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Carpal Tunnel Syndrome: Risk Factors, Symptoms & Treatment
Dr. Joseph Woodward, a wrist and hand surgeon at EvergreenHealth, joins us to discuss Carpel Tunnel. A syndrome that affects over 3 million people a year.
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Learn more about Joseph Woodward, MD
Joseph Woodward, MD
Dr. Joseph Woodward is a fellowship-trained hand surgeon, providing care for both elective hand problems and hand trauma. During his plastic surgery residency training, he developed skills in soft tissue handling and wound management.Learn more about Joseph Woodward, MD
Transcription:
Caitlin Whyte: Welcome to Check-up Chat with EvergreenHealth. I'm Caitlin Whyte. Carpal tunnel is quite common with more than 3 million cases in the US per year. So in this episode, we are going to cover carpal tunnel, causes, symptoms and diagnosis with Dr. Joseph Woodward, a wrist and hand surgeon at EvergreenHealth.
So doctor, let's start with just some anatomy basics. What is the carpal tunnel and what does it do?
Joseph Woodward, MD: So the carpal tunnel is a tunnel at the wrist that contains the flexor tendons that bend our fingers into our palm and as it so happens, the median nerve, which gives sensation to several of the fingers and innervates some of the muscles into the hand. The structures are contained within the carpal tunnel as they travel from the forearm into the hand.
Caitlin Whyte: And then what causes carpal tunnel syndrome and how is that diagnosed?
Joseph Woodward, MD: Carpal tunnel syndrome is a compression of the median nerve as it travels through the carpal tunnel. And it's a constellation of findings that we see upon examination and with history of numbness of fingers, usually the thumb, index, middle, and sometimes the ring finger, which is the the area innervated by the median nerve. And it also can cause some pain at the wrist that can seem like aching or shooting pain that can travel up into the forearm. It's diagnosed usually by a combination of history, examination for lack of sensation and weakness, and also, in certain cases, what are called nerve conduction studies, which are studies we do to look at how well the signal is traveling through the tunnel and whether or not, in some cases, muscles are affected and losing their innervation and becoming weak.
Caitlin Whyte: Now, how would someone know if their wrist pain is something more? Like, how do you know when it's just maybe overuse, was sitting weird or when it's time to go to a healthcare provider?
Joseph Woodward, MD: Yeah, it's hard to say sometimes. And sometimes we have to cast a wide net in order to find the diagnosis. It can be things such as tendonitis or arthritis and all that plays into activities or overuse, but one of the classic things for carpal tunnel is numbness. We also see a pattern of numbness. That's often worse at night or holding in our hands in a certain position such as driving or holding a newspaper and when those things are occurring, that is classic for carpal tunnel.
Caitlin Whyte: Now, if someone has carpal tunnel and they don't know it and they kind of just brush off their symptoms, will this cause further damage?
Joseph Woodward, MD: Yeah. That's one of our concerns. And then why we always recommend at least getting it checked out. There are mild cases of carpal tunnel that do not need surgery or invasive treatment and can be treated conservatively, and the earlier we catch it, the better. But in certain cases, what we start to get worried about is permanent nerve damage from long-term compression. And then, we don't always see the innervation or the sensation come back fully and we sometimes don't see the strength come back if it's been let go too long.
Caitlin Whyte: Let's talk about those acute cases first. How can carpal tunnel syndrome be treated without surgery?
Joseph Woodward, MD: Yeah. In mild cases or cases that seem to be coming on without severe weakness, we can treat these usually with a combination of rest and certain types of braces that we can use at night. Oftentimes, this is exacerbated at night and sometimes with mild cases, bracing at night is an effective enough treatment if it's done for several weeks. If symptoms don't improve with bracing, then often surgery is recommended to try and take the pressure off the nerve.
Caitlin Whyte: Well, that leads me into my next question. When does the conversation start to center around surgery? And then what does the surgery process look like? What's recovery time like and stuff like that?
Joseph Woodward, MD: Yeah. So we get to surgery when we see weakness or numbness that's becoming more permanent. We also use the nerve conduction studies I spoke of earlier as a guide. When we get these, they often categorize these cases as mild, moderate, or severe in terms of the compression of the nerve. With mild cases, we often try the bracing we discussed. But with moderate or severe cases, there's concern that letting it go unchecked can lead to that permanent nerve damage we discussed, so we usually recommend surgery in that setting.
Surgery is an outpatient surgery. You come and go the same day and it has a relatively quick recovery. We ask you to take it easy usually for a couple of weeks after the procedure. And I, for example, do it endoscopically through a small incision that minimizes the downtime. There is some downtime after the surgery for a few weeks where we ask you not to lift heavy things, but it's relatively quick and most things you're still able to do, such as type, write, any that sort of thing.
Caitlin Whyte: Well, doctor, as we wrap up here, it sounds like any kind of wrist pain you should talk to your doctor, but is there anything else you want people to know?
Joseph Woodward, MD: Mostly is exactly what you said, to not ignore, especially if you're noticing numbness or weakness, it's worth getting checked out. It may be something as simple as a tendonitis that some therapy or stretching or exercises will help out with, or something like arthritis, which may lead the conversation in a different direction. But if you're noticing these symptoms we've been discussing, it's worth getting checked out so that appropriate management can be instituted earlier in the process.
