Selected Podcast
Prevention and Treatment of Carpal Tunnel
Dr. Taruna Crawford explains the symptoms of carpal tunnel, prevention, and treatment options available.
Featured Speaker:
Dr. Crawford is Board Certified in Orthopedic Surgery and holds a Subspecialty Certificate in Hand Surgery from the American Board of Orthopaedic Surgery. She is also a Certified Independent Medical Examiner by the American Independent Medical Examiners.
Taruna Crawford, MD, CIME
Dr. Taruna Madhav Crawford comes to Riverside with several years of experience in her field. She received her Doctor of Medicine at Northwestern University Feinberg School of Medicine, located in Chicago, IL. Dr. Crawford then completed a General Surgery Internship and Orthopaedic Surgery Residency at the University of Cincinnati in Cincinnati, OH. Additionally, Dr. Crawford gained additional experience through her Fellowship with the American Academy of Orthopaedic Surgeons through the Washing Health Policy Fellows in Rosemont, IL and a Fellowship in Hand Surgery at the Philadelphia Hand Center associated with Thomas Jefferson University Hospital located in Wynnewood, PA.Dr. Crawford is Board Certified in Orthopedic Surgery and holds a Subspecialty Certificate in Hand Surgery from the American Board of Orthopaedic Surgery. She is also a Certified Independent Medical Examiner by the American Independent Medical Examiners.
Transcription:
Prevention and Treatment of Carpal Tunnel
Alyssa Diaz (Host): Hello listeners, and welcome to the Well Within Reach podcast. I'm your host Alyssa Diaz, and today we’ll be hearing from one of Riverside’s orthopedic specialists, Dr. Taruna Crawford, on a common condition called carpal tunnel. Dr. Crawford, thanks for joining us on the podcast.
Taruna Crawford, MD, CIME (Guest): Thanks for having my Alyssa.
Host: We’ll just start with a little introduction to you as an orthopedic surgeon. Let’s talk about your background and training.
Dr. Crawford: Sure. So I am an orthopedic surgeon. I've done most of my training here in the Chicagoland area. Early on I did my college and medical school at Northwestern. I subsequently went and did an orthopedic surgery residency in Cincinnati. That’s surgery that addresses bones, tendons, ligaments, nerves, joints. After that, I went on for additional specialty training in hand surgery at the Philadelphia hand center before I move back to the Chicagoland area to start in practice in 2010.
Host: Today’s topic, prevention and treatment of carpal tunnel, is something that you see everyday and probably it’s very near and dear to your practice.
Dr. Crawford: It is definitely one of the more common conditions that we see as orthopedic hand surgeons.
Host: So let’s start at the beginning. What is carpal tunnel?
Dr. Crawford: Carpal tunnel is basically a condition that happens that can cause numbness and tingling in the hand. Sometimes it can cause pain. The carpal tunnel is an actual tunnel that exists at the level of your wrist, and it’s a tunnel of space that the nerves that provide you with sensation to your thumb, index, middle finger primarily pass through. There's also space there for tendons. What can happen is sometimes that space is a mismatch for the structures that are in the space. So carpal tunnel is when you have pressure in the space that causes numbness and tingling sensation in the hand or associated pain.
Host: Is there a specific cause behind carpal tunnel?
Dr. Crawford: There's actually numerous causes of carpal tunnel. Carpal tunnel can come from things such as an acute injury like a wrist fracture or fractions around the wrist. It can occur from aging. It can occur from arthritis that actually kind of makes the space smaller because of the bone structure and the joint structure changes. You can get thickening of the carpal tunnel ligament. It’s called the transverse carpal ligament. That thickening can cause a decrease in the amount of space in the tunnel. It can come from swelling within the tunnel itself, and that can come from various conditions that cause inflammation such as inflammatory arthritis, certain conditions that are related to the kidneys. There’s numerous reasons. People can also frequently get carpal tunnel if they perform certain job duties that require lots of repetitive grasping with the wrist in an awkward positioning where they’re doing forceful grasping in a repetitive manner. Then there’s certain medical conditions that do increase your risk of getting carpal tunnel such as diabetes or a thyroid condition or morbid obesity.
Host: Wow. So it really is a very common condition. How often do your patients perhaps think it’s something else?
Dr. Crawford: It’s funny. The most frequent thing that I hear patients come in to say is they didn’t realize it was carpal tunnel. They just thought they were sleeping funny on their wrists. Then when you kind of dig a little bit deeper and start thinking about it, frequently they say, “Well you know I just have a tendency to do that.” If you ask how do you do that? Sometimes it comes out, “Well it’s almost every night I sleep like that.” So sometimes as you dig a little bit deeper and get a better history and kind of ask the right questions, you can kind of decipher and figure out what these symptoms are and why people feel the way that they do.
Host: Is a diagnosis something that patients are referred to you for, or does it start with their primary care providers?
Dr. Crawford: It can be either. Certainly, this is a common enough condition that primary care physicians see this frequently in their own practice. Gerontologists who see older patients can see this frequently. Sometimes it’s a little bit more stealthy and perhaps the symptoms aren’t quite as obvious. So I might see a patient who comes in and they have either numbness or tingling, or they have pain. They’re not really sure where it’s originating from.
Host: What are some of the treatment options once an individual knows they have carpal tunnel?
Dr. Crawford: So one of the first things that we do with diagnosing the carpal tunnel and helping kind of determine what our treatment options are is we want to kind of stratify how severe the carpal tunnel is. If the carpal tunnel is more mild then sometimes there's treatment options such as using a wrist brace, modifying activity, taking an anti-inflammatory, using a cortisone injection, weight loss, or control of some other medical conditions. When people have more moderative or advanced carpal tunnel, frequently these conservative measures may not work. Then sometimes these patients will feel benefit from undergoing a carpal tunnel release from a symptom management standpoint. Carpal tunnel isn’t just about sensation. The nerve actually provides you with both sensory component, so the feeling in your fingers and hand. It also effects the muscles in your hand. So sometimes when patients have more advanced disease, what we do is we do a carpal tunnel release so that we don’t end up with nerve damage where it’s causing weakness in the hand and weakness in the muscles which can effect patients pinch and grip and overall strength in the hand.
Host: Okay. This is something that is maybe a long-term condition that patients just learn to manage or is it something that you see a lot of patients overcome?
Dr. Crawford: So it is something that it can sometimes be a long-term condition that’s managed. If it’s more of a mild carpal tunnel, sometimes using wrist braces can work well for people for a period of time. For other people, it can be more progressive in nature. The main thing is it’s best to have it evaluated by a professional so that they can determine at what point it’s appropriate to provide additional treatment beyond just like monitoring or wrist braces. It’s one of those things I tell my patients very frequently it’s something that is what I consider low-hanging fruit in your life. Meaning it’s not something that’s just a component of aging. You have to just live with this. You're just not going to have good sleep for the rest of your life and that’s just how it is. Treating carpal tunnel is something that is very straight forward, has been around for decades easily since the 60s. We have very good outcomes. So if it is something that’s providing discomfort, if it’s inhibiting your function, if it’s disturbing your sleep or effecting your abilities to perform your activities of daily living or just it’s painful for you, it’s something that we can certainly treat and we can treat it effectively in an appropriate fashion.
Host: Dr. Crawford, how might individuals seek care for conditions like carpal tunnel or other orthopedic conditions for that matter?
Dr. Crawford: So you can always talk to your primary care physician if you have a musculoskeletal condition such as carpal tunnel or other orthopedic injuries or hand injuries. If you're having pain or stiffness or swelling or numbness or tingling, you can discuss it with your primary. You can also seek out specialty help and see an orthopedic surgeon or hand surgeon specifically if the symptoms you're feeling are in your hand.
Host: The Riverside orthopedic office can be reached at 815-802-7090 or online at chooseriversideortho.com. Dr. Crawford thanks for joining us on the Well Within Reach podcast.
Dr. Crawford: Thank you.
Host: For more information on this topic and others, visit riversidehealthcare.org.
Prevention and Treatment of Carpal Tunnel
Alyssa Diaz (Host): Hello listeners, and welcome to the Well Within Reach podcast. I'm your host Alyssa Diaz, and today we’ll be hearing from one of Riverside’s orthopedic specialists, Dr. Taruna Crawford, on a common condition called carpal tunnel. Dr. Crawford, thanks for joining us on the podcast.
Taruna Crawford, MD, CIME (Guest): Thanks for having my Alyssa.
Host: We’ll just start with a little introduction to you as an orthopedic surgeon. Let’s talk about your background and training.
Dr. Crawford: Sure. So I am an orthopedic surgeon. I've done most of my training here in the Chicagoland area. Early on I did my college and medical school at Northwestern. I subsequently went and did an orthopedic surgery residency in Cincinnati. That’s surgery that addresses bones, tendons, ligaments, nerves, joints. After that, I went on for additional specialty training in hand surgery at the Philadelphia hand center before I move back to the Chicagoland area to start in practice in 2010.
Host: Today’s topic, prevention and treatment of carpal tunnel, is something that you see everyday and probably it’s very near and dear to your practice.
Dr. Crawford: It is definitely one of the more common conditions that we see as orthopedic hand surgeons.
Host: So let’s start at the beginning. What is carpal tunnel?
Dr. Crawford: Carpal tunnel is basically a condition that happens that can cause numbness and tingling in the hand. Sometimes it can cause pain. The carpal tunnel is an actual tunnel that exists at the level of your wrist, and it’s a tunnel of space that the nerves that provide you with sensation to your thumb, index, middle finger primarily pass through. There's also space there for tendons. What can happen is sometimes that space is a mismatch for the structures that are in the space. So carpal tunnel is when you have pressure in the space that causes numbness and tingling sensation in the hand or associated pain.
