Ashlee Williams, MD (Host): If you've ever felt a tingle, numbness, or electric jolt through your wrist after a long day on your keyboard or phone, you are not alone. Carpal tunnel syndrome affects millions of people often starting with the subtle signs that are easy to dismiss. Welcome to The Healthier You Podcast. I'm Dr. Ashlee Williams, and today I'm joined by Dr. Nikhil Oak, a Board-Certified Orthopedist here at Kaiser Permanente to discuss what's really happening inside the wrist, the habits that may be making things worse, what you can do to relieve symptoms, and how to know when it's time to see a specialist. Thank you so much, Dr. Oak for joining me today.

Nikhil Oak, MD: Thanks for having me.

Host: So let's just start with the basics. We always like to start with the basics. What is carpal tunnel syndrome and what are the earliest signs that someone might be developing carpal tunnel syndrome?

Nikhil Oak, MD: So carpal tunnel syndrome is basically a pinched nerve at the wrist. It's the median nerve as it enters the hand, and it usually affects the thumb, index, middle, and sometimes the ring fingers. And usually what it causes are pain, tingling, numbness. Usually they start appearing gradually these symptoms and occurs at nighttime more often. And it's commonly referred to as pins and needles type of sensation when it first starts happening. So those would be the earliest signs you might think you might be developing some carpal tunnel.

Host: How do we know if we need to seek medical evaluation? Like what happens if it's left untreated?

Nikhil Oak, MD: Carpal tunnel, as it progresses, it can cause more and more pressure on the nerve, and your symptoms can actually get more severe. So if you're getting more symptoms that occur during the daytime, the period or the length of time can increase, and they're happening multiple times a day; that's something to be a little bit worried about and try to get early treatment, to get ahead of it and prevent any further nerve damage, which can lead to weakness and muscle atrophy, and sometimes permanent numbness in the fingers.

Host: So even if we don't have desk jobs where we're typing all the time, we're still, most people are on their phones all the time. What role does repetitive hand or wrist movement play in the development of carpal tunnel? And are there any ergonomic changes that can significantly decrease the risk of developing carpal tunnel?

Nikhil Oak, MD: So there are good correlations between people that are involved in a lot of forceful gripping, repetitive tasks like assembly line work, computer work, vibrating tool use. And all these occupations can elevate the risk. There's no clear data that suggest causation yet, but there's definitely a correlation.

So anything that increases pressure on the median nerve with especially non neutral positions. So when your wrist is neutral, that's kind of straight up and down, and flexion and extension can increase the pressure on that nerve. So basically, ergonomic assessments and adjustments are the first-line of treatment where you want to try to keep your wrist neutral, changing your workstation height, using an ergonomic pad, changing the way you use your mouse, taking some breaks. Those are the probably the first way to kind of mitigate your symptoms. And then you can progress to using braces and things like that.

Host: Speaking of braces, there are so many different models on the market to choose from. Are there certain designs or certain braces that are more effective than others?

Nikhil Oak, MD: My advice to patients, is to use a brace that you're going to use at night, that's comfortable. So you want to use a brace that keeps your wrist in neutral, that doesn't forcefully flex or extend your wrist. So if you just search a carpal tunnel brace or wrist splint, those usually are good options for patients to wear. The time to wear the brace, for my patients, I, tell them to wear them at nighttime, for about a month, and then wear it during the daytime, during the activities that cause it to be irritated. But you don't want to wear it all the time. The reason to wear the splint is to keep that wrist in a neutral position to prevent pressure on that nerve.

 So in mild carpal tunnel syndrome, it can help calm the nerve down and decrease symptoms, but it's not always effective in everybody.

Host: And I think that's a key, right? Is wearing it at night. I think a lot of people don't know that, that it's more important to wear it at night and that it does take a while for the symptoms to improve. It's not like if you wear it for a couple of weeks, your symptoms are going to get better. Right?

Nikhil Oak, MD: Right. You have to just be consistent with it, and usually I say four to six weeks. Be very regular. Try it every day, And then after that period of time, if it keeps bothering you, then you definitely should come in and get evaluated.

Host: Exactly. So let's talk about the next step. So you have a mild or a moderate case. How successful are non-surgical surgical treatments like occupational therapy, activity modification, or even steroid injections?

