Host: Which conditions the people are considered about carpal tunnel syndrome, what does that mean?
Guest: Carpal tunnel syndrome. So carpel means the wrist, tunnel is because the nerve is going through the tunnel, and syndrome is the symptoms. Carpal tunnel syndrome is pressure on the median nerve, one of the nerves that goes from the forearm into the hand. As it goes from the forearm into hands through the wrist, it gets pressure inside the tunnel and that is why they call it carpal tunnel syndrome.
Host: So the tunnel can't get any bigger, if the size gets swollen or there is no place there to go so this pressure gets to the outside?
Guest: So what happens is in the tunnel there are ten tendons and one nerve. So if the ten tendons become swollen for any reason, now there is too much pressure on the nerve.
Host: And is there anything that will relieve the pain?
Guest: If you bend the wrist more the pressure increases so the symptoms increase; if you extend the wrist, the same thing. You should keep the wrist in neutral where it is straight and the pressure is the least. And so we try to put a splint to hold the wrist in neutral position, in straight position and that releases the symptom.
Host: So most of these pain relievers do not even help, is that correct?
Guest: Pain relievers are totally useless for carpal tunnel syndromes.
Host: And what usually causes this, use said this is tendon formation, so where does it come from?
Guest: Most of the cases that we see the reason for carpal tunnel syndrome is not known. It occurs in people who never went to work. It occurs in people who work a lot. It occurs in people who are doctors, lawyers, architects, people who work hard, people who use their hands a lot, people who don't use their hands, but there are other conditions in which it is definitely a contributing factor.
Host: And that would be the people who use, maybe, computers too much or type too much, would that be a factor?
Guest: Only 10% of the people that I see with carpal tunnel syndrome ever used a computer and so computer is not necessarily the cause of carpal tunnel syndrome.
Host: Would it be any benefit if you did a lot of -- to have interruptions, exercise with your hands a little bit in other directions, will that help a little bit?
Guest: That is a good point, because I tell all my patients who are using computers that they should work for 20 minutes or 25 minutes and take a five-minute break. It is just like refueling your car, and so you want to refuel your hand with circulation during those five or ten minutes that you can take a break.
Host: And if you immobilize it, it seems to get worse and worse and they go to you and you have tried everything, what can you do as a hand surgeon?
Guest: My next line of defense is a cortisone injection, and the cortisone injection helps in two ways; one, if it releases your symptoms, it tells you the surgery is going to help, a lot; if it doesn't relieve your symptoms that doesn't mean to much, now you are going to need surgery for sure.
Host: What is your focus when you are doing the surgery?
Guest: The purpose of the surgery is to make the tunnel a little larger, so the tunnel is made by bones on one side and the ligament on the other side. And all we do is we split the ligament and so now the tunnel is a little bigger than before.
Host: And generally that relieves in most of the cases?
Guest: I would say 95% of the patients…
Host: But there is always some, no matter what you do, it doesn't get better.
Guest: There are some, for example, people who are on kidney dialysis. They get certain proteins that are not cleaned by the dialysis; they deposit in the wrist and so even after we release the tunnel, the amyloid stuff continues to deposit in the wrist. So it continues to produce pressure on the nerve as you go along.
Host: Thank you very much.
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