Caitlin Whyte (Host): Carpal Tunnel Syndrome is a name you may have heard before but might not know much about. So to tell us more about carpal tunnel, we are joined by Dr. Anthony Villare, an Orthopedic Surgeon at Upland Hills Health in Dodgeville.

 This is the Inspire Health Podcast from Upland Hills Health. I'm Caitlin Whyte.

Host: So Doctor, start us off this episode today, just what is Carpal Tunnel Syndrome and what causes it?

anthony carpel tunel_1: Carpal Tunnel Syndrome is where the nerve that travels down your forearm and past your wrist and into your hand gets a constant level of compression around it to the point where people get numbness. It's almost like sitting too long and your leg falls asleep. They get numbness into their fingers and it can stay there long enough to where they are, they actually start to get like a nerve pain with the numbness.

And, when it persists, that's when you know we have to get treatment. A lot of times we get it and,  it resolves fairly quickly but carpal tunnel syndrome can persist for months and years for a patient.

Host: So when it comes to these symptoms, how do symptoms impact the quality of life for a patient? And what are some things that people complain about?

anthony carpel tunel_1: Well, patients mainly complete about numbness. That is usually the first thing that presents when someone has carpal tunnel. They can't quite pick up that paperclip anymore, or that they have difficulty holding something they don't know they're holding it. And you can imagine how that might impact them at a job where they're using their hands all the time, let alone trying to open a doorknob. Or, a pickle jar, something like that. Just simple things on a daily basis can be difficult. Holding a fork or a knife, can get annoying if you can't feel it. Carpal tunnel syndrome can come about and can get worse because of what we call repetitive task injuries. If you are constantly using your hands. Now a lot of us, we all use our hands in our lives, in our work though.

But sometimes the job details have us using our hands more and that can cause inflammation across the carpal tunnel, that causes a squeezing of the nerve. And then patients get the numbness. Now it might go away through the day. I think a lot of times patients will, begin to say, I have numbness. It wakes me up at night and I have to go shake my hand out, and then after a couple minutes it goes away and I go back to sleep. That might be how it starts, but then it might progress. Pregnant women, they can get carpal tunnel syndrome. Inflammation due to pregnancy, water retention, all that, combined with all these other things. And if it's there long enough, like I said, you can start to get actually a nerve type pain and if it actually goes on unabated and untreated for years, and I've had patients that have come to me for 10 years, they've had this thing. And we then treat them. But, if it goes on long enough, remember those nerves feed muscles into your hands and if that signal from that nerve is interrupted for long enough and we're talking years, that muscle can start to atrophy or die away because it's not getting an adequate nerve signal to it. And then that can affect how a person, what kind of grip strength they have and how they use their fingers and for pinching and picking up things so it can really snowball and get bad. But it, it generally takes a long time for that to happen.

Host: Gotcha. Gotcha. So it sounds like, these frustrations are simple, but they are in fact disrupting and frustrating. So what can people do on their own to reduce the symptoms and the discomfort they feel from this carpal tunnel?

anthony carpel tunel_1: Most patients will start to just take anti-inflammatories. Simple non-surgical treatments they can do; wear a wrist splint at nighttime. You can purchase one at any pharmacy, some grocery stores, Walmart and stuff. So get a wrist splint, like a hard one with a metal shank on the palm side.

 Wear it at bedtime because when, at nighttime when you're sleeping, you don't know what position your wrist is in. You might be holding it in a wrong position and it's making it worse. So it helps to support the wrist, hold it in one position, and see if that helps. Identifying maybe what you're doing at work or even at home. Maybe you garden a lot or something. If you do a lot of hobbies at home where you're using your hands a lot, if you change some of that, it might help relieve the symptoms. Anti-inflammatories, ice, an ice massage over the wrist can sometimes help.

 And it does help some patients. Those are the patients I generally don't see because, they've sort of taken care of it on their own. They've seen their family doctor about it. It's when that doesn't work. And they've, they've given it the college try and it doesn't get better. That's when it gets referred to me because, what's the next step?

