Joey Wahler (Host): It's a condition that can adversely affect your daily life and, if left untreated, can get progressively worse. So, we're discussing carpal tunnel syndrome and how it's treated. Our guest, Kyle Sommers, an occupational nurse practitioner with Woodlawn Health.

Host: This is Woodlawn Health-Doc Talk, a podcast from Woodlawn Health. Thanks for listening. I'm Joey Wahler. Hi, Kyle. Thanks for joining us.

Kyle Sommers: Thank you for having me today.

Host: Great to have you aboard. So first, for those that don't know, what is carpal tunnel syndrome, we've all heard of it, and what are the symptoms?

Kyle Sommers: So, to start out with what carpal tunnel is, at the base of your palm and your wrist, that intersection, parallel you have a carpal ligament that runs across. And through that, you have a median nerve. When that ligament gets irritated from repetitive movements, it can swell and get inflamed and that will pinch that nerve, leaving you to have symptoms of pain or tingling, loss of sensation in your hand and through the thumb, index finger, middle finger, ring finger, and causes that feeling like your hand's gone to sleep.

Host: Well, you mentioned the carpal ligament for which it's named. I learned something there already. I thought maybe the name came from a Mr. or Mrs. Carpal that was the first victim way back centuries ago.

Kyle Sommers: Nope. We've got so many intricate parts to the hand.

Host: We all have heard of carpal tunnel coming from being in that frozen position, hands working the keyboard at work, right? What other scenarios can lead to this?

Kyle Sommers: So, repetitive movements of any kind, forceful movements over and over, even something as simple as a repetitive action where you're gripping very tight. So, it could be driving, constantly gripping that steering wheel; the shifter, if you're driving a manual transmission or a truck; typing, holding the phone. And I think the most surprising thing that people don't realize is certain positions that we take that we're not aware of when we're sleeping. Curling up your wrist under your pillow, supporting your head while you're sleeping, that constant pressure on that wrist can have the same result.

Host: Interesting. I didn't know that either. So, let me ask you about that last one, sleeping with your hand or wrist in an unhealthy position. So, is the fix there to do something to avoid that? Or if you can't, is the fix there a brace? Because sometimes those old school braces go a long way even today, right?

Kyle Sommers: Oh, absolutely. I mean, we can say, you know, keep your wrist straight, don't curl up under your pillow. But once you're sleeping soundly, you're not even aware of your position or your movement. So, it's very common to apply a splint to the wrist and the forearm to keep that in a natural position and prevent you from curling it up. There's been a lot of evidence to support simply wearing the braces every night consistently for over a month often resolves most cases of carpal tunnel.

Host: Interesting. So, how can we help prevent carpal tunnel or at least reduce its symptoms?

Kyle Sommers: It goes back to the basics of self-care, being aware of what we're doing, being diligent in our self-care as far as stretching, stopping and taking a moment to take a break. Being aware of the symptoms and addressing them sooner than later, whether that would be to take some ibuprofen, which would naturally help reduce some of that inflammation, taking a break from the repetitive action, starting to wear the splint at night, doing simple things before and after activity like stretching and working out those muscles, giving them time to rest.

Host: Well, you mentioned addressing this if it does occur sooner rather than later. So, speaking of which, if untreated, how does carpal tunnel get progressively worse and how does that affect our quality of life?

Kyle Sommers: So, there's three stages of diagnosis: mild, moderate, severe. Often at times when it's mild, it's not persistent. You might notice that when you're doing a repetitive activity and you start to feel that numbness in your fingers, you stop, you kind of give your hand a shake, and then you go back to it. It's not something that wakes you up at night or interferes with your daily life. But if you continue to push through and you're not taking those healthy measures like taking a break and stretching, it can become persistent. There's times that it might disturb your sleep, actually waking you up. Now, your hand and your wrist, you're fully functional during that time frame, but you're feeling that numbness on a regular basis more often than not. Then, we can move on into the severe stage where you start to have weakness in that hand. You will have your sleep disrupted on a regular basis. And it can get to the point that it can prevent you from carrying out normal activities, as in affecting your grip. Even like if you pick up, you know, your coffee cup to move it, you may feel like you're going to lose that, specifically losing control of their grip and the dexterity and movement in your fingers.

