Carpal Tunnel Syndrome: Signs, Symptoms, Causes and Treatments

Common hand and wrist problem can be prevented and treated

You wake in the night with a painful tingling sensation in your fingers — or no sensation at all.

As your condition advances, you have trouble holding the steering wheel to drive or typing on your computer keyboard. You experience weakness in your hand and begin dropping small objects.

If these signs and symptoms sounds familiar, you may have carpal tunnel syndrome, which is a very common problem. The condition is often associated with overuse of the hands and wrist and other factors.

“It’s important to get evaluated if you develop symptoms of carpal tunnel syndrome to get a diagnosis and rule out any other problem,” says Lorenzo Pacelli, MD, an orthopedic surgeon at Scripps Clinic Carmel Valley and Scripps Clinic Torrey Pines. “Talk to your doctor if your condition is interfering with your sleep at night and your day-to-day activities.

“Carpal tunnel syndrome is not something you want to ignore because if it goes untreated for a period of time, it can cause permanent damage to the nerve and use of your hand,” Dr. Pacelli says.

What is carpal tunnel syndrome?

Picture a tunnel running from your forearm through the center of your wrist. This narrow passage is called the carpal tunnel. Your median nerve, which supplies feeling and function to your thumb and first three fingers, runs through it.

Carpal tunnel syndrome occurs when the median nerve becomes compressed, either by a swollen ligament or inflammation of the tendons within the tunnel. Pressure on the nerve may cause numbness and tingling and pain in the wrist, hand or fingers (excluding your little finger).

What are the early signs?

Early signs of carpal tunnel syndrome often involve tingling or mild pain in the hands or wrist, usually during the night. “As the condition worsens, tingling may happen during the day. Hand weakness may make it hard to grasp small objects and perform other activities,” Dr. Pacelli says.

Who gets carpal tunnel syndrome — and why?

Carpal tunnel syndrome affects up to 5% of the adult population in the United States. The condition is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel.

Age, heredity and gender are among several risk factors.

Carpal tunnel syndrome is most often diagnosed between the ages of 40-60.

Women are three times more likely than men to experience the condition. Fluid build-up in the ligaments during pregnancy, menopause and before menstruation may trigger some cases.

Inflammatory conditions, such as rheumatoid arthritis, wrist injury or dislocation, diabetes and obesity are other risk factors.

Work activities that involve repetitive use of the wrist or hand may also contribute to nerve compression.

Treatments for carpal tunnel syndrome

Treatments range from rest to over-the-counter medication to physical therapy and surgery. A non-surgical approach may be all you need to get better.

“Resting the affected area for a period may be enough to ease inflammation. Also helpful is taking breaks more often or doing less of the activity that is causing you pain,” Dr. Pacelli says.

Next steps – if needed – may include using a splint to sleep, physical therapy and anti-inflammatory medication. “Sometimes we’ll do a cortisone injection to help reduce the swelling around the tendon to help to take pressure off the nerves,” Dr. Pacelli says.

Physical therapy can help restore functional mobility. At Scripps, physical therapists or occupational therapists provide hand therapy services.

Yoga is an alternative therapy that has been shown to reduce pain and improve grip strength.

When is surgery an option?

If pain or numbness are severe or do not improve with non-surgical treatments, surgery is an option.

Carpal tunnel release is one of the common procedures in the United States. In this procedure, the surgeon cuts through a ligament in the wrist to relieve pressure on the median nerve. The procedure is done with numbing medicine.

“It’s a very effective procedure. Recovery is two to three weeks. The hand stays a little weak for up to a month. But most of the time, the symptoms go away within the first week of the surgery,” Dr. Pacelli says.

4 tips for reducing risk of carpal tunnel syndrome

The following tips can help reduce your risk of carpal tunnel syndrome:

1.   Change the way you work

Make adjustments to promote correct posture and positioning and reduce repetitive stress. As you work, your wrists should be in the same position as they are when you dangle your arms at your sides.

2.   Take frequent breaks from repetitive tasks

Avoid excessive exertion of your hand and wrist muscles. Minimize vibration from machines or tools.

3.   Stretch your wrists before you start tasks and during breaks.

Learn to do isometric and stretching exercises to strengthen the muscles in the wrists and hands.

“Do exercises where you stretch your fingers and redistribute swelling around the tendons,” Dr. Pacelli says. “Wear protective braces if you are susceptible to carpal tunnel syndrome.”

