Carpal tunnel injury is rare for pitchers

Last week, Boston Red Sox starting pitcher David Price was forced to miss at least one start due to symptoms of numbness in his dominant left hand. He was eventually diagnosed with carpal tunnel syndrome (CTS), a condition not commonly associated with major league pitchers. Subsequently, a controversy has ensued based on speculation that the condition is actually related to Price’s avid participation in computer games.

The carpal tunnel is a structure in the wrist formed by several bones at the base known as the carpal bones with a ligamentous roof called the flexor retinaculum. Within the tunnel a large nerve, known as the median nerve, brings sensation and movement to a discrete portion of the hand.

Narrowing of the carpal tunnel may be the result of direct trauma that produces acute swelling, arthritic changes in the carpal bones and enlargement of the flexor retinaculum due to repetitive use.

The presenting symptoms of CTS are usually neurological in nature as a result of compression of the median nerve. Typical complaints include changes in sensation in the thumb, index and middle digits of the affected hand. These include a tingling sensation that comes on during the night or when first awakening. Early symptoms oddly improve with movement such as shaking the hand. Later symptoms include weakness with fine movements involving the thumb and index finger.

The diagnosis is made by clinical examination and electrodiagnostic studies that can specifically isolate the area of injury to the median nerve and quantify the severity of the damage.

“Carpal tunnel syndrome is a very uncommon injury in baseball pitchers,” reports Dr. Joel Ferreira, an orthopedic hand surgeon at the UConn Musculoskeletal Institute. “It’s typically caused by constant repetitive use of the hands from lifting/typing or vibratory tool use as well as sewing and crocheting. In my practice, I rarely see patients develop CTS from video games.“

Conservative management includes the use of nocturnal wrist splints and steroid injections. Surgical decompression is reserved for more severe damage to the median nerve. Although the cause of Price’s CTS may be debated, the treatment options are clear.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu