You may not realize how much your hands do until you have trouble using them. Hand pain can limit many daily activities and affect your quality of life. If you work at a computer or other similar field, hand issues might even affect your work.
In this segment, Dr. Jesse T. Lewis discusses how, if hand pain interferes with your daily life, it might be time to consider a visit to a hand surgeon.
Get a Grip on Your Hand Pain
Featured Speaker:
Dr. Jesse T. Lewis, Tidelands Health physician
Dr. Jesse T. Lewis is an Orthopedic Surgery Specialist with Tidelands Health. Transcription:
Get a Grip on Your Hand Pain
Bill Klaproth (Host): Hand surgery can treat diseases that cause pain and impair the function of the hand and wrist such as carpal tunnel syndrome. And here to talk with us about hand surgery and carpal tunnel syndrome, is Dr. Jesse T. Lewis, a hand surgeon at Tidelands Health. Dr. Lewis, thank you so much for your time. So, is carpal tunnel the number one thing you treat with hand surgery?
Dr. Jesse T. Lewis (Guest): It is probably one of the more common things that I see. It’s certainly a syndrome that comes up in general conversation when people talk about hand pain or numbness. So, it is certainly something that if the patient doesn’t have, they often come to me thinking that they have carpal tunnel syndrome.
Bill: And what is the main cause of carpal tunnel syndrome?
Dr. Lewis: Well the causes can range from a lot of things, actually. What carpal tunnel syndrome is, is there is a tunnel or space in the wrist which is surrounded by both bones and a ligament and through that space there are nine tendons and an important nerve called the median nerve and so anything that causes swelling or decreased space in that tunnel can cause it. So, this can range from inflammation or tendon inflammation or joint dislocations, fractures, arthritis. Sometimes we see it in fluid conditions such as pregnancy where the body just has more fluids, so there a number of different causes. The most common that I see typically is what we call idiopathic, meaning there is not a specific cause for it, it is just for whatever reason the nerve has started to present symptoms of this compression.
Bill: And is that due to repetitive motions, we think of the person on the keyboard all day?
Dr. Lewis: You know the – a lot of people tend to think that. There has been studies that have looked into that and there has not been a clear causation with things like keyboarding or other clerical things. There are certainly repetitive vibration like a jackhammer use that does you know can cause that stuff but those things like keyboarding can certainly aggravate a nerve that is already mildly aggravated, so it can certainly cause irritation of the nerve, whether or not it was the direct cause is tough to say.
Bill: And when is it time for someone to see the doctor?
Dr. Lewis: You know I think people are pretty good at recognizing kind of when they have been set up. A lot of times, specifically carpal tunnel syndrome can cause pain, numbness and tingling at night and certainly anytime our sleep is interrupted, patients tend to want to seek help with that. There are milder symptoms that we will sometimes see such as weakness with grip or occasional clumsiness. Certainly, when those types of things become bad enough the patients tend to present. But I would say it’s variable. Usually it’s the pain, numbness and tingling especially at night that brings patients to see me more than anything.
Bill: And is the first course of treatment nonsurgical?
Dr. Lewis: Certainly, I would say with rare exception. Occasionally, I’ll see patients that have profound atrophy meaning the muscles have not been getting innervated for quite some time and at that point, the potential for nonoperative intervention to work becomes much less. But I would say on average, certainly nonoperative intervention whether it be an injection or splinting especially nighttime splinting is usually the first course of treatment.
Bill: And then who is a good candidate for hand surgery if nonsurgical treatment doesn’t work?
Dr. Lewis: With any type of nerve compression it’s rare that a patient would not a surgical candidate. I can do this surgery purely under local anesthesia so, meaning the patient does not have to go to sleep. Certainly, most patients prefer to be knocked out a little bit, but from a surgical candidate standpoint, I don’t feel there really a person who doesn’t meet a surgical candidate requirement.
Bill: So, then most of this is done as outpatient surgery?
Dr. Lewis: Certainly, yeah, it’s a relatively short procedure. It’s done outpatient and that just means that the patient can go home the same day after the procedure.
Bill: And what about recovery time?
Dr. Lewis: So recovery is just like any other type of nerve treatment. Recovery is a little bit variable. I
would say on average, most people feel that their nighttime symptoms tend to improve relatively quickly. By the time I see patients back for their first two-week visit, most of the time, they say yeah, I have noticed a difference. That being said, the recovery from the actual surgery itself or the surgery trauma is usually in the four or so week range. I certainly have patients that are doing much better well before then. But as far as nerve recovery goes, to where the numbness and tingling in the fingers are completely recovered it’s a little bit variable. Part of that depends on the severity of the nerve compression and that can be whether or not this has been going for a long time or in the cases of trauma, where the nerve was severely stretched or injured, sometimes that nerve recovery is incomplete.
Bill: And does the person then need to wear a brace or some sort of cast for the recovery time?