4.   Simple wrist exercises for carpal tunnel syndrome

There are simple wrist exercises that are designed to help prevent and treat carpal tunnel syndrome.

A physical or occupational therapist can help you strengthen your hand and wrist. They can teach you how to do specific hand stretching exercises.

How to Get Rid of Nausea: Home Remedies for Nausea Relief

Most people have experienced nausea, that queasy feeling that often comes on suddenly. While nausea is not usually serious, it can be acutely uncomfortable.

“Nausea is an uneasiness of the stomach that is often accompanied by an urge to vomit,” says Erin Lester, MD, a family medicine physician at Scripps Coastal Medical Center Solana Beach. “Anyone can experience nausea, and the symptoms are straightforward. You feel like you’re going to vomit, although you may not actually do so.”

Causes of nausea

Pregnancy is one of the most common causes of stomach upset, often morning nausea, although the condition may occur at any time of the day. Often triggered by changing hormones, nausea during pregnancy is not usually a reason for concern, although it may be bothersome.

Other causes of nausea unrelated to pregnancy include:

Stress and anxiety

When you’re stressed or anxious, your gut’s normal rhythm of digestion is disrupted, which can leave you feeling nauseated. Taking deep, calming breaths can help you feel calmer and reduce the nausea. Sipping a cup of ginger tea or chewing on a piece of candied ginger may also help, says Dr. Lester. The spicy root has properties that are thought to ease nausea.

Dehydration

Even mild dehydration can cause stomach upset, so if you feel thirsty, don’t ignore it. Drinking a glass of plain water may be all you need to make your nausea go away. If you have symptoms of severe dehydration, such as fatigue or dizziness, see a doctor right away.

Low blood sugar

If you haven’t eaten for a few hours, you may have low blood sugar, causing you to feel nauseated and even dizzy. Eating something, particularly carbohydrates, will bring your blood sugar back to normal so you’ll start feeling better.

Medications

Many medications, including supplements and over-the-counter medicines, can lead to a queasy stomach. It will usually help if you eat something small before taking your medications.

“The best way to treat nausea without an identifiable cause is to stop anything that might be causing irritation to the stomach lining. Avoid alcohol, spicy foods and smoking,” explains Dr. Lester.

How to stop nausea

When you do experience the occasional upset stomach, simple home remedies can offer relief. Try these tips:

• Drink clear liquids

• Eat bland foods, such as saltine crackers or plain bread

•  Avoid fried, greasy or sweet foods

• Eat slowly

• Eat smaller, more frequent meals

• Do not mix hot and cold foods

• Drink beverages slowly

• Avoid activity after eating

• Avoid brushing your teeth after eating

Try the following (regardless of age) to stop vomiting:

• Drinking gradually larger amounts of clear liquids

• Avoiding solid food until the vomiting episode has passed

• Resting

• Temporarily discontinuing all oral medications, which can irritate the stomach and make vomiting worse. Before discontinuing prescribed medications, check with your doctor.

If you have any questions or concerns, reach out to your primary care physician.

“Your doctor is there to help you,” says Dr. Lester. “In the majority of situations, nausea can be treated easily at home and does not indicate a more serious underlying condition, but always check with your primary care physician if you have any doubts.”

My Doctor Is Not In, Can I See an NP or a PA?

by Scripps Healthcare

Nurse practitioners and physician assistants can both treat you

Your cough isn’t getting any better after a week. Your throat is aching now. But when you try to make an appointment, your primary care doctor is not available.

You’re asked if you’d like to see someone sooner. A nurse practitioner (NP) or physician assistant (PA) can see you in the morning.

Not sure what to do? Or the difference between physician assistants and nurse practitioners?

There are differences in their training and requirements. But both are licensed health care providers who can treat patients. And as their ranks grow, they are helping to increase access to health care for millions of Americans.

“Nurse practitioners and physician assistants are highly qualified medical professionals who can provide the same general care services as physicians,” says Carol Coloma, NP, a family nurse practitioner at Scripps HealthExpress in San Marcos.

In contrast to a nurse or medical assistant, who can take your weight and blood pressure and prepare you to see the doctor, a NP and PA can examine and treat you. Both hold advanced education degrees and extensive medical training.

