Transcription:

Prakash Chandran: If you're feeling pain in your hands or wrists, you may be experiencing symptoms of carpal tunnel syndrome. For the people that are affected chronically, hand-based therapy may be the most effective way to relieve their symptoms and treat the condition. We're going to talk about it today with Ling Li, an occupational therapist at Ridgecrest Regional Hospital.

This is the Ridgecrest Regional Hospital podcast. My name is Prakash Chandran. So first of all, Ling, it's great to have you here today. Let's just start with the basic question around what exactly causes carpal tunnel syndrome.

Ling Li: Well, thanks for having me on. So with carpal tunnel syndrome, first, we need to kind of understand what the carpal tunnel is. It's just a tunnel created by the bones and a ligament that goes across your wrist, through which some tendons and a nerve called the median nerve goes through. And what happens here is sometimes the median nerve can get compressed leading to pain and tingling and numbness in the fingers, usually the thumb, index finger, middle finger, and the thumb side of the ring finger.

Prakash Chandran: Understood. So when we talk about carpal tunnel syndrome, how does a person know when they're starting to develop it? Like cam you maybe talk about some of the symptoms?

Ling Li: So the ones that are most well-known are probably the numbness and tingling at the thumb, index finger, middle finger and ring finger. It doesn't have to exactly present in that way. Sometimes it's just one or two of those fingers. And oftentimes, what people will find is when they just shake out their wrist, the pain goes away. Another major factor of it is when people are sleeping and they wake up at night with some wrist pain and hand pain, that could be a pretty big sign that it could be carpal tunnel syndrome.

Prakash Chandran: Understood. And I'm always curious, you know, when I hear about carpal tunnel syndrome, I oftentimes think of people in technology that are in front of their desk at a computer all the time. And if they're, for example, sitting in a non-ergonomic way, then for example, their wrist might kind of be in the wrong position and that's what causes it. But can you maybe speak to that and other professions that are more likely to potentially develop carpal tunnel over time?

Ling Li: Certainly. Well, definitely people who work at desks a lot, in front of a computer, typing and using a mouse, that can definitely be a risk factor. Other professions such as assembly line workers, factory workers, warehouse workers, people who use industrial equipment, welders, packaging workers, they can be prone to it experiencing carpal tunnel syndrome due to the repetitive nature of their work. And even, you know, just any job where you have to use some kind of tool that vibrates in your hand and you're gripping on to that, that can lead to some irritation to the carpal tunnel syndrome.

Prakash Chandran: Okay. So let's talk then about treatment. Let's say that someone is experiencing some of this numbness or wrist pain that you're talking about. What are the different options that they have to get better?

Ling Li: The conservative approach is to splint the hand at night, keeping the hand in a neutral position, maybe even slightly extended, so that it's not going in those directions where it creates increased pressure at the carpal tunnel. So usually, the patient will be splinted during the night and also during activities during the day where he or she has to do those repetitive motions. And treatment also involves using ice to maybe calm down the tissue and reduce inflammation. And those are actually the main things usually, and just making sure to be careful with, you know, ergonomics and posture, because those can also contribute to that compression.

Prakash Chandran: So, one of the things that we're talking about today is this hand-based therapy. And, for me, for example, I'm in technology and I've been told to like take my thumb, for example, and stretch it back a little bit, so I kind of feel that stretch, I guess, in my wrist a little bit and then I can also press down on my fingers. Is that hand-based therapy or are we talking about something else?

Ling Li: Oh, yeah, that's definitely something that I'll sometimes go over with patients. It's just going into certain exercises and stretches that patients can be doing, modifications to their work setup and modifications to their workflow to encourage people to be healthier and avoid those repetitive motions. Taking breaks every hour is a good way to kind of reduce the risk just a little bit.

Prakash Chandran: And, you know, I know that there is a range of, I guess, severity when it comes to carpal tunnel syndrome. I've heard and you've mentioned that there's a lot of things that you can do to treat it without surgery, but when does it come to the point where surgery is needed?

Ling Li: Well, usually, I'd say after a bout of conservative therapy fails, if the symptoms do not resolve after that, then usually the doctors will consider doing a carpal tunnel surgery where they cut apart the ligament that holds the carpal tunnel, the tendons and the median nerve in place. It's completely fine for them to do because you have other ligaments that hold things in place. So that way, they can relieve the pressure to the carpal tunnel and the median nerve.

