing. If these do not help, the typical next steps are to obtain a nerve conduction study to determine where and to what extent the compression of the median nerve is.

Surgical intervention for carpal tunnel consists of a surgical release of the transverse carpal ligament, a structure that links wrist bones together and acts as a covering over the nerve in the wrist, causing the pressure on the nerve. There are different ways to release the ligament, either with a camera and small incision on the wrist, known as “endoscopic carpal tunnel release” or with a small incision in the palm known as a “mini open carpal tunnel release.” Both ways to release the ligament typically offer a quick return to work and improvement in your symptoms. Both of these procedures are performed as an outpatient surgery, where you would go home the same day from the surgery center or hospital.

Sometimes numbness and tingling can occur in the small finger or pain and numbness may travel down from the neck/shoulder into the hand which are not related to carpal tunnel syndrome. Like the workup of carpal tunnel, evaluation of these conditions in the office may require a nerve test with treatment consisting of bracing, NSAIDs, and possible surgery on a different area of the arm or actually in your neck.

I am happy to discuss your numbness and tingling in the hand and help you get back to the activities you enjoy. Please call the OSS HEALTH HANOVER office at 717.633.0031 or visit us at osshealth.com.