Nikhil Oak, MD: So we try to do everything we can to avoid any more invasive procedures. So we always start off with activity modifications, bracing, and then physical therapy or occupational therapy to basically work on a little bit of wrist mobility. There's these exercises they can teach you or you can learn called Nerve Glide exercises that basically move the nerve through the canal and through your arm. And that can help decrease some of your symptoms. So these are all things we want to try first. And then if you continue to have symptoms or symptoms progress or very severe, some patients are candidates for a steroid injection, and the steroid injection is pretty successful in the short term. And in milder cases it can give long-term relief. But the effect of the steroid basically causes the pressure in the nerve to decrease, and that allows that nerve to work better. But you know, it's variable in terms of how long that shot can last. Some of the studies that look at longer term data show 30 to 60% of patient's end up needing something else in the future. But at least in the short term, three to six months, the shot is a good option.

Host: So let's say the shot doesn't work. You've done everything you can. You wore the brace, you've done the physical or occupational therapy, and you have to get surgery. What is the typical recovery period like after surgery, and what factors influence a normal return of wrist function?

Nikhil Oak, MD: So, surgery is outpatient. So you would go home the same-day, same-day surgery. You can use your hand for light use right away. So my office workers are usually back to work within a day or two as long as they're not doing a lot of heavy lifting and manual labor. That would be the main consideration for return to work is what kind of occupation they have, and also how severe their symptoms are to begin with.

So if someone is coming to me with very severe numbness, burning pain, muscle weakness, it's going to take longer for them to recover. But most moderate cases, people are able to do light duty work within a couple weeks. And in terms of grip strength and manual labor, it's usually about four to six weeks off, before they can go back to their regular occupation. But that nerve, the recovery is variable, so depending on how compressed it was or how long it was compressed, it can take more or less time to recover. Very rarely do people have permanent nerve damage. And in most cases people do improve after the surgery.

Host: That's true. Everyone is different. Some people may have chronic medical conditions that may contribute to their carpal tunnel. Can you talk a little bit about factors such as diabetes, thyroid disorders, obesity, and their impact on the severity of carpal tunnel syndrome?

Nikhil Oak, MD: Good question. So those three conditions you just listed are kind of the main, comorbidities that can increase the severity or risk of carpal tunnel. So diabetes, it can basically cause inflammation and increase glycosylation in the tissues, and it can make the wrist stiffer and more prone to inflammation. And that can lead to pressure on the nerve. And diabetic nerves are in general, more sensitive. So if you've heard of diabetic neuropathy, that can go hand in hand with some carpal tunnel syndrome and that can make the severity a little bit worse or the recovery after surgery worse. Other conditions like thyroid disease like hypothyroidism can cause fluid retention. And that can cause tissue swelling and that can increase your nerve compression. So those are two conditions that cause worsening of severity. And then obesity is another kind of independent risk factor, that can kind of increase the prevalence of carpal tunnel. It's unclear exactly the mechanism, but some people think it's increased tissue pressure in the canal and thickening the sheath lining on the tendons that can cause pressure on the nerve. But there's definitely a correlation between obesity, BMI and carpal tunnel.

Host: I think these are all great points. As primary care doctors, we focus a lot on all the things that diabetes can affect in the body, including neuropathy. So we do do the diabetic foot exam annually, but it's good to know that diabetes can affect any nerve, including the median nerve. So thank you so much for this great information, Dr. Oak. We learned a lot about carpal tunnel syndrome and treatment options available. Here are the top takeaways.

One, identify symptoms early, gradual nighttime tingling, numbness or pins and needles in the thumb and first three fingers can be the first warning signals and signs of carpal tunnel syndrome. Two. Prioritize ergonomics by keeping wrists in a neutral position, optimizing your workstation setup, and taking regular breaks to reduce unnecessary pressure on the median nerve.

Three, start with conservative management, including nighttime wrist bracing, nerve glide exercises, activity modification, and anti-inflammatory medications. Don't delay treatment. Ongoing chronic pressure on the median nerve can lead to permanent nerve damage, weakness, and muscle loss in the hand. If symptoms persist despite conservative care, an evaluation can help determine whether injections or surgery are needed to prevent long-term complications.

For more information from our experts, visit kp.org/doctor and listen to more episodes of Healthier You wherever you get your podcast. If you enjoyed this episode, be sure to subscribe and share it with other's.

Have questions or health topics you'd like to address in future episodes, let us know in the comments. Thank you and from all of us at Kaiser Permanente, be well.