Nurse practitioners and physician assistants in primary care

The number of NPs and PAs has steadily risen since the 1960s when programs for these medical professions began largely in response to a nationwide shortage of primary care physicians. Today, there are more than 325,000 licensed NPs, and about 140,000 certified PAs, practicing in the United States in a variety of health care settings.

At Scripps, NPs and PAs staff more than a dozen Scripps HealthExpress walk-in clinics. These convenient clinics — located at Scripps Clinic and Scripps Coastal Medical Center sites across San Diego County — provide same-day care for minor illnesses and injuries. Primary care teams made up of primary care physicians, NPs and PAs are also common at Scripps primary and specialty care offices.

Nurse practitioner’s role and scope of practice

Both PAs and NPs must have completed specific educational requirements and training programs in order to be able to treat patients. NPs and PAs provide the same general care services as physicians, including:

• Conducting physical exams

• Diagnosing and treating common, routine and acute illnesses

• Ordering and interpreting lab tests and X-rays

• Prescribing medication

What’s the difference between an NP and a PA?

Although their roles are similar, NPs and PAs have some differences in background and training.

NP programs are based on the nursing model and have a strong population focus. All applicants must be registered nurses (RNs) before they can complete the graduate-level education and clinical training needed to earn an NP degree.

NP licensing is done at the state level, generally by the board of nursing for the state in which the NP will practice. Certification is sometimes required to obtain a license. Certification is granted by national organizations in specialty areas of nursing practice.

Understanding the NP’s role

In addition to providing general care, NPs generally play a greater role in patient education and counseling than PAs. They focus on illness prevention and staying well. Most NPs specialize in primary care areas, such as family medicine, gerontology, women’s health, pediatrics or acute care.

A handful of states require NPs to practice in collaboration with a physician, including California, or under a physician’s direct supervision. Many states allow NPs to practice without any physician involvement.

Understanding the PA’s role

Physician assistant programs are master's level programs. Students must complete at least two years of college coursework in basic and behavioral sciences before applying to a PA program. Many PA programs also require prior health care experience with hands-on patient care.

Most students have a bachelor’s degree and about three years of health care experience before entering a PA program, according to the American Academy of Physician Assistants.

PA programs are based on the medical model and are more disease-centered. In addition to classroom and laboratory instruction, PAs complete clinical rotations in areas such as primary care, surgery, pediatrics and emergency medicine. PAs practice in medicine in all settings, including primary, emergency and surgical subspecialties.

The designation of PA-C, or physician assistant-certified, means the PA has been certified by the National Commission on Certification of Physician Assistants. Like NPs, many PAs pursue additional education to focus in a specific area.

Most states, including California, require PAs to have an agreement with a specific physician in order to practice.

PA vs. NP

So how do you know whether to see the doctor or a PA or NP?

“When you are faced with the choice of seeing an NP or PA right away or waiting for a physician, it’s generally better to get in and be seen,” Coloma says.

For coughs, earaches, rashes and other routine ailments, it’s fine to see an NP or PA. “Both work under the supervision of a physician and will discuss your care with him or her in case your problem turns out to be something more serious,” Coloma says.

Coloma adds, “The PA or NP will make sure your doctor is aware of your condition and proper actions are taken to provide the care you need.”

How to Schedule a Mammogram During Coronavirus Pandemic: What to Know

How to Schedule a Mammogram During Coronavirus Pandemic: What to Know

by Scripps Healthcare

Screening mammograms and COVID-19 vaccines are important

Scheduling an annual screening mammogram remains the best way to detect any early signs of breast cancer. However, some people have had questions about scheduling a mammogram during the COVID-19 pandemic. How safe are health facilities? Can I postpone my mammogram? Can the COVID-19 vaccine affect my mammogram?

Let’s start with what hasn’t changed. Breast cancer is still the second most common cancer among women in the United States according to the Centers for Disease Control and Prevention (CDC). Research shows it is easier to treat breast cancer when it is caught early. A screening mammogram is used to look for signs of breast cancer in women who don’t have any breast symptoms or problems.

Health care facilities, like those at Scripps, are still safe places for mammograms, with enhanced precautions in place to protect patients, doctors, nurses and staff from potential exposure to the coronavirus.

“If you are overdue for one, we encourage you to schedule your annual screening mammogram and work with your doctor if you have any questions,” says Rebecca Hsu, MD, a diagnostic radiologist at Scripps MD Anderson Cancer Center and Scripps Clinic. “Regular mammograms are the best tests doctors have to find breast cancer early.”

