Ask the Doc: Q&A on Carpal Tunnel Syndrome

Author: Jung Park, MD

Facebook Live Broadcast on April 2, 2020 with Jung Park, MD, Hand Surgeon

Thanks everyone for joining me on this Facebook Live event.

This is Dr. Jung Park transmitting live from Doylestown, Bucks County.

Before I get started, I hope every one of you and your family is doing well during the COVID-19 pandemic. This is a very serious problem that is affecting the entire world and we all need to do our part. We need to stay home, keep our social distance, wash hands frequently, take care of our hands and do everything we can to avoid contracting the virus.

First, allow me to introduce myself. I’m a board-certified, fellowship-trained orthopedic surgeon with subspecialty certificate in hand surgery. I have been part of Bucks County Orthopedic Specialists since 2013. Gosh, it has already been 7 years!

We are an Orthopedic subspecialty group that has been serving Doylestown and the surrounding area for over 40 years. We currently have 11 physicians and 6 physician assistants. Collectively, we cover pretty much all subspecialties, including pediatrics, spine, sports, joint replacements, and foot and ankle. We are dedicated to serving our community and we have introduced services such as same day joint replacements and wide awake surgery, which I will elaborate further in a little bit.

Today, I’m planning on answering your questions, busting the myths about carpal tunnel syndrome. We have been collecting questions on social media platforms since the beginning of the week and even during this live feed, you can submit your questions and I will answer them as we go. For those listening live, please submit your questions anytime. I have my trusty assistant, the CEO of BCOS, Randy Gross here, 6 feet away from me, writing those questions for me.

Before we get to your more specific questions, I’m going provide a brief Q&A of the most common questions that I hear in my office:

Q: The most common question I get is, what exactly is carpal tunnel syndrome?

A: To answer this question, we have to understand what the carpal tunnel is. When we look at it anatomically, it is literally a tunnel with floor and side walls that are made of bones and the roof is a thick ligament. Inside the tunnel travel nine tendons and the median nerve. All these structures come from the elbow and forearm and cross the wrist before they spread to the fingers in the hand. As you can see, the wrist is the thinnest portion. It is a bottleneck; it is a very confined space. Anything that causes that space to become even smaller can cause compression of the structures inside the tunnel. The median nerve is the structure that is most sensitive to compression and can cause symptoms such as numbness, tingling, pain, and weakness of the hand. Symptoms tend to get worse with any activity or position that causes further compression inside the carpal tunnel. This includes having the wrist flexed or extended for prolonged time.

Q: How do I know if I have Carpal Tunnel Syndrome?

A: Carpal tunnel syndrome is diagnosed by a combination of history from the patient, physical examination and nerve studies. The nerve study is performed by a physician, usually a neurologist or a physiatrist. They will place electrodes along the length of the affected arm and check the response time and velocity to a small electric stimulation. This study confirms the suspected diagnosis and also tells me how severe it is.

Q: What are the treatment options for CTS?

A: There are three main treatment options and it depends on the severity of the symptoms and the nerve study findings. For mild to moderate CTS, we have many options, such as exercises, using a brace at nighttime, steroid injection or surgery. For severe, long standing symptoms, surgery may be the best option.

Q: Are there any exercises that I can do on my own?

A: Absolutely. Exercises definitely help.

I would like everyone to do this together.

  • Let’s first sit upright or stand up.
  • We can start by relaxing and stretching our neck and shoulder.
  • Bring the shoulder blades back and stretch the neck in all directions.

All the nerves in our hands come from the brainstem, down the neck before they branch out to the arms and finally to our hands and fingers. So, it makes sense to incorporate the neck and shoulder into our stretches.

  • Then, bring the elbow straight and bend the fingers back.
  • Hold for 10-15 seconds and you should feel the stretch on the forearm.
  • You should repeat this sequence of stretches for 3-5 times.

If your symptoms are severe or if you are involved in repetitive activities during the day, you may have to do this several times a day, maybe every hour. One final stretch is combining all the stretch moves together. And this is something you may want to do slowly as it could trigger some numbness or tingling in the fingertips.

Ah, that felt good.

Q: What else can I try on my own?

A: You can wear braces at nighttime or when you are doing activities that trigger your symptoms. There are many different kinds of braces. The main purpose of the brace is to prevent holding the wrist in extreme positions for extended periods of time. Therefore, you don’t want to apply a compressive tight band around your wrist. You want something comfortable that keeps your wrist still in a neutral position. I brought an over the counter brace with me. I did not get any sponsorship for this talk, so I’m not going to mention who makes this particular brace.

Q: My doctor says I need surgery - is that the best option for me?

