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Bill Klaproth (Host): Do you have numbness and tingling in your index, ring and middle fingers, occasional shock-like sensations or weakness in your hand? Hmmm. You may have carpal tunnel syndrome. Here to talk more about carpal tunnel and the carpal tunnel release and relief procedure; which you are going to want to hear about, is Dr. Paul Paterson, an orthopedic surgeon at ECMC. Dr. Paterson, thank you for being here.

Paul D. Paterson, MD (Guest): Well thanks for having me, Bill. I really appreciate it.

Host: Yes, so let’s dig into this Dr. Paterson. What is carpal tunnel syndrome?

Dr. Paterson: Carpal tunnel is what’s known as a compression neuropathy which is essentially a nerve that gets pressed on. And when that happens, when a nerve gets pressed on, it decreases the blood supply to that nerve and the patient will then have symptoms. In this case, the nerve is called the median nerve which is a major nerve that passes through a tunnel in the wrist area and that can get compressed and it leads to numbness and tingling and pain and if left long enough, can lead to permanent numbness and weakness in the hand.

Host: So, in that tunnel, if the nerve gets compressed, you called it compression neuropathy; that’s what causes carpal tunnel syndrome?

Dr. Paterson: Exactly. And unfortunately, when the nerve gets compressed, it also not only does it decrease the blood supply, but there are nutrients moving up and down the nerve and that gets – that transport gets stopped and the nerve actually starts to swell. So, you can imagine if you have got a tight space and then the nerve starts to get bigger; you can get that inverse spiral almost like a dog chasing its tail where the nerve gets bigger, there is more compression, there’s less blood supply, there’s less transport, the nerve continues to get bigger and bigger and bigger. The only way then to treat that is to eventually release the pressure on the nerve.

Host: Right, so it sounds like it compounds itself. So, who is at risk for this and how does this happen?

Dr. Patterson: The most common reason is known as idiopathic and essentially that means we don’t know why. Women are much more likely to have carpal tunnel than men. If you take a look at it from an age standpoint, it’s usually folks that are in their late 30s and into their 40s is one large peak. And then another peak is when patients are in their 70s and 80s.

Host: Wow, that’s really interesting. So, how do you diagnose this then?

Dr. Paterson: It’s primarily what we call a clinical diagnosis so, it’s really based on the patient’s story and their physical exam. And the story is usually pretty classic. It’s patients who have pain, numbness and tingling, usually in the thumb, index and middle fingers. Oftentimes, it’s much worse at night and disrupts people’s sleep. It’s also common when people are trying to read a newspaper or drive a car and then when we see them in the office, there are a couple of very simple little physical exam findings which help to localize the diagnosis to the carpal tunnel.

Host: So, hearing you answer that, I’m thinking then people that use their hands throughout the day, we think of manipulating a mouse or typing or other things; are those people more at risk for carpal tunnel?

Dr. Paterson: That’s a really interesting question. There’s a lot of controversy regarding just what role that has in all of this. There are certain jobs particularly if you use a vibratory tool that have a very clear association with this. But the exact role for office work can be controversial. It really depends on the activities and just how much you are doing of that.

Host: So, let’s talk about treatment options then. Once someone is diagnosed with carpal tunnel syndrome, before we get to the carpal tunnel release and relief procedure; what are the normal treatment options before that?

Dr. Paterson: If you can get to someone in the first three to six months of their symptoms, you have a chance to keep them out of a surgical situation and decompression of the nerve and we use a combination. Usually splints, modifying activities that you know might be provocative, anti-inflammatory medications the patient can take orally, a Motrin-like agent and then injections of steroids into the carpal tunnel can be very useful.

Host: Very good and then are those treatments generally successful?

Dr. Paterson: If you get to patients early, the American Academy of Orthopedic Surgery actually has guidelines for the treatment of carpal tunnel. And while it’s – this gets what’s called a grade B recommendation for nonsurgical treatment options and that you can make the patient’s symptoms less. It’s hard to make them go away once it has become chronic. So, and that is an arbitrary distinction, but once you get beyond that six month mark, if the nerve is really swollen and these measures probably don’t do enough to eliminate it. And at that point, you are either going to continue to have some chronic symptoms on and off or at that point, you become a candidate to release this and surgical release of the nerve and allowing the blood flow to return to the nerve is the only grade A recommendation by the American Academy of Orthopedic Surgeons.