Dr. Lewis: So, postoperatively, again with rare exception, it is usually a soft dressing and that just means no cast or no splint. What I usually do for routine carpal tunnel release is have the patient take the dressings off on day three and they can shower and pretty much the incision is small enough that you could put a Band-Aid over it and so patients usually come in at the two-week mark with either nothing on it because the incision doesn’t bother them or a Band-Aid if it still causing a little bit of irritation for them.
Bill: Dr. Lewis does this usually occur in one hand or the other or do you see it in both hands at the same time?
Dr. Lewis: I would say more commonly, it is usually one hand that is most bothersome but whether through provocative testing or oftentimes I’ll get a nerve study to look at both sides and they’ll have symptoms from the nerve being irritated bilaterally or on both sides, however, whether it is because the one side has more severe compression or for whatever reason, more symptoms on that side, they don’t tend to notice the other side so much.
Bill: Right, and are there any risks involved in carpal tunnel surgery?
Dr. Lewis: Certainly, any time we do surgery and cut the skin, there is risk of infection and this particular surgery and most surgeries involving the hand that risk is very low, much less than one percent. The biggest risk with carpal tunnel surgery is probably injuring the nerve. The point of the surgery is to release the nerve so we do look directly at it and injuring the nerve is very rare, so there is always risks certainly, but in this particular surgery, they are fairly low.
Bill: Is there any danger in letting this go and not seeing a doctor and risking permanent pain or damage?
Dr. Lewis: Certainly. And it is not so much the pain, permanent pain that is concerning, when I’m thinking about treating a nerve; what happens when you have compression on a nerve for a long period of time, the muscles that the nerve goes to begins to lose input and they actually atrophy or slowly die and so there is not a specific cut off point for when this occurs, but we do know the longer the nerve is compressed, the more likely permanent damage is to occur and so when a patient for whatever reason doesn’t get better with nonoperative management, it’s one of the instances where I would recommend surgical release just because of the possibility of permanent nerve damage.
Bill: Right, well that makes sense. And Dr. Lewis, why should someone choose Tidelands Health for their hand and wrist needs?
Dr. Lewis: Well I think here at Tidelands Health, all of our surgeons and especially me starting out, are very eager to see patients return to their baseline activities, things that they like to enjoy and I feel like our facilities are great and accommodating the whole process from the initial evaluation, treatment and postoperative recovery.
Bill: Well, Dr. Lewis, thank you again for your time and talking with us about carpal tunnel syndrome. And for more information about Tidelands Health physicians, services and facilities you can visit tidelandshealth.org. That’s tidelandshealth.org. This is Better Health Radio. I’m Bill Klaproth. Thanks for listening.
Get a Grip on Your Hand Pain
Bill Klaproth (Host): Hand surgery can treat diseases that cause pain and impair the function of the hand and wrist such as carpal tunnel syndrome. And here to talk with us about hand surgery and carpal tunnel syndrome, is Dr. Jesse T. Lewis, a hand surgeon at Tidelands Health. Dr. Lewis, thank you so much for your time. So, is carpal tunnel the number one thing you treat with hand surgery?
Dr. Jesse T. Lewis (Guest): It is probably one of the more common things that I see. It’s certainly a syndrome that comes up in general conversation when people talk about hand pain or numbness. So, it is certainly something that if the patient doesn’t have, they often come to me thinking that they have carpal tunnel syndrome.
Bill: And what is the main cause of carpal tunnel syndrome?
Dr. Lewis: Well the causes can range from a lot of things, actually. What carpal tunnel syndrome is, is there is a tunnel or space in the wrist which is surrounded by both bones and a ligament and through that space there are nine tendons and an important nerve called the median nerve and so anything that causes swelling or decreased space in that tunnel can cause it. So, this can range from inflammation or tendon inflammation or joint dislocations, fractures, arthritis. Sometimes we see it in fluid conditions such as pregnancy where the body just has more fluids, so there a number of different causes. The most common that I see typically is what we call idiopathic, meaning there is not a specific cause for it, it is just for whatever reason the nerve has started to present symptoms of this compression.
Bill: And is that due to repetitive motions, we think of the person on the keyboard all day?
Dr. Lewis: You know the – a lot of people tend to think that. There has been studies that have looked into that and there has not been a clear causation with things like keyboarding or other clerical things. There are certainly repetitive vibration like a jackhammer use that does you know can cause that stuff but those things like keyboarding can certainly aggravate a nerve that is already mildly aggravated, so it can certainly cause irritation of the nerve, whether or not it was the direct cause is tough to say.
Bill: And when is it time for someone to see the doctor?
