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Prakash Chandran (Host): If you’re feeling pain in your hands or your wrists, you may be experiencing symptoms of either carpal tunnel syndrome or trigger finger, but what’s the difference and how can you prevent or treat these conditions? Let’s talk to Dr. Hans Bengtson, an orthopedic surgeon at Northfield Hospital. This is Northfield Hospital and Clinics podcast series. I’m Prakash Chandran. So, Dr. Bengtson, what can you tell us about carpal tunnel syndrome?

Dr. Hans Bengtson (Guest): Carpal tunnel syndrome is ultimately a problem that causes numbness and tingling in your hand, maybe even sometimes your forearm. It typically involves the thumb, index, long, and maybe some of your ring finger. It typically spares your small or pinky finger, but that numbness and tingling obviously becomes a problem.

Host: Why do we get carpal tunnel syndrome? Is it you’re on your computer a lot and you don’t have the proper ergonomics?

Dr. Bengtson: Carpal tunnel syndrome is often caused by pressure on the median nerve. That’s the main root cause of it. The nerves come out of our neck, down our shoulder and arm, into our forearm and wrist and hand area, but somewhere along that chain, there’s pressure on the nerve. The most common spot is on the palm side of your wrist. There’s a small tunnel, if you will, the carpal tunnel, which does include a variety of tendons, but also this one significant nerve, and the problem here is that there’s pressure on that nerve. There’s a variety of things that might ultimately cause the pressure. Maybe it’s rheumatoid arthritis, and you have an inflammation going on. Maybe it’s pressure because of the wrist position, if we cock our wrists back or fold them down far, especially for prolonged times, like during sleep, that can put pressure on the nerve. So there’s a variety of things that might ultimately cause it. You’re right, we talk a little bit about computers and we think about keyboarding, but keyboarding has not definitely been shown to be the cause of carpal tunnel, certainly it might exacerbate the problem. The same goes for assembly line work. Those jobs might have a repetitive wrist action, and that too might cause it to be inflamed and therefore again pressure on the nerve. That’s the main problem.

Host: So it seems like whenever there’s any sort of repetitive wrist action or pressure on that nerve, as you’re saying, that can cause the risk for carpal tunnel. What is the most common cause that you see day in and day out for this disease?

Dr. Bengtson: You know one of the things I think is really age. As we age, it seems that the space for where that nerve runs, it gets a little bit smaller, and again maybe that’s related to some arthritis changes in the wrist area where extra bony growth or inflammatory changes condense or compress where that nerve can run. There are a variety of factors though that put people at risk. We talked about some of these anatomic factors or the way the body is made. We do recognize that women are at a higher risk for carpal tunnel syndrome compared to men. There are other things such as obesity, just simply being a larger individual that might be more pressure on the nerve, workplace factors as we talked about, sometimes other medical conditions. Maybe menopause can actually do this. Maybe there’s some fluid fluctuations in the body at that time. Pregnancy has actually been shown to have a high risk for carpal tunnel syndrome, although thankfully once the pregnancy is complete, the carpal tunnel tends to go away on its own in that situation.

Host: Wow I had no idea that things like pregnancy and obesity could lead to carpal tunnel syndrome, so it’s very interesting to hear about. What about prevention? What can people do if they’re doing a repetitive job, how can they prevent themselves from getting carpal tunnel?

Dr. Bengtson: Oh that’s such a great question. You know we talk about prevention and we’re all for them. These are things that we can do to minimize the long term sequelae or the long term complications of it. Certainly trying to change up the tasks that one has to do, maybe that means taking frequent breaks, just giving your hands or wrists a different activity. Maybe it means reducing the force that we’re actually doing it with. So if we’re having to grip something very firmly or our wrist is cocked back hard for a long period of time, just changing that can even make a difference. You know, posture makes a difference, as our shoulders are rolled forward, which we tend to do when slouched, that can actually change how the nerves come out of that neck and shoulder region, that can put pressure on them up in that spot and can effect the way it effects all the way down to your wrist and fingers. Maybe changing the computer mouse or keyboard. You know, trying to keep the keyboard roughly at elbow height or maybe slightly lower, can cause the wrist to be in a more comfortable position. We’ve certainly talk about ergonomic changes. Things that you can do if you’re at a desk job and you can just change the keyboard anatomy, the way that your wrists rest. Same with the mouse, there are fancy, ergonomic mouse devices that can stand up where your wrist is in a more natural position. These are all things that we can do to try to prevent.