Host: Is there a specific cause behind carpal tunnel?
Dr. Crawford: There's actually numerous causes of carpal tunnel. Carpal tunnel can come from things such as an acute injury like a wrist fracture or fractions around the wrist. It can occur from aging. It can occur from arthritis that actually kind of makes the space smaller because of the bone structure and the joint structure changes. You can get thickening of the carpal tunnel ligament. It’s called the transverse carpal ligament. That thickening can cause a decrease in the amount of space in the tunnel. It can come from swelling within the tunnel itself, and that can come from various conditions that cause inflammation such as inflammatory arthritis, certain conditions that are related to the kidneys. There’s numerous reasons. People can also frequently get carpal tunnel if they perform certain job duties that require lots of repetitive grasping with the wrist in an awkward positioning where they’re doing forceful grasping in a repetitive manner. Then there’s certain medical conditions that do increase your risk of getting carpal tunnel such as diabetes or a thyroid condition or morbid obesity.
Host: Wow. So it really is a very common condition. How often do your patients perhaps think it’s something else?
Dr. Crawford: It’s funny. The most frequent thing that I hear patients come in to say is they didn’t realize it was carpal tunnel. They just thought they were sleeping funny on their wrists. Then when you kind of dig a little bit deeper and start thinking about it, frequently they say, “Well you know I just have a tendency to do that.” If you ask how do you do that? Sometimes it comes out, “Well it’s almost every night I sleep like that.” So sometimes as you dig a little bit deeper and get a better history and kind of ask the right questions, you can kind of decipher and figure out what these symptoms are and why people feel the way that they do.
Host: Is a diagnosis something that patients are referred to you for, or does it start with their primary care providers?
Dr. Crawford: It can be either. Certainly, this is a common enough condition that primary care physicians see this frequently in their own practice. Gerontologists who see older patients can see this frequently. Sometimes it’s a little bit more stealthy and perhaps the symptoms aren’t quite as obvious. So I might see a patient who comes in and they have either numbness or tingling, or they have pain. They’re not really sure where it’s originating from.
Host: What are some of the treatment options once an individual knows they have carpal tunnel?
Dr. Crawford: So one of the first things that we do with diagnosing the carpal tunnel and helping kind of determine what our treatment options are is we want to kind of stratify how severe the carpal tunnel is. If the carpal tunnel is more mild then sometimes there's treatment options such as using a wrist brace, modifying activity, taking an anti-inflammatory, using a cortisone injection, weight loss, or control of some other medical conditions. When people have more moderative or advanced carpal tunnel, frequently these conservative measures may not work. Then sometimes these patients will feel benefit from undergoing a carpal tunnel release from a symptom management standpoint. Carpal tunnel isn’t just about sensation. The nerve actually provides you with both sensory component, so the feeling in your fingers and hand. It also effects the muscles in your hand. So sometimes when patients have more advanced disease, what we do is we do a carpal tunnel release so that we don’t end up with nerve damage where it’s causing weakness in the hand and weakness in the muscles which can effect patients pinch and grip and overall strength in the hand.
Host: Okay. This is something that is maybe a long-term condition that patients just learn to manage or is it something that you see a lot of patients overcome?
Dr. Crawford: So it is something that it can sometimes be a long-term condition that’s managed. If it’s more of a mild carpal tunnel, sometimes using wrist braces can work well for people for a period of time. For other people, it can be more progressive in nature. The main thing is it’s best to have it evaluated by a professional so that they can determine at what point it’s appropriate to provide additional treatment beyond just like monitoring or wrist braces. It’s one of those things I tell my patients very frequently it’s something that is what I consider low-hanging fruit in your life. Meaning it’s not something that’s just a component of aging. You have to just live with this. You're just not going to have good sleep for the rest of your life and that’s just how it is. Treating carpal tunnel is something that is very straight forward, has been around for decades easily since the 60s. We have very good outcomes. So if it is something that’s providing discomfort, if it’s inhibiting your function, if it’s disturbing your sleep or effecting your abilities to perform your activities of daily living or just it’s painful for you, it’s something that we can certainly treat and we can treat it effectively in an appropriate fashion.
Host: Dr. Crawford, how might individuals seek care for conditions like carpal tunnel or other orthopedic conditions for that matter?
Dr. Crawford: So you can always talk to your primary care physician if you have a musculoskeletal condition such as carpal tunnel or other orthopedic injuries or hand injuries. If you're having pain or stiffness or swelling or numbness or tingling, you can discuss it with your primary. You can also seek out specialty help and see an orthopedic surgeon or hand surgeon specifically if the symptoms you're feeling are in your hand.
Host: The Riverside orthopedic office can be reached at 815-802-7090 or online at chooseriversideortho.com. Dr. Crawford thanks for joining us on the Well Within Reach podcast.
Dr. Crawford: Thank you.
Host: For more information on this topic and others, visit riversidehealthcare.org.