Living in the Lehigh Valley
Living in the Lehigh Valley: Carpal Tunnel
Season 2022 Episode 25 | 9m 14sVideo has Closed Captions
Grover Silcox gives a look at the causes and solutions of Carpal Tunnel.
Carpal tunnel syndrome is a common condition that causes pain and discomfort. Grover Silcox gives a look at the causes and solutions
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Problems with Closed Captions? Closed Captioning Feedback
Living in the Lehigh Valley is a local public television program presented by PBS39
Living in the Lehigh Valley
Living in the Lehigh Valley: Carpal Tunnel
Season 2022 Episode 25 | 9m 14sVideo has Closed Captions
Carpal tunnel syndrome is a common condition that causes pain and discomfort. Grover Silcox gives a look at the causes and solutions
Problems with Closed Captions? Closed Captioning Feedback
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Learn Moreabout PBS online sponsorship- Hello and welcome to Living in the Lehigh Valley, where our focus is your health and wellness.
I'm your host, Brittany Sweeney.
Do you wake up to find your fingers tingly and numb?
Do you have to shake them to get the feeling back?
Does pain radiate from your wrist into your hand?
Well, for many people, these are the symptoms of carpal tunnel syndrome.
Our own Grover Silcox met with some hand surgeons and specialists to find out more about this often debilitating condition.
He joins us now.
Grover, it's always great to see you.
- Good to be here, Brittany, thank you.
- This can be really hard for people and really impact their lives.
- Absolutely.
According to the Rheumatology Research Foundation, between 4-10 million Americans suffer from carpal tunnel syndrome.
- And it can be really, really painful.
- Yeah, it really depends on the person, but it's frequently the pain that drives someone to a hand surgeon or their provider.
- I think many people either know someone who suffers from the condition, or have even had the surgery.
- According to the NIH, carpal tunnel syndrome is among the most common repetitive strain injuries.
- It makes sense.
- And actually, carpal tunnel syndrome was first described in the 1800s, and the first operation was performed in the 1930s.
The debilitating impact of carpal tunnel syndrome can affect a person's work and personal life.
Even making a fist can be painful and challenging, depending on the severity of the injury.
Again, citing the NIH, "Carpal tunnel is among the greatest drivers of worker's "compensation costs, lost time, lost productivity "and disability".
I set out to learn more about carpal tunnel syndrome and the nonsurgical and surgical remedies to relieve it.
The pain in your wrist, the numbness and tingling in your fingers and the way you fumble and drop things are among the signs of carpal tunnel syndrome.
- I had a problem with my right hand.
I had a lot of numbness.
I wasn't able to sleep, pain in my fingers.
About an hour and ten minutes... - Robert Buchman, a 70-year-old retired design technician with PPL, speaks about suffering with carpal tunnel.
- When I was sleeping, I would wake up with pain in my hand, my fingers would hurt, and I had to get out of bed and walk around and lower my hand to get some feelings back into my hand.
The ever-increasing pain drove Buchman to seek help from hand surgeon Dr. Jay Talsania, at OAA Orthopedic Associates in Allentown.
- I explain carpal tunnel as really a pinched nerve in the wrist.
Typically, it's worse at nighttime because we tens.
In the beginning, a little rare numbness and tingling that can progress all the way to loss of muscle and constant numbness.
So, when the nerve is entrapped underneath here, the nerve endings that go up to the thumb, the index finger, the middle finger, and, as you can see, half of the ring finger, those get impacted as far as the symptoms.
So, most patients who have numbness and tingling in these digits through here, along with pain that goes up to the forearms because of entrapment of the median nerve here at this level.
- Those who suffer from carpal tunnel might associate the cause with their job or other repetitive activities they've done over the years.
But this isn't necessarily the case.
- The idea that there's some aggregate source of which you develop the symptoms and the condition, and that may have nothing to do with it.
But we do know that there may be associated diagnoses like diabetes, hypothyroidism, rheumatoid disease.
Occasionally, somebody can have a structural issue, like a cyst, for example, at the wrist, putting pressure on the nerve.
So that's much less common.
It typically affects about 5% of the population.
So, it's not like everybody gets it.
The most common reason is unknown.