Host: Yeah so for sure, it’s so interesting you’re saying switch it up, whether it be the device that you’re using or just how you do things. I think rest, really prevent yourself from that repetitive nature. So I want to switch it up a little bit and talk about trigger finger. You know it’s not as well known as carpal tunnel, so can you talk a little bit about what trigger finger is?

Dr. Bengtson: You know it’s another one of those frequent hand problems that people encounter in daily life. Trigger finger is a problem with the tendon. That’s different than carpal tunnel, which is a problem with the nerve. A similar process happens in that the tendon for a trigger finger in our hands and fingers goes through a sheath, a tube if you will, and sometimes as life goes on or certain tasks are done, both the tendon itself can become inflamed, and maybe even the sheath gets a little bit irritated and inflamed, but when that’s the case, initially it’s a smooth rod or rope, kind of gliding through a lubricated tunnel, no problem, big deal, doesn’t matter, but the problem happens when it gets inflamed. Now it starts to get a little thickened, you get a little more friction in there, and then things start to get even more irritated. That actually can produce a little bit of some swelling on the tendon, so now you’ve got a little nubbin if you will that has to slide through this smooth sheath and it just doesn’t want to go very smoothly, but when it gets to the end of the tunnel, now it kind of gets stuck out there, and you can’t get that tendon to slide back through the sheath or the tunnel because of that little nubbin or swelling, and so when that happens, a person’s finger might get stuck where it’s actually locked almost against their palm. Well occasionally you can open it just with your own strength just by extending your finger with a little discomfort, but when it’s more severe, a person might actually have to take their other hand and extend that finger all the way. That actually can be painful and more discomforting to the patient.

Host: Yeah, I’ve never heard of anything like this before. Is it generally this repetitive stuff that you’re talking about? People that do a lot of things with their fingers that could get trigger finger?

Dr. Bengtson: It does seem to be one of the main risk factors for it. You’re absolutely right, repetitive activities. Not necessarily keyboarding things, more gripping things, where you have to actually bend your fingers into your palm. That’s who seems to have a little bit more problem with it. You know, in my practice I’ve certainly seen a variety of farmers who might get this. Those folks have to do a lot of gripping and squeezing firmly, but it might be assembly line workers as well or those who are doing projects on their own home on the weekends. It’s this problem that just gripping into your hand seems to occasionally flare this. Other risk factors for it do include people who are diabetic. There is something about diabetes that creates more inflammation, more stickiness to the tissue, and that puts people definitely at a high risk for it. There’s a lot of other unknown things that might put a person at risk for trigger finger too, but these are some of the main things that put people at risk, and now if a person gets trigger finger or one of their fingers catching, it doesn’t necessarily mean that their other fingers are going to get it, or those on the other hand are going to get it, but I must tell you, it does seem to happen more often than not.

Host: Yeah that’s good to know, and so let’s talk a little bit about prevention for trigger finger. I assume it’s really the same type of treatment. You know, really trying to take breaks if you’re doing things that extend the finger into that palm and switching up potentially the device that you’re using. Would that be correct?

Dr. Bengtson: I would agree with you. You know, changing up some of those routines, those activities, trying to avoid the firm gripping. Well the hard part there is sometimes our life just mandates those tasks, and so what you can do is certainly try to calm it down, maybe anti-inflammatory medications, changing some of your routines. These things can be tried to help minimize it. Trigger finger is experienced more commonly in the morning, and I think probably at nighttime, we don’t even know we’re doing it, but we make a fist of some sort, and that puts that tendon again stuck out that sheath, and now we can’t straighten it. So when we wake up in the morning, bam it’s painful, it doesn’t want to straighten, those are the times people often feel the trigger finger.

Host: So I’m curious is there a way that people can tell that either carpal tunnel or trigger finger is coming on? Like maybe they might have strain in their wrist or fingers. How can people detect when they might have a problem?

