Do you experience numbness, tingling, or pain in your hand and fingers? You may be suffering from Carpal Tunnel Syndrome. Board-certified upper extremity specialist, Dr. Daniel L. Gaffney of MD West ONE hosted a webinar on the latest treatments for "Carpal Tunnel Syndrome in 2021".
Dr. Gaffney covers:
- What is carpal tunnel syndrome?
- What are the symptoms?
- What are the causes?
- What are the treatment options?
Dr. Gaffney discusses the symptoms, causes, and treatment of Carpal Tunnel Syndrome including non-surgical treatments and an outpatient treatment that's performed without anesthesia. He also hosted a Live Q&A session which had some great points of discussion. We've included the answers to those questions below the webinar. Scroll down to watch the webinar, view the Q&A or make an appointment with Dr. Gaffney.
Live Q&A Questions & Answers:
I live in the Pacific Northwest and there are an abundance of CBD and Marijuana dispensaries. Are there studies for or against the use of CBD for alleviating carpal tunnel symptoms?
There is no good data to either support or refute CBD as a treatment for carpal tunnel syndrome at this time. There are ongoing studies. Typically, when funded by industry, they will be positive in nature showing relief and when put to independent randomized controlled trials, they are unable to show any benefit. If the future will hold, I am sure there will be more study on that subjective, but currently, I cannot recommend for or against it.
Is there anything else that can mimic carpal tunnel?
There are a variety of different conditions that can mimic carpal tunnel. Essentially anything that involves nerves of the upper extremity may mimic carpal tunnel. You can have a pinched nerve in your shoulder or in your neck or around the elbow that can cause numbness or tingling down into the hand. Some people will have nerve-specific diseases like ALS or Multiple Sclerosis that can cause tingling into the hands as well. I would recommend an evaluation by a hand surgeon to determine whether it is a carpal tunnel or something that could be mimicking carpal tunnel.
Do you recommend an EMG as first-line diagnosis?
I do not recommend an EMG as a first-line diagnosis. Definitely a history and physical performed by a knowledgeable medical professional as a first-line diagnosis. Many times, EMG’s are unnecessary tests if the symptoms are classic either for or against carpal tunnel syndrome. However, it is a great confirmatory and can be a helpful adjunctive test, but not necessarily in all cases.
My wife is pregnant and suffering from carpal tunnel symptoms at night. She is trying to manage conservatively with a brace. How long do you recommend trying conservative options?
In the setting of pregnancy, carpal tunnel managed with a brace is a great option. I would try that for at least four if not, six weeks. If she is really struggling with sleep at night, cortisone injections are the next-in-line treatment for the pregnant patient. Most pregnant women do get relief from their carpal tunnel syndrome after delivery and it is uncommon that it will stick around long after delivery. So, they will typically not require surgery for this. If the symptoms are resistant to bracing after about two to four weeks or if the symptoms are so severe as they are preventing sleep, frequently a carpal tunnel cortisone injection will be helpful to relieve those symptoms.
Where can you get carpal tunnel surgery?
Well, there are many qualified hand surgeons all around the country. I would look for a Fellowship-trained and Board-Certified hand surgeon with continued education through the American Society of Surgery for the hand. Here in Omaha, Nebraska I would have to plug our surgeons here at MD West One. We have four Fellowship-Trained hand surgeons. We have clinics from Fremont, West Omaha, Central Omaha, and Council Bluffs with outlying clinics as well. We have surgery performed in Fremont, West Omaha, Mid-town Omaha, and Council Bluffs as well.
For the wide-awake surgery, do you have to go off blood thinners?
No. Typically, we are able to do wide-awake hand surgery in patients who are on blood thinners while leaving them on blood thinners. Sometimes they do have to stop, if it is safe to stop. It decreases the complication rate, but if a patient is safer staying on their blood thinner than coming off, we can perform this surgery while still on blood thinners.
Can an MRI rule out carpal tunnel syndrome?