And I can tell you there are things out there. Everybody's trying to develop a better mouse trap with this thing.  And there are things like physical therapy or occupational therapy may help. I think it does, and this is my own personal experience. I can't say that I have found occupational therapy to get rid of carpal tunnel altogether. Cortisone injections into the carpal tunnel is an option. I don't like doing that. I don't passing a needle down near the nerve and injecting it. I haven't found also, early on in my career, I did those a couple times. I didn't feel that anybody was really getting a solution with that.

We might've just been kicking the can down the road. It helped for a little while, but then it always came back, so I stopped doing cortisone injections. So if those simple, non-surgical conservative treatments don't help, and you got to try these things for like, two, three months. But if they don't help, when I see you, if you give me that history, I'm going to recommend surgery. Like it's definitive and I don't want to say it's quick, but patients can get some quick relief from it.

Host: Mm-hmm. With these treatment options, whether surgical or non-surgical, what are the recovery processes like?

anthony carpel tunel_1: The one thing we have to remember with the surgery is we're not trying to really do much to the nerve. The nerve isn't the problem. The problem is it doesn't have enough room for the space it's in. It's getting squeezed off, so all it needs is about like a millimeter or more of room.

So what we do with surgery is we just release a ligament over the top that normally would act like a trampoline. When we're younger, it's nice and elastic, but as we get older it gets more rigid, so we just release that ligament. And that gives the nerve, that breathing room it needs and it's a simple little surgery. After we do that, it's really up to the patient's body and the nerve to bounce back and to heal from it. So could be instantaneous. I've had some patients that tell me the next day they had no more numbness, no more tingling, no more pain or anything.

And then there's other patients, it can take weeks and sometimes up to three months for the symptoms to improve or resolve. And it really just kind of depends. It's not always dependent on how beat up the nerve might be before that, because I've seen some severe carpal tunnel patients get better right away and not get better. So I think it's really kind of a factor of how quickly that nerve wants to bounce back, how quickly their body can heal, and also how they're using it after the surgery. So I always try to promote minimal to moderate use of that hand after surgery. I'll give you a wrist splint to wear just as a reminder, not to use it for a lot, but, but there's always time for the incision to heal.

Give it about two weeks. We put stitches in to close the incision, then we take them out and there's always some tenderness around the incision. But beside that, it could be days, if not months, for the symptoms to improve after surgery of carpal tunnel. There's no way to predict it really.

Host: Well that does lead me into my next question here and my last as we close out today. Can a patient that develops carpal tunnel ever expect to return to their normal hand activities without any symptoms? Or is it something that's kind of with us once we have it?

anthony carpel tunel_1: No. Definitely with surgery or with treatment, whether it's conservative or not, you can definitely relieve yourself of the problems, the symptoms of carpal tunnel, and if we do surgery on it, absolutely you can get back to pain-free, numb-free function, usage of the hand afterwards.

 There's no reason you shouldn't. I mean, if sometimes patients may have irreversible nerve damage, but even that's not a guarantee that they won't get back. When we do carpal tunnel surgery, like I said, the problem is not the nerve. But sometimes if the nerve has been damaged for years and years and years, sometimes there's scar tissue that builds up in the casing of the nerve, and sometimes you have to open that up and that's where you get really tricky with it.

 But we're talking like a very few, small number of patients at that end of the spectrum. Most patients, yes, I think once they heal from the incision and it's not tender anymore and they've softened up the, the scar and all that. I would completely expect the numbness and whatever kind of nerve pain they might have had to eventually resolve. It may take time, but I would expect it to resolve.

Host: Always good to hear that a pain-free path can be in the future. Doctor, thanks for coming back and sharing this knowledge with us. Check out our website aat uplandhillshealth.org for more information on our doctors and treatment options. This has been the Inspire Health Podcast from Upland Hills Health.

I'm Caitlin Whyte. Be well.