Dr. Lewis: You know I think people are pretty good at recognizing kind of when they have been set up. A lot of times, specifically carpal tunnel syndrome can cause pain, numbness and tingling at night and certainly anytime our sleep is interrupted, patients tend to want to seek help with that. There are milder symptoms that we will sometimes see such as weakness with grip or occasional clumsiness. Certainly, when those types of things become bad enough the patients tend to present. But I would say it’s variable. Usually it’s the pain, numbness and tingling especially at night that brings patients to see me more than anything.
Bill: And is the first course of treatment nonsurgical?
Dr. Lewis: Certainly, I would say with rare exception. Occasionally, I’ll see patients that have profound atrophy meaning the muscles have not been getting innervated for quite some time and at that point, the potential for nonoperative intervention to work becomes much less. But I would say on average, certainly nonoperative intervention whether it be an injection or splinting especially nighttime splinting is usually the first course of treatment.
Bill: And then who is a good candidate for hand surgery if nonsurgical treatment doesn’t work?
Dr. Lewis: With any type of nerve compression it’s rare that a patient would not a surgical candidate. I can do this surgery purely under local anesthesia so, meaning the patient does not have to go to sleep. Certainly, most patients prefer to be knocked out a little bit, but from a surgical candidate standpoint, I don’t feel there really a person who doesn’t meet a surgical candidate requirement.
Bill: So, then most of this is done as outpatient surgery?
Dr. Lewis: Certainly, yeah, it’s a relatively short procedure. It’s done outpatient and that just means that the patient can go home the same day after the procedure.
Bill: And what about recovery time?
Dr. Lewis: So recovery is just like any other type of nerve treatment. Recovery is a little bit variable. I
would say on average, most people feel that their nighttime symptoms tend to improve relatively quickly. By the time I see patients back for their first two-week visit, most of the time, they say yeah, I have noticed a difference. That being said, the recovery from the actual surgery itself or the surgery trauma is usually in the four or so week range. I certainly have patients that are doing much better well before then. But as far as nerve recovery goes, to where the numbness and tingling in the fingers are completely recovered it’s a little bit variable. Part of that depends on the severity of the nerve compression and that can be whether or not this has been going for a long time or in the cases of trauma, where the nerve was severely stretched or injured, sometimes that nerve recovery is incomplete.
Bill: And does the person then need to wear a brace or some sort of cast for the recovery time?
Dr. Lewis: So, postoperatively, again with rare exception, it is usually a soft dressing and that just means no cast or no splint. What I usually do for routine carpal tunnel release is have the patient take the dressings off on day three and they can shower and pretty much the incision is small enough that you could put a Band-Aid over it and so patients usually come in at the two-week mark with either nothing on it because the incision doesn’t bother them or a Band-Aid if it still causing a little bit of irritation for them.
Bill: Dr. Lewis does this usually occur in one hand or the other or do you see it in both hands at the same time?
Dr. Lewis: I would say more commonly, it is usually one hand that is most bothersome but whether through provocative testing or oftentimes I’ll get a nerve study to look at both sides and they’ll have symptoms from the nerve being irritated bilaterally or on both sides, however, whether it is because the one side has more severe compression or for whatever reason, more symptoms on that side, they don’t tend to notice the other side so much.
Bill: Right, and are there any risks involved in carpal tunnel surgery?
Dr. Lewis: Certainly, any time we do surgery and cut the skin, there is risk of infection and this particular surgery and most surgeries involving the hand that risk is very low, much less than one percent. The biggest risk with carpal tunnel surgery is probably injuring the nerve. The point of the surgery is to release the nerve so we do look directly at it and injuring the nerve is very rare, so there is always risks certainly, but in this particular surgery, they are fairly low.
Bill: Is there any danger in letting this go and not seeing a doctor and risking permanent pain or damage?
Dr. Lewis: Certainly. And it is not so much the pain, permanent pain that is concerning, when I’m thinking about treating a nerve; what happens when you have compression on a nerve for a long period of time, the muscles that the nerve goes to begins to lose input and they actually atrophy or slowly die and so there is not a specific cut off point for when this occurs, but we do know the longer the nerve is compressed, the more likely permanent damage is to occur and so when a patient for whatever reason doesn’t get better with nonoperative management, it’s one of the instances where I would recommend surgical release just because of the possibility of permanent nerve damage.
Bill: Right, well that makes sense. And Dr. Lewis, why should someone choose Tidelands Health for their hand and wrist needs?
Dr. Lewis: Well I think here at Tidelands Health, all of our surgeons and especially me starting out, are very eager to see patients return to their baseline activities, things that they like to enjoy and I feel like our facilities are great and accommodating the whole process from the initial evaluation, treatment and postoperative recovery.
Bill: Well, Dr. Lewis, thank you again for your time and talking with us about carpal tunnel syndrome. And for more information about Tidelands Health physicians, services and facilities you can visit tidelandshealth.org. That’s tidelandshealth.org. This is Better Health Radio. I’m Bill Klaproth. Thanks for listening.