Host: So, six months in, someone still has chronic pain; is that when you go to the carpal tunnel release and relief procedure?

Dr. Paterson: That’s when I would offer it to them. If they – not everybody is going to want surgery. Some people are going to want to continue nonsurgical treatment options. That’s understandable, but I think the release and relief program that we started a little over a year ago; is a pretty enticing way to get the job done, in a very low anxiety setting, in a single appointment and allow for very quick recovery.

Host: So, we like low anxiety, done in one day; tell us about the procedure.

Dr. Paterson: So, what happens is that if you – most patients have a very good idea that they have carpal tunnel syndrome because it’s so common even if your primary care doctor hasn’t diagnosed you with it; many patients can make their own diagnosis just using the internet nowadays. So, you would make an appointment to see us on a Tuesday. You would come in. And over the course of about 90 minutes, we would evaluate you. We would get the story, we would do a physical exam. We would use an ultrasound to do an objective measure on the size of the nerve. And if we meet certain parameters as far as your clinical score and your ultrasound score; then we would say okay, well these are your treatment options. You can continue nonsurgical treatment options, or we have this surgical treatment option that takes about five minutes, done under a strict local anesthetic, through about a five millimeter incision that can be done very comfortably. In fact, so comfortable and so safe that we are going to start doing this in the office in May. So, you can do it in that setting.

The results have been so predictable over the year that we don’t actually schedule a follow up for a patient because they do so well afterwards. Most patients just get seen that one time, they get treated. Most of their nighttime symptoms and burning and tingling painful symptoms are gone that night. The soreness from the surgery, 90% of the patients by – so this is done on a Tuesday by Saturday, 90% of the patients are really very comfortable. There is some residual soreness that will hang around for a few weeks, but by six weeks; most patients are back to doing everything they want and very happy.

Host: It sounds like an amazing procedure. So, is everyone a good candidate for this procedure then?

Dr. Paterson: Well, anybody with just pure carpal tunnel. If at that evaluation, at that appointment, if we think that there are other issues at play that might be another nerve that’s pinched either at your neck or at you elbow; we may say you know, we really want to wait or if the diagnosis is confusing; we won’t treat it then and we will work it up further to try and make sure we understand exactly where the issue lies. But anybody with carpal tunnel is an excellent candidate for this procedure.

Host: So, for people with pure carpal tunnel syndrome and then we do – do we know about the long term success of this procedure?

Dr. Paterson: We have been doing a prospective study for just over 15 months now and the durability is excellent. It seems to behave just like other carpal tunnel release methods that are out there.

Host: Wow, Dr. Paterson, this is quite a procedure. This sounds like a great way to give people that relief they are looking for. You just made people very happy. They are jumping up and down for joy right now. So, is there anything else we should know about the carpal tunnel release and relief procedure?

Dr. Paterson: Well, actually again, I think to make sure you understand further about the procedure. It’s not like other surgeries where you can’t eat the night before. It’s okay to eat that day. You can – many of our patients drive themselves to and from the appointment. It’s done - when we move it into the office; we are actually going to try and create almost a spa-like setting. So, I always ask patients – we listen to music that they want to listen to. The lights get turned down low. It’s a very different experience and we see many patients who have from word of mouth now heard about how easy this is, who have been putting up with symptoms for several years, trying nonsurgical treatment options from time to time, but now are finally getting the relief because there’s an easy and very reliable way to get rid of their symptoms.

Host: I love how you said that making a spa-like setting. It’s kind of like the carpal tunnel of love almost.

Dr. Paterson: I’m going to steal that if you don’t mind.

Host: Okay, please do. Please do. Dr. Paterson, thank you so much for your time today. Really enjoyed talking to you about the carpal tunnel release and relief procedure. It really does sound amazing and for more information, please visit www.ecmc.edu, that’s www.ecmc.edu. This is the True Care Healthcast from Erie County Medical Center. I’m Bill Klaproth. Thanks for listening.