Host: And then, what would be the most severe scenario that can result?

Kyle Sommers: Severe scenario would be permanent nerve damage, because if we allow that ligament to remain swollen and inflamed, compressing that nerve for an extended period of time, eventually that nerve would be affected and you could lose feeling and function.

Host: I want to ask you about treatment options, of course, in a moment. But first, going back to preventative measures, more people, as you know nowadays, whether it's at work or at home, they work more often on the computer standing up, where everything is in the up high position. People do that, of course, for a variety of reasons. Does that help to avoid carpal tunnel?

Kyle Sommers: So, standing's not going to help, obviously, because we're looking at a different part of the body. But there are things you can do in that same concept, just applied to the arm and the wrist. Switching up your activity where you have things hands-free, using an automated talk text instead of continuing to type or continuing to hold a cell phone device at that same position all the time. So, we could do those things. You could wear a brace while you're doing your work to maintain extra support on those tendons and ligaments, so that the entire strain of your repetitive movement doesn't necessarily fall solely on the ligament. The brace can take part of that. Taking a break every hour to go ahead and stretch out those fingers, stretch the wrist, stretch the forearm, and repeat that five to ten times on your break, and then go back to your work.

Host: Gotcha. So, as promised, what treatment options are available for carpal tunnel?

Kyle Sommers: So initially, you can try some anti-inflammatory medications over-the-counter such as ibuprofen or Aleve. There's steroid injections, which once you're actually seeing a primary care doctor or an orthopedic specialist, they may recommend an injection into the wrist, that steroid would then provide localized relief by addressing the inflammation and swelling and reducing it. Obviously, wearing the splints that we've talked about is wonderful. And if you've tried all of those things and had no relief, finally there is a surgery where you can go in and release the pressure by having a surgeon put a small cut into that carpal tunnel ligament, loosening it, releasing it, that in and of itself has a 90% success rate. We'd like to take care of it with preventative measures before going to surgery, but surgery is very effective.

Host: And what is usually the recovery process and recovery time if that surgery is required?

Kyle Sommers: So, the expectation for surgery was that you would have a small incision in your wrist with a couple of stitches. You'd wear a bandage for a couple of days and you'd have a modified activity, keeping light activity during the healing period. You're encouraged to make a fist, work that range of motion on those fingers, and you can expect to return to full range of motion in a couple weeks, or return to full activity within six weeks. Now, granted some jobs may be more strenuous and you may have to go slightly beyond that six weeks, depending on the type of work you do.

Host: Sure. Couple of other things. I presume the criteria used to determine the best treatment depends largely on which of those three levels of carpal tunnel you have, right?

Kyle Sommers: Certainly, which leads back to addressing the problem sooner than later, seeking advice on how to handle it sooner than later. So often, we all think we can just push through, right? But the longer we push through, the more likely we are to have permanent damage to that median nerve.

Host: Now, once treated, in summary here, give our listeners, please, Kyle, an idea of what they can expect in terms of being able to resume normal activity symptom-free.

Kyle Sommers: You can expect to be back to full activity within six to eight weeks.

Host: Really? So, most people can address this in a positive manner, huh?

Kyle Sommers: Absolutely. If you come in at the very early stage and you try the wrist splints, you're going to want to give that a good month. So, you're looking at four weeks right there. If we move into the more aggressive treatment with the surgery, you can still expect to be back in six to eight.

Host: Wow. That sounds very encouraging indeed. And I know I, for one, am definitely, after speaking with you, going to look into this automated talk text because, if it means hearing more of my voice in exchange for keeping my hands healthy, why not, right?

Kyle Sommers: Absolutely. Use this technology that we have.

Host: Absolutely. So folks, we trust you are now more familiar with carpal tunnel syndrome and its treatment. Kyle Sommers, a pleasure. Thanks so much again.

Kyle Sommers: Thank you.

Host: And for more information, please visit woodlawnhealth.org. Again, that's woodlawnhealth.org. Now, if you found this podcast helpful, please share it on your social media. I'm Joey Wahler. And thanks again for listening to Woodlawn Health-Doc Talk, a podcast from Woodlawn Health.