Prakash Chandran: There's going to be people out there that might be struggling with this, but just kind of decide not to get it fixed. Have you ever seen cases where people just don't get it fixed? And what happens then?

Ling Li: Well, I haven't personally seen someone get to that point, but usually what happens is if it's not treated, it can just lead to just continued weakening of the hand, lack of coordination in the fingers and the thumb. And as I may have mentioned before, the muscles at the base of the thumb may atrophy and, you know, your sensation can become somewhat abnormal due to the nature of it being a nerve issue.

Prakash Chandran: Are there certain demographics that are more prone to getting carpal tunnel or are there certain factors that make some people more susceptible than others?

Ling Li: Well, actually women are more likely to develop carpal tunnel syndrome and anyone who has an anatomically narrower carpal tunnel, they're at a higher risk. In fact, people who have had wrist fractures can have an increased risk of developing it. People who have diabetes, rheumatoid arthritis, hypothyroidism, and all of those can lead to increased risk for carpal tunnel syndrome. And there are rare cases where women who are pregnant also develop carpal tunnel syndrome, but in those cases, it usually resolves after they give birth.

Prakash Chandran: So, you know, one of the things that we always like to talk about is prevention. So can you maybe speak to some of the things people can do to reduce the chances of developing carpal tunnel syndrome?

Ling Li: Well, of course, leading a healthier lifestyle overall and being active can be helpful. Keeping an eye on your posture and your positioning at work and taking breaks as needed. Try to take a break every hour to stretch out your hands and your wrists, that can help to reduce the risk of carpal tunnel syndrome.

If you are doing an activity, try to maintain your wrist in neutral, and that's just straight on without bending it forward or bending it backwards. As much as possible, try to avoid gripping repetitively and using too strong of a grip. One thing that we often recommend to people is using foam to build up the handles of some of their tools so that their hand can grip it without exerting too much force.

Another thing that I've seen is people using fingerless gloves to keep the hands warm because when you're working in a cold environment, that can also make the risk more susceptible to getting irritated at the carpal tunnel. So also if you're working at a desk, using like a keyboard and a mouse, I'd recommend keeping the keyboard at about slightly lower than the elbow height. So try to keep it a little lower so that your fingers can droop down in a relaxed position.

Prakash Chandran: Yeah, that makes a lot of sense. So just make sure that they're kind of in, as you said, the neutral position as much as possible when you're doing activities. If you're sitting at a desk, make sure that, I guess, it's a 90 degrees to your shoulders and your wrists, so your fingers droop down on the keyboard. And that you're taking breaks, you're taking breaks often to stretch, to stand up and to move your hands around, right?

Ling Li: Yes. So try to avoid flexing at the wrist as you're typing. It should be just straight on with your forearm or almost straight on. And another thing to avoid is just making sure you're not putting pressure onto the median nerve or onto the carpal tunnel if you're leaning on your desk or something that could, of course, affect things and make the symptoms worse. So try not to be leaning your wrist against the edge of your desk. That's a big one. And sometimes they do have those little ergonomic mouse pad things that bump up. I'd actually recommend against using that one, because sometimes people will just place their wrist entirely on the little pad and that just increases the pressure to the carpal tunnel.

Prakash Chandran: So just as we close here, you've probably seen hundreds of patients with carpal tunnel syndrome. What is one thing that you wish more patients knew before they came to see you with carpal tunnel?

Ling Li: Probably getting it treated earlier rather than later is probably going to be the most helpful. So getting that brace or taking it to the doctor and seeing the doctor about it as soon as possible. You know, it gets harder and harder to treat the longer you postpone.

Prakash Chandran: Understood. So if you are experiencing some of the symptoms that we talked about, some of that tingling or wrist pain, then it's worth your time to go in and just get it checked out to make sure that everything is okay, because if it is carpal tunnel, then you can treat it earlier and it's much easier to do so earlier than later, right?

Ling Li: Absolutely correct. And you know, oftentimes you don't even need to come in to see a hand specialist or a hand therapist. You could just be put on a brace and, as long as that helps to resolve the symptoms, you should be okay. If it doesn't get better, then of course, you would want to see a person who's a little bit more specialized in that area.

Prakash Chandran: Perfect. Well, Ling, I think that's the perfect place to end. I really appreciate your time today. That's Ling Li, an occupational therapist at Ridgecrest Regional Hospital. For more information on RRH Outpatient Rehab Services, visit our RRH.org. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks for checking out this episode of the Ridgecrest Regional Hospital podcast. My name is Prakash Chandran, and we'll talk next time.