- Surgeons diagnose carpal tunnel by ruling out other conditions through a thorough examination which includes nerve testing.
- We get some testing called nerve testing, EMG.
And by getting that testing, that tells us the severity upon which the nerve is entrapped, and that sometimes has an impact in terms of how strongly I might make a recommendation for surgery.
- I personally do about 200-300 carpal tunnels a year, it's pretty much our bread-and-butter-type procedure, but for every patient that's going to surgery, there may be 10-15 patients that I tell them they can live with it, they can wear a splint, they may not want to have surgery, and certainly the splints can help them.
But if they're still not sleeping, I find it very helpful to give a cortisone injection, which may be 1-2 a year, can take away the night pain and solve the problem.
Robert Buchman tried splinting, but the pain grew more severe.
- I had two splints I used to wear, because I had a little bit on this hand, also.
But I wore those splints at night too, so I could sleep.
But it didn't work.
- He's your typical patient.
Most people come seek treatment when they have trouble sleeping.
- We brought him back within a week or two for the nerve test, and unfortunately, it showed a pretty compromised median nerve.
And he was traveling, so I put him on the O.R.
schedule, and we fixed him last week.
- We begin endoscopic carpal tunnel by placement of the video endoscope into the wrist... - The surgery is performed as an outpatient procedure.
- The basics of the surgery is the release of the ligament, which is called the transverse carpal ligament, which is present here within the palm.
And there's a couple of ways that that is done.
One is where you're making an incision in the palm.
This is a traditional open carpal tunnel release.
And then, the other way is to make an incision outside of the palm where you don't have to make an incision in the palm to make an incision back at the forearm, and you go inside out to endoscopically release it.
Now, both procedures effectively release this transverse carpal ligament to open up the carpal tunnel.
Patients are usually given some sedation, and then, a little bit of a local anesthetic.
It doesn't take me longer than just a few minutes to do the basics of what needs to be done to free up this ligament.
- We then remove the endoscope and have completed the procedure.
- They have a stitches that are put into where their Don't go out and try and mow the lawn on Sunday when you had surgery on Friday.
Often patients will just simply come in at their first post-op at around a week, take out their sutures.
I give them some tips in terms of things that they do.
And for most of my patients, that's typically their last visit.
It's a very quick operation.
- I don't know if you can see, but that's what was the result of the operation.
And it's a one-inch scar, or a one-inch operation.
It's really nothing.
And I let it go till last Tuesday.
And boy, there was no reason to.
I mean, they're really, this operation is nothing.
I do everything that I didn't do before, and that I have no pain, no tingling, nothing.
- According to Doctors Weiss and Talsania, hand surgery, like all surgeries, has some risks, but they are rare.
Most patients do well and find varying degrees of relief from the effects of severe carpal tunnel.
- And just because you have bad carpal tunnel does not mean you need surgery, if you choose you do not want surgery, that's okay.
It's not cancer.
It's not your heart.
But I think it's something that can be helped with, and a variety of methods and surgery should be last.
Unless it's a very severe case, then we recommend it.
I've had patients that I injected four years ago.
They were scared to have surgery, and now they can't sleep and they come back, and they say, "You were right, I should fix it."
And I say, "It's okay, you're ready now."
Patients drive the decision.
We're just part of the team.
- As the doctors underscored, it's so important to rule out other conditions besides carpal tunnel syndrome before doing anything else.
That's why your physician or a licensed hand surgeon is the first person to consult before taking any other measures when the condition becomes a concern and/or intolerable.
- Grover, a lot of folks may think, myself included, that certain jobs bring on the carpal tunnel.
I always thought that someone maybe who types a lot, say a reporter, but that's not necessarily the case.
- I thought the same thing, and I think many people do.
But according to the docs, it's hard to really pinpoint one activity that might be the cause and that it's probably an accumulation of activities over a period of time.
- Sure, but as your report pointed out, there are ways to fix this, some remedies to help it, help you so you don't have as much pain.
- Exactly.
- All right, some great information, Grover Silcox, as always, thank you so much for joining us.
And that'll do it for this edition of Living in the Lehigh Valley.
I'm Brittany Sweeney, hoping you stay happy and healthy.
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Living in the Lehigh Valley is a local public television program presented by PBS39