Caitlin Whyte: Well, doctor, thank you for this info and for giving us some of your time today. To learn more or to make an appointment, please call (425) 899-4810. That's (425) 899-4810. Or visit evergreenhealth.com/ortho-sports-medicine. This has been Check-up Chat with EvergreenHealth. I'm Caitlin Whyte. Stay well.
Caitlin Whyte: Welcome to Check-up Chat with EvergreenHealth. I'm Caitlin Whyte. Carpal tunnel is quite common with more than 3 million cases in the US per year. So in this episode, we are going to cover carpal tunnel, causes, symptoms and diagnosis with Dr. Joseph Woodward, a wrist and hand surgeon at EvergreenHealth.
So doctor, let's start with just some anatomy basics. What is the carpal tunnel and what does it do?
Joseph Woodward, MD: So the carpal tunnel is a tunnel at the wrist that contains the flexor tendons that bend our fingers into our palm and as it so happens, the median nerve, which gives sensation to several of the fingers and innervates some of the muscles into the hand. The structures are contained within the carpal tunnel as they travel from the forearm into the hand.
Caitlin Whyte: And then what causes carpal tunnel syndrome and how is that diagnosed?
Joseph Woodward, MD: Carpal tunnel syndrome is a compression of the median nerve as it travels through the carpal tunnel. And it's a constellation of findings that we see upon examination and with history of numbness of fingers, usually the thumb, index, middle, and sometimes the ring finger, which is the the area innervated by the median nerve. And it also can cause some pain at the wrist that can seem like aching or shooting pain that can travel up into the forearm. It's diagnosed usually by a combination of history, examination for lack of sensation and weakness, and also, in certain cases, what are called nerve conduction studies, which are studies we do to look at how well the signal is traveling through the tunnel and whether or not, in some cases, muscles are affected and losing their innervation and becoming weak.
Caitlin Whyte: Now, how would someone know if their wrist pain is something more? Like, how do you know when it's just maybe overuse, was sitting weird or when it's time to go to a healthcare provider?
Joseph Woodward, MD: Yeah, it's hard to say sometimes. And sometimes we have to cast a wide net in order to find the diagnosis. It can be things such as tendonitis or arthritis and all that plays into activities or overuse, but one of the classic things for carpal tunnel is numbness. We also see a pattern of numbness. That's often worse at night or holding in our hands in a certain position such as driving or holding a newspaper and when those things are occurring, that is classic for carpal tunnel.
Caitlin Whyte: Now, if someone has carpal tunnel and they don't know it and they kind of just brush off their symptoms, will this cause further damage?
Joseph Woodward, MD: Yeah. That's one of our concerns. And then why we always recommend at least getting it checked out. There are mild cases of carpal tunnel that do not need surgery or invasive treatment and can be treated conservatively, and the earlier we catch it, the better. But in certain cases, what we start to get worried about is permanent nerve damage from long-term compression. And then, we don't always see the innervation or the sensation come back fully and we sometimes don't see the strength come back if it's been let go too long.
Caitlin Whyte: Let's talk about those acute cases first. How can carpal tunnel syndrome be treated without surgery?
Joseph Woodward, MD: Yeah. In mild cases or cases that seem to be coming on without severe weakness, we can treat these usually with a combination of rest and certain types of braces that we can use at night. Oftentimes, this is exacerbated at night and sometimes with mild cases, bracing at night is an effective enough treatment if it's done for several weeks. If symptoms don't improve with bracing, then often surgery is recommended to try and take the pressure off the nerve.
Caitlin Whyte: Well, that leads me into my next question. When does the conversation start to center around surgery? And then what does the surgery process look like? What's recovery time like and stuff like that?
Joseph Woodward, MD: Yeah. So we get to surgery when we see weakness or numbness that's becoming more permanent. We also use the nerve conduction studies I spoke of earlier as a guide. When we get these, they often categorize these cases as mild, moderate, or severe in terms of the compression of the nerve. With mild cases, we often try the bracing we discussed. But with moderate or severe cases, there's concern that letting it go unchecked can lead to that permanent nerve damage we discussed, so we usually recommend surgery in that setting.
Surgery is an outpatient surgery. You come and go the same day and it has a relatively quick recovery. We ask you to take it easy usually for a couple of weeks after the procedure. And I, for example, do it endoscopically through a small incision that minimizes the downtime. There is some downtime after the surgery for a few weeks where we ask you not to lift heavy things, but it's relatively quick and most things you're still able to do, such as type, write, any that sort of thing.
Caitlin Whyte: Well, doctor, as we wrap up here, it sounds like any kind of wrist pain you should talk to your doctor, but is there anything else you want people to know?
Joseph Woodward, MD: Mostly is exactly what you said, to not ignore, especially if you're noticing numbness or weakness, it's worth getting checked out. It may be something as simple as a tendonitis that some therapy or stretching or exercises will help out with, or something like arthritis, which may lead the conversation in a different direction. But if you're noticing these symptoms we've been discussing, it's worth getting checked out so that appropriate management can be instituted earlier in the process.
Caitlin Whyte: Well, doctor, thank you for this info and for giving us some of your time today. To learn more or to make an appointment, please call (425) 899-4810. That's (425) 899-4810. Or visit evergreenhealth.com/ortho-sports-medicine. This has been Check-up Chat with EvergreenHealth. I'm Caitlin Whyte. Stay well.