COVID vaccine and mammograms

If you are unable to schedule your screening mammogram before receiving the COVID-19 vaccine, doctors recommend having your mammogram done a minimum of four weeks after receiving your second vaccine dose. This applies to two-dose vaccines by Moderna and Pfizer.

The reason for this recommendation is that some women who receive these vaccines develop swollen lymph nodes, usually under the arm on the same side of the body where the vaccine was injected. This is a normal immune reaction to the vaccine and generally subsides within four weeks. It’s not yet known if the recently approved Johnson & Johnson vaccine may have a similar effect.

Scripps experts are raising awareness about timing considerations for scheduling screening mammograms and the COVID-19 vaccine.

“Because enlarged lymph nodes can be seen on mammograms, patients due for their annual screening mammograms are encouraged to schedule their mammograms either before they have received the first dose of the vaccine or at least four weeks after they have received the second dose. This will reduce the chances of getting called back for additional imaging due to the enlarged lymph nodes,” Dr. Hsu says.

Under normal circumstances, swollen lymph nodes are a sign of breast cancer and would raise concern appearing on a mammogram and would require further testing.

If you get vaccinated first and do not want to miss a scheduled mammogram, make sure to tell your doctor about your vaccination to help get the most accurate mammogram reading.

Is it safe to delay a screening mammogram?

For patients of average risk, postponing an annual screening mammogram a month or two during the pandemic should not affect the risk of breast cancer.

“If you are significantly overdue for a mammogram, it is especially important to make and keep your mammogram appointment,” Dr. Hsu says.

A delay is only recommended for screening mammograms, where the patient has no breast cancer symptoms. There should be no delay if the patient has symptoms.

A diagnostic mammogram is used to look at a woman’s breast if she has breast symptoms or if a change is seen on a screening mammogram. A diagnostic mammogram may include extra views of the breast that aren’t part of screening mammograms.

You should contact your doctor right away if you notice changes in your breasts or are experiencing unusual symptoms.

Be on the lookout for the warning signs of breast cancer. Consult with your doctor if you develop any of these symptoms:

• Bloody or clear nipple discharge that occurs without squeezing the nipple

• Breast dimpling or puckering

• Swollen, red or warm breasts

• Changes in size or shape

• A hard knot or thickening in the underarm area or inside the breast

• A scaly, itchy rash or sore on the nipple

• Inversion (pulling inward) of the nipple or breast

• Pain in one spot that doesn’t go away in two to three weeks

How safe are breast care locations?

If you’re a Scripps patient, don’t hesitate to schedule a doctor’s visit to discuss a medical issue, change of health status or for a preventive visit, including a mammogram, due to concerns about COVID-19.

“We have extensive safety procedures and protocols in place to protect patients, doctors, nurses, staff members and anyone else who enters a Scripps facility,” says Ghazala Sharieff, MD, MBA, Scripps chief medical officer, clinical excellence and experience.

Those safety precautions include:

• Curbside check-in through the MyScripps mobile app

• Asking that patients visit their doctor without a companion, if possible

• Screening for everyone entering a facility

• Requiring all physicians, staff members, patients and visitors to wear face masks or coverings

• Rigorous cleaning and disinfecting protocols for all facilities and equipment

Steps you can take to protect yourself from COVID

In addition to wearing a face covering, you can take other steps to reduce your risk when you go to your doctor’s office, including:

• Practice social distancing in waiting rooms.

• Practice proper hygiene by washing your hands frequently with soap and warm water for at least 20 seconds.

• Use hand sanitizer before and after your visit.

• Avoid touching communal surfaces in the office, such as doorknobs and elevator buttons, as much as possible.

• Avoid touching your face, eyes, nose and mouth.

• Do not come in if you are feeling sick or have a fever or cough.

While a mammogram takes only a short while to complete, it does involve close contact between a patient and medical professional.

“We have safety measures in place for every step of your visit and we encourage you to ask questions about how we do breast imaging,” Dr. Hsu says.

How Does COVID-19 Affect Older Adults?

Six ways to prevent illness, social isolation and lonelinessOlder adults – especially those with medical conditions – have been hit hard by COVID-19 and need extra support.

Those age 65 and older account for 80 percent of coronavirus-related deaths, according to the Centers for Disease Control and Prevention (CDC). People 85 and older have the highest risk of severe illness from COVID-19.