Dr. Bengtson: You know being proactive in the preventative type things is great, but there are times where it continues to progress. Trigger finger, starting with, people often just sense a little bit of discomfort in the palm of their hand. If you look at where the big knuckle is on the back of your hand, and kind of draw that around to the palm side of your hand, that’s often where people feel the discomfort, right in line with the digit. It starts with just a little bit of discomfort when you’re gripping something, maybe there’s pressure on the palm there, and then gradually it starts to become a little bit more of a minor discomfort, minor catching, and then more major catching. It’s sort of this natural progression. There’s not necessarily a precursor or something you can really anticipate and say, uh oh, oh no, I’ve got it. It’s more just this gradual progression. For carpal tunnel syndrome, the symptoms are, while different, also gradual in onset. It tends to be at first maybe just a little bit of numbness and tingling in those fingers – on the palm side of those fingers, but you know it goes away on its own. Maybe you don’t even have to shake it up. Maybe you just change your occupation or your situation, excuse me, for the day, and that resolves that numbness and tingling, but eventually it’ll become more significant where, boy I have to really stop driving because as my hand’s on that steering wheel, I just can’t stand it, I got to shake it out. Same in the middle of the night, carpal tunnel syndrome, people often wake up at night. They’ve got this numbness and tingling, they wake up and have to shake it out and now it’s resolved. Those progression of symptoms are the changes that we see.

Host: Got it. So let’s say that someone didn’t take those measures to be preventative, and they are stuck with the trigger finger or carpal tunnel, let’s talk a little bit about the treatment options that you offer. Maybe let’s start with carpal tunnel syndrome and what you can do for them.

Dr. Bengtson: Absolutely, so anything that comes through our door, we often think about what are the nonoperative things that we can do? Yes, there are surgical options, but maximizing those nonoperative things certainly are valuable. Some of those things for carpal tunnel syndrome include wrist splinting, especially wearing a splint at nighttime. As I mentioned earlier, when sleeping we can put our wrists in odd positions, and that can set us up for an event to happen through the nighttime, got to wake up, shake your hand out. So one way to avoid that is wearing a wrist splint. It’s trying to put the wrist in a neutral position through the nighttime. Occasionally people might need that during the day as well, but typically not. As we’re living our daily life, we’re usually moving enough to change positions and minimize those risk factors. Other things that people can try include medicines, anti-inflammatory medicines like ibuprofen, Aleve. These types of medicines calm inflammation, and as we said, that’s part of the problem putting pressure on the nerve. Finally a cortisone injection might be considered. Cortisone is the ultimate anti-inflammatory and the benefit to that is it’s delivered right around the nerve, and so it can really work directly on the site of the problem.

Host: And what about trigger finger?

Dr. Bengtson: Trigger finger has probably a little bit less options that we can use to minimize its symptoms. Part of the issue when it comes to the splinting is it’s truly hard to limit your finger motion. Although I must admit, I had a gentleman come in with duct tape, a little tube that he had fashioned to minimize how much his finger will bend at the nighttime. For him, it was working well, but it is a little bit challenging to find those splints to be honest. But the same applies, and that medicine such as anti-inflammatories are still helpful for trigger fingers. Cortisone injections can absolutely be done. We talked about the problem of the tendon in the sheath or the tunnel, well that cortisone can be delivered right into that tendon sheath to bathe that tendon, calming down the inflammation.

Host: I have to ask the question, what about texting and thumbs? You know we’re on our phones so much these days, and it feels like that’s a massively repetitive motion. Do you have any thoughts around that?

Dr. Bengtson: I don’t know that it’s been proven yet, but certainly anecdotally, I have seen a variety of cases like that. Patients are coming in acknowledging the change in their habits, and that has shown some trigger thumbs, just like the fingers, the thumb yes it can be involved too.

Host: All right doc, well I appreciate all the education today. That’s Dr. Bengtson, an orthopedic surgeon at Northfield Hospital. Thanks for checking out this episode of Northfield Hospital and Clinics podcast series. Head to northfieldhospital.org to get connected with Dr. Bengtson or another provider. If you found this podcast helpful, please share it on your social channels, and be sure to check the entire podcast library for topics of interest to you. Thanks so much.