A: I personally recommend surgery to those with severe objective findings, such as muscle atrophy seen on exam or severe nerve study findings and for those with severe symptoms that do not respond to conservative measures. Surgery consists of releasing the roof of the carpal tunnel, which is the thick ligament structure. It is a quick but very successful procedure. It takes about 10 minutes. I make about an incision in the palm about an inch long, spread the tissue around and when I can clearly visualize the ligament, which is the roof of the carpal tunnel, I can fully release it. As soon I do that, the pressure on the median nerve is released. I then close the skin with 3-4 stitches and it is covered with a very light bandage, almost like a band-aid type of dressing. You can remove the dressing in 3-5 days and start washing your hand gently. Sutures are removed in 10-14 days.

GOING TO THE QUESTIONS SOME OF YOU ASKED ONLINE:

Michele M asks: Hello Dr. Park! I put off getting my hands and wrists examined for a long time. I finally had an EMG scheduled, but it was canceled due to the pandemic. I am in so much pain and my hands are useless due to numbness and pain. Any suggestions for maintenance relief while I wait?

A: Hi Michele, sounds like you are just like me. I tend to put things off until it’s really bad.

This is an excellent question. The first thing we have to do is to establish a diagnosis. EMG, nerve conduction study is part of the diagnostic tool. Given the circumstances that we are in now, if you have not started yet, I recommend that you begin doing the stretch throughout the day, and wear a brace at nighttime. But, if you have not yet been evaluated by a hand surgeon like myself, you should definitely do that first since you may have other conditions that is aggravating the pain

Bonnie D. asks: Do I have to have anesthesia for carpal tunnel surgery?

A: Great question Bonnie! I do nearly everyone under just local anesthesia, with the patient wide awake. It is just like going to the dentist, but you can also talk during the procedure. I hate when my dentist talks to me and all I can respond back is hmm hm. I don’t even want to nod or shake my head so that he does not drill the wrong tooth!

Doing surgery under local anesthesia has many benefits. You don’t suffer from the bad side effects of the anesthetic drugs, there is no need for extensive preoperative blood work or tests, you don’t have to fast the night before, and you could even drive yourself in and out of the surgery! And most importantly, we get to know each other a little more. You get to hear the bad jokes that are said in the OR.

Karen C. asks: Would like to know if there are supplements or medicine that are useful to address Carpal Tunnel?

A: Hi Karen, this is a question that I get a lot. Wish that there was a simple pill that you could make it better. But, the reality is that there is not. If you don’t have any contraindications, you can try any anti-inflammatory medications. But, there is really not enough evidence to support use of any oral treatments such as diuretics, gabapentin, even NSAIDs, pyridoxyne, astaxanthin capsules.

Rhiannon D. asks: What is the expected recovery time following the procedure to fix carpal tunnel? Would I be able to return to work right away using my affected hand?

A: Thanks Rhainnon for the question. It’s all relative. Depends on what you do for work. You can start light activities right away. So, if you have a light desk job, you may return even on day 1. After 2 weeks, when the wound is fully healed, you may still have some scar pain, but you can return to activities as tolerated. Obviously, if you are a carpenter or work in construction, it may take longer, maybe even a few months until you can work with no discomfort.

Jake H asks: I was diagnosed with carpal tunnel syndrome 5 years ago and was told that it is only mild based on the EMG. My symptoms are somewhat manageable. Am I doing more damage by waiting? When should I consider surgery?

A: That’s an excellent question Jake. Am I doing more damage? How proactive should I be? These are questions that I hear all the time. I would say that if your symptoms are manageable, I think you are doing the right thing. But, definitely pay close attention to your symptoms. What I mean is that, take a mental note of the activities that cause your symptoms and see if it is changing. For example, let’s say you ride a motorcycle or a bicycle. If initially it took half an hour to get the numbness and now it’s taking less time, then you may need surgery. For women, it’s usually putting makeup on or using a blow dryer. If you have to take breaks due to the numbness, it is probably progressing and should get evaluated.

ADDITIONAL QUESTIONS FROM THE FB LIVE AUDIENCE (SEE VIDEO)

Wrapping things up, thank you everyone for joining and listening my very first Facebook Live event. Before I go offline, I want to put a plug about our telemedicine visits. We at BCOS are open and we are physically seeing urgent and emergent patients in the office. Additionally, we have also started telemedicine this week. This may be the future of medicine. So far, I have had more than 10 patient interactions and they have been quite successful in my opinion. I was skeptical at first, since I rely a lot of my diagnosis on direct physical examination. But the appointments worked well and I think patients really appreciate the virtual visits.

Please call our office at 215-348-7000 and we can schedule your televisit. It will be scheduled just like an office visit for a certain day and time. And just before that time, we will email you or text you a link. Once you click on the link, we will be on a one on one video chat like this. We will be able to diagnose and formulate a personalized plan based on your particular condition and circumstance.

Remember, we’re just a phone call away!

Thank you very much again and this is Dr. Jung Park signing off. Have a wonderful day at home with clean and now healthy hands!

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