Post provided by Robert Foster, MD
In the last post we discussed how CTS is diagnosed and nonsurgical treatment. Part two discusses the surgical treatment for carpal tunnel syndrome.
Surgical carpal tunnel release remains the standard of care for severe carpal tunnel syndrome or when conservative treatment modalities have failed. Unfortunately, there still seems to be a great deal of fear and misinformation surrounding carpal tunnel surgery. Today carpal tunnel surgery can be performed with local anesthesia, with the patient wide awake, eliminating the need for fasting or an I.V. Many patients who have local anesthesia will come to surgery alone and drive themselves to and from the surgery center. For those patients who are still anxious about being alert during surgery, oral and I.V. sedation can still be made available.
Mini-incision carpal tunnel surgery is performed with the patient lying flat on their back with a small tourniquet on their forearm to prevent bleeding during surgery. A small half inch incision is made at the base of the palm and through this incision the transverse carpal tunnel ligament is divided in half, essentially opening the roof of the carpal tunnel and removing the pressure on the median nerve. Once the ligament is divided, the incision is closed with only one or two stitches. The entire procedure usually takes only 10 to 15 minutes. Following surgery, a light, soft dressing is applied, with no splint, and is worn for four to five days. Once the dressing is removed, a simple band-aid can be used to cover the incision to protect the stitches. After surgery patients are encouraged to move their wrist and fingers frequently and use their hand as tolerated. Many patients return to work and normal activities the day after surgery, although a couple of days of rest and light duty are not uncommon. The stitches are removed 10-14 days after surgery and most patients have significant improvement of their symptoms by the time they are seen for the post-op appointment. Once the carpal tunnel is released, recurrence of carpal tunnel syndrome is rare.
Today both surgical and non-surgical treatment of carpal tunnel syndrome is relatively safe and simple. Surgical treatment has a very high rate of success and patient satisfaction with a low rate of complications and risk. Non-surgical treatments, while not a permanent cure, can provide significant relief of symptoms. If you are one of the millions affected with carpal tunnel syndrome, talk to your doctor about your options or get an opinion for a specialist.
Monday, July 19, 2010
Wednesday, July 14, 2010
Carpal Tunnel Syndrome, Part 1
Post provided by Robert Foster, MD.
In 2009 over one million people sought medical treatment for carpal tunnel syndrome (CTS). It is estimated that carpal tunnel syndrome affects nearly three percent of the population, or over 8 million people in the United States alone. Despite simple and effective treatments, many people continue to needlessly suffer with symptoms of CTS.
Carpal tunnel syndrome is caused from compression of the median nerve as it passes through the carpal tunnel at the wrist. The median nerve is responsible for supplying sensation to the thumb, index finger, middle finger, and part of the ring finger. Compression of the nerve causes slowing of the electrical signal that can result in a multitude of symptoms, such as numbness, tingling, burning, aching, weakness, and radiating discomfort up the arm.
Carpal tunnel syndrome is not caused from working on the computer or repetitive key stroking. In fact, most cases of CTS do not have an exact identifiable cause. However, repetitive motion activities, such as typing on a keyboard, can aggravate carpal tunnel symptoms in those who have it. Conditions frequently associated with or cause an increase risk of carpal tunnel syndrome include pregnancy, obesity, trauma, smoking, diabetes, hypothyroidism, rheumatoid arthritis, and kidney disease.
Treatment of carpal tunnel syndrome can be conservative or surgical. Conservative treatments include splinting, therapy, oral medications, and steroid injections. Splinting and steroid injections are the most common and effective conservative measures. Splinting is effective because it prevents excessive flexion of the wrist, which can increase pressure on the median nerve within the carpal tunnel space. Steriod injections into the carpal tunnel space decrease inflammation and swelling, which relieves pressure on the median nerve and improves blood flow to the nerve tissue. While usually not a permanent cure, steriod injections frequently can improve symptoms for a prolonged period of time and are often used in conjunction with wrist splints. Physical therapy and oral medications are less effective for the long term treatment of carpal tunnel syndrome. Other therapy modalities such as laser therapy, heat therapy, and chiropractic care seem to have less or even no effect.
Wednesday, June 2, 2010
Adult Repetitive Strain Disorders, Part Two
Post provided by Barbara Bergin, MD
In the last post we discussed what repetitive strain disorders are, why we get them, and what you can do about them. Today's post continues with getting back to what you love after getting better and how to prevent repetitive strain disorders.