Great question. It cannot rule out carpal tunnel. Even an EMG test cannot rule out carpal tunnel. As mentioned above, on EMG about 10 to 20 percent of people with clinical carpal tunnel syndrome will have a normal EMG. On an MRI scan, the variability from person to person is too great to be able to completely rule in or rule out carpal tunnel. There is a bell-shaped curve of normal-sized and shaped median nerves and even if you fall well within that bell-shaped curve, you can still have carpal tunnel syndrome.
What locations do you see patients and how do I schedule an appointment?
I believe the website is attached to the webinar here. You can either schedule online or call (402) 390-4111 to schedule an appointment. I see patients at Methodist HealthWest at about 156th & Dodge Street, at our Farnam location at 80th & Farnam Street, and in Council Bluffs at our Methodist Jennie Edmundson Clinic.
Can physical therapy help at all?
There are no good studies to definitively say that physical therapy does help, however, anecdotally, I have had many people who have used stretching exercises, as well as, guided therapy to help them alleviate their symptoms. I am happy if my patients get better and feel better so there is no harm in trying it. And definitely with bracing, carpal tunnel can be improved and hopefully, surgery avoided.
How often is carpal tunnel release performed in conjunction with nerve release in a patient's elbow?
A combined release is very uncommon in my practice and virtually all hand surgeon’s practice. Combined release may be considered in the setting of two different compressed nerves. So, if an ulnar nerve is compressed at the elbow, which would be the most common compressive neuropathy about the elbow, so it is a different nerve, and the median nerve is compressed at the wrist, then those two done in conjunction is not that uncommon. The same risk factors that put you at risk for carpal tunnel syndrome can put you at risk for cubital tunnel as well. Having to decompress the median nerve at the elbow, as well as, the wrist, is a much less common scenario. The nerve can be compressed at both places and we refer to this as a double crush and this is occasionally required in the revision setting following a failed carpal tunnel release surgery. Although uncommon, it can happen.
Is rehab beneficial after carpal tunnel surgery?
Most people have a very uneventful recovery following carpal tunnel release surgery and are able to regain their motion and strength and alleviate their pain all on their own. Occasionally, people will become either stiff in their fingers, painful or have trouble getting their strength and mobility back. I am a big advocate of hand therapy in that setting.
Does dry needling help with carpal tunnel?
There are no good randomized controlled trials showing a definitive benefit to dry needling in the setting of carpal tunnel. Again, anecdotally some people have had relief from this. If it is not harmful and it is not too expensive, doing things to avoid surgery, I would advocate for, however, there is not good science to back up dry needling for carpal tunnel.
Are there any sports where athletes are more susceptible to carpal tunnel syndrome - Discus, shot put, tennis?
There is little data on this subject. However, we know that powerful grasping, repetitive grasping, and heavy lifting can lead to increased pressures within the carpal tunnel. Therefore, stick and racquet sports may put you at a higher risk, as well as, very heavy weight-lifting and other weight-based sports – Strongman, discus, shot put. However, there is not good natural history to implicate any one specific sport.
What are some ways to prevent carpal tunnel?
There are modifiable risk factors for carpal tunnel. I have listed several of them before. It may not be exactly prevention, but you can modify your risk factors. Obesity is a big one. It has definitely been shown that the increased body mass can increase mass within the carpal tunnel whereas our bones and our ligaments do not grow as the rest of us grows with age. So, maintaining a normal body weight can help decrease the chance that you develop carpal tunnel syndrome later in life. Also, avoiding vibrational machinery, power tools, jackhammers, and the like. Using them on a regular basis for a prolonged period of time may put you at a higher risk. So, avoiding doing excessive amounts of work if you are in that sort of scenario, sometimes doing a career change can help prevent that. Also avoiding other diseases such as diabetes which goes along with obesity, following a healthy diet and keeping a normal weight, and regularly exercising.
What about heat, ice, and elevation?
I am a big fan of ice in this scenario in decreasing swelling and if you decrease swelling, potentially, you can decrease the pressure within the carpal tunnel. But some people just do not tolerate ice well that far out and close to the fingers. It is definitely something you can try, but your results may vary. Heat may be helpful as well. It can be helpful in using before stretching out the wrist, fingers, and hand to kind of get the joints lubricated and get you ready and may help prevent some symptoms before starting the day.