Many seniors are staying safe by staying home and social distancing, but are now at increased risk of social isolation and loneliness, which can result in depression, anxiety and other health problems.

Fortunately, many services are available to help seniors stay safe and socially engaged during the pandemic. These services include food delivery, online exercise programs and other free or low-cost offerings through public health services.

“We want our seniors, especially those most at risk for severe illness from COVID-19, to stay home as much as possible during the pandemic and to have a support system in place that can help ensure their safety and well-being at home,” says Alexander Meilan, DO, an internal medicine physician at Scripps Clinic Torrey Pines.

Dr. Meilan recommends the following:

1.   Don’t hesitate to seek emergency and non-emergency care

Don’t delay going to the emergency room or calling 911 for any medical emergency. Emergency departments have COVID-19 prevention plans to keep their patients and staff safe.

Staying in contact with your doctor is important especially for seniors with chronic conditions. In many cases, non-emergency visits can be done via telemedicine. In some cases, an in-person visit is necessary, such as getting an annual flu shot.

Caregivers can help their seniors download a telemedicine app to their smart phones or tablets and teach them how to use it. Make sure the app has privacy features to protect patient health information.

2.   Stay connected, prevent loneliness

Older adults should have a plan to safely stay in touch with family and friends during the pandemic to help prevent the ill-effects of social isolation and loneliness.

“Older adults should have someone they can reach out to if they need help getting food, medicine and other supplies. If they live alone, regular human contact can mean a lot to their health and well-being,” says Dr. Meilan.

Regularly scheduled phone calls, video conferences, texting and emails can help make up for a lack of in-person contact.

Caregivers can help their seniors set up and understand video conferencing options, such as FaceTime or Zoom.

3.   Stay physically active

Getting exercise may seem harder with gyms closed or concerns about going to one when they open. Many options are available to stay active without risk of exposure during the pandemic.

Find fun and creative ways to stay active at home. Join an online exercise class or find an exercise video for seniors on YouTube.

Go out for a walk. Make sure to wear a mask, especially if physical distancing is going to be difficult. Caregivers can join their seniors in a walk but should also take precautions.

Staying active may be harder for older adults with medical conditions that limit their ability to regularly exercise. The CDC recommends 150 minutes of moderate-intensity aerobic exercise per week but says those who cannot do this much should stay as physically active as their abilities and conditions will allow.

According to the CDC, regular exercise:

• Improves sleep

• Improves balance and reduces risk of falling

• Improves joint mobility

• Extends years of active life

• Helps prevent weak bones and muscle loss

• Delays onset of cognitive decline.

4.   Check delivery and pick up options

For those who have concerns about going out to buy groceries due to COVID-19 or who lack transportation or have limited physical mobility, look for grocery stores that offer pickup and delivery services to reduce their risk of exposure. Ask if they offer discounts or free delivery for seniors. Consider asking a neighbor or other family member to do the shopping for you.

For those who prefer to shop in person, look for stores that offer senior-only hours. Make sure they require customers to wear face covering. Get in and out of the store as quickly as possible.

Caregivers who shop for food for their seniors can set aside time for conversation after delivering groceries to help prevent loneliness.

5.   Prevent falls at home

More time at home may increase the chances of an accidental fall that results in injury. Learn how to reduce the risk of falling at home.

Make home safer, for example, by removing loose rugs, adding handrails to stairs and hallways if needed and keeping adequate lighting in dark areas.

Also:

• Schedule a risk assessment for falls with health care provider.

• Stay active, focus on balance, strength training and flexibility exercises.

• Schedule annual vision and hearing exams.

• Manage medications, understand their side effects.

6.   Make a list of resources

Create a list of organizations to contact for information, health care services

including mental health or counseling as well as food and other support.

• San Diego County’s Aging and Independence Services provides an array of services, including access to home-based support services, meals and counseling help.

• Elderhelp of San Diego provides community-based solutions through staff and volunteers committed to helping older adults live independently in their own homes.

• Stay at Home. Save Lives. Check in is a statewide campaign in California to help combat isolation and food insecurity among people 65 and older.

• AARP Foundation's Connect2Affect program provides information, and options for older people to stay socially connected.

• The federal Substance Abuse and Mental Health Services Administration has a hotline, 800-662-HELP (4357), to help people find counseling services in their area.