Transcription:

Melanie Cole, MS (Host): If you start to feel that pain in your thumbs and your wrists and it gets difficult to do your daily tasks, it might be time to see a physician. You might have carpal tunnel syndrome. My guest is Dr. Christopher Jobe. He’s an orthopedic surgeon at Oroville Hospital. Dr. Jobe, tell us a little bit about carpal tunnel syndrome. What is it?

Christopher Jobe MD, RMSK (Guest): It’s the compression of the median nerve. Of the nerves that go to your hand, the median nerve is the biggest in terms of how much skin it covers. It covers the thumb and the next two and a half fingers, and it covers the muscles of the thumb. It’s the one nerve that goes through a confined space, called the carpal tunnel. Also in that space there are tendons and occasionally some muscle. So if there is any swelling in there, the nerve is the one that suffers, and the person gets numbness in the thumb and the next two and a half fingers.

Host: Dr. Jobe, how does it happen? How do you get carpal tunnel? What are some ergonomic risk factors? Is it texting? Are you seeing more of this because of texting and thumbs? Or typing on the computer in improper positions? Tell us how it’s most likely to occur.

Dr. Jobe: Well, it is associated with use of the hand. It happens in certain populations if you have a tendency to get a little inflammation of the lining of the tendons. People who get trigger finger are often more inclined to get carpal tunnel. It often happens after a day of work and you're straining the structures. The nerve is not the guilty party. The problem is that other things within the carpal canal have swollen. I have carpal tunnel myself. I had it operated back in 1983. There were two muscles that came up into the carpal canal. When you have a heavy day of work, the muscles would swell a little like muscles do anywhere. The carpal canal is unforgiving and it’s the nerve that suffers.

Host: Wow. It can certainly be painful. I’ve known people with it. So tell us about options for treatment and tell us a little bit about minimally invasive ultrasound endoscopic carpal tunnel release. What does that mean when we hear that very long term carpal tunnel release surgery?

Dr. Jobe: Well, you have two options in treating this. One is to try to decrease the swelling. So you do that by having a person wear night splints at night so that they can't flex their wrist. Or you inject some cortisone up into the canal to try to get the inflamed tissue to shrink down. The opposite is the carpal tunnel release where you're making the space or the volume bigger so that the compression on the nerve doesn’t happen. What I do is an ultrasound guided carpal tunnel release. This is done through a small incision just proximal to the wrist. With the ultrasound, you can see the nerve, the arteries, the tendons, any abnormal malformation that might get in your way, although those are very rare. Then you can watch the device come up and put it in place. Then with a retrograde cutting knife, a knife cutting towards the arm, cut the ligament. It’s called the transverse carpal ligament. Basically what you're doing is you're making the volume of the carpal canal bigger and that takes the pressure off the nerve.

Host: Cool. So how long does it last? Is this a permanent fix?

Dr. Jobe: I think it should be permanent. But I did have one patient who had had an open surgery—very successful 10 years ago. He was a diabetic. He reappeared in my office 10 years after his first surgery with a recurrent carpal tunnel. So this time we did an ultrasound guided release and it was also very successful. I suspect that what happens is that ligament that we cut heals, but it heals in a lengthened position. So for most people, this is a permanent fix. For this man, I think he had developed a secondary source of swelling. He had developed some diabetes and some thyroid disease. So he needed to be re-released. He’s the only one in a couple hundred patients that I've seen where it was recurrent.

Host: Then who is a candidate? Why would someone have open surgery, like he did, versus this ultrasound guided, which is more minimally invasive? Are there some people for whom they are not a candidate for the minimally invasive version?

Dr. Jobe: Yes. Usually when they're referred to us by the primary care physician with a diagnosis of carpal tunnel. We can confirm this with about 99% accuracy with the ultrasound. So in addition to doing that, what you're looking on the ultrasound to see if that have a malformation that would require you to do this open. The most recent one, the patient had a very large artery up in the carpal canal. So we did that hand open, but his opposite wrist we did with ultrasound guidance. It turns out at that open dissection, I probably could have done him with ultrasound. But because I had never seen such a median artery, I thought we better be on the safe side and do this one open.

Host: So interesting. Something that so many people suffer from. So after they’ve had this procedure, then what? How soon can they get back to doing things and really kind of using their hands the way that they used to? Tell us about that.

Dr. Jobe: Well, one of the advantages is that we don’t have to splint the patient as we did in the old days with the long open release. So people when their pain decreases, they can use the hand right off the bat. Now when I say use the hand, for most tasks. The hardest thing for a carpal tunnel release patient to do is to get up off of a chair because this force your wrist into hyperextension, and you’re pressing on the skin right over where we released that ligament. So for example, the head of our maintenance and security, I did both of his wrists. He didn’t want to do them separately. So we did both of them and he was back at work in four days, but yet he still had pain when tried to push off of a chair. But he was able to do work. I've done a couple of weight lifters who insisted on going back to the gym. They insisted on going back to the gym. So I said okay. You can do that, but you have to make me a list of what you can and cannot do. What they found is that right after the release, they could do bench presses, et cetera. But you couldn’t get their wrist backwards or flex forward. They said that was very painful. As long as they kept their wrist straight, they were capable of doing things.

Host: As we wrap up, and what an interesting topic Dr. Jobe. Give us your best advice as an orthopedic surgeon of what you would like us to do to hopefully prevent carpal tunnel in the first place. Are there some adjustments that we can make to our workplace stations, to the things that we’re doing on our laptops, our phones? The repetitive strain injuries we’re giving ourselves by using our hands in these ways.

Dr. Jobe: Well, based on the experience of the weight lifters, I would say the things that keep your wrist. So ergonomic adjustments on your chair at work, using the mouse, that kind of thing. There’re whole specialists that look at work stations to make them more ergonomic. Some of this is unavoidable. The carpal tunnel that I had was always the night after a big day of surgery. What the surgeon who did my wrist said that you’ve got this muscle that’s going down in there. There’s really nothing you could have done about it.

Host: So then give us your best advice. What would you like people to know about taking really good care of their hands?

Dr. Jobe: Well, I think that the working position of your wrist. Your wrist doesn’t have to be perfectly straight. You want it to be, what we call, dorsiflex. Kind of cocked up a little bit, but the overall access of the wrist to be straight. For repetitive motions to keep it in that position. So you'll notice some of these ergonomic work stations, you adjust the chair height so that you're not having to make your wrist in weird positions. I think that’s the main thing you can do. If you start to get carpal tunnel symptoms and you don’t have any muscle paralysis, wear splints on your wrists at night that holds your wrist in a good ergonomic position and allows you to sleep overnight. There’s a certain number of people that this just isn’t going to work, and you may need to inject the wrist, and eventually operate on them.

Host: Thank you so much Dr. Jobe for joining us today. Something that so many people have issues with. Thank you, again, for sharing your expertise. You're listening to Growing Healthy Together, a podcast by Oroville Hospital. For more information, please visit orovillehospital.com. I'm Melanie Cole.