Once I get well can I go back to doing things like I was before?
- Probably not. Most people get these disorders because they are somehow anatomically predisposed to getting them, or because they are not put together to participate in certain activities. Frankly, most human beings are not put together to perform certain sports activities on a regular or high intensity basis. Our joints just will not tolerate repetitive strain for extended periods of time. Sometimes it is just a matter of conditioning ourselves to participate; like building up to run or swim long distances. But most of the time we get repetitive strain disorders because we are just wearing out our parts. We must make permanent changes. Again, that can mean minor alterations of the way we do things around the house, but it can also mean changing the way we participate in a sport or even discontinuation of that sport. I'm sorry to say this, but it's true. Most of these repetitive strain disorders occur in people who are 40+. I just don't see them in twenty year olds. If you refer to an earlier post, "Having Peace with Your Pain, " you'll understand a little more about my thoughts on that subject.
- Treating these conditions is kind of like treating hypertension. If your doctor says you have to take an anti-hypertensive medication, do you think you can just take that for a short period of time and your hypertension is cured? Can you stop taking the pill? Will your hypertension come back? Are you ever truly cured of hypertension? No. Occasionally there are people who will make major lifestyle changes and can lower their blood pressure but most people have to continue taking the medications for the rest of their lives. This is the same with most of these repetitive strain disorders. They will come back if you go back to doing things exactly the way you were doing them before. If you make 90% of the modifications permanent, you might be able to continue to enjoying some of the activities which previously caused you pain! You can live with that!
How can I prevent repetitive strain disorders?
- Some of them might be unavoidable, but general principles can always be applied: maintain a healthy weight, exercise in moderation, avoid extremes of high impact and high intensity exercises as you age, and maintain flexibility. It's also important to recognize repetitive strain pain and address it early, either by seeing your orthopedic surgeon (that's me) or your primary care physician, or by making the modifications yourself. It's common for people to try to "work through" the pain, thinking that it's better to work it than rest it. This kind of approach to pain probably stems from the idea that you have to "work through" the conditioning pain of getting into a higher intensity exercise like running. The first time you run a half mile, it hurts; your lungs, your feet, your legs. But as you continue to run and run longer distances, it gets better. This is not the philosophy to take with the pain you experience in a tendon or joint as the result of a certain activity or after that activity. Learn to recognize the difference and address it. Rest it. Ice it. Take Aleve or Advil (if your doctor says it's okay). Then modify it!
In the last post we discussed what repetitive strain disorders are, why we get them, and what you can do about them. Today's post continues with getting back to what you love after getting better and how to prevent repetitive strain disorders.
Once I get well can I go back to doing things like I was before?
- Probably not. Most people get these disorders because they are somehow anatomically predisposed to getting them, or because they are not put together to participate in certain activities. Frankly, most human beings are not put together to perform certain sports activities on a regular or high intensity basis. Our joints just will not tolerate repetitive strain for extended periods of time. Sometimes it is just a matter of conditioning ourselves to participate; like building up to run or swim long distances. But most of the time we get repetitive strain disorders because we are just wearing out our parts. We must make permanent changes. Again, that can mean minor alterations of the way we do things around the house, but it can also mean changing the way we participate in a sport or even discontinuation of that sport. I'm sorry to say this, but it's true. Most of these repetitive strain disorders occur in people who are 40+. I just don't see them in twenty year olds. If you refer to an earlier post, "Having Peace with Your Pain, " you'll understand a little more about my thoughts on that subject.
- Treating these conditions is kind of like treating hypertension. If your doctor says you have to take an anti-hypertensive medication, do you think you can just take that for a short period of time and your hypertension is cured? Can you stop taking the pill? Will your hypertension come back? Are you ever truly cured of hypertension? No. Occasionally there are people who will make major lifestyle changes and can lower their blood pressure but most people have to continue taking the medications for the rest of their lives. This is the same with most of these repetitive strain disorders. They will come back if you go back to doing things exactly the way you were doing them before. If you make 90% of the modifications permanent, you might be able to continue to enjoying some of the activities which previously caused you pain! You can live with that!
How can I prevent repetitive strain disorders?
- Some of them might be unavoidable, but general principles can always be applied: maintain a healthy weight, exercise in moderation, avoid extremes of high impact and high intensity exercises as you age, and maintain flexibility. It's also important to recognize repetitive strain pain and address it early, either by seeing your orthopedic surgeon (that's me) or your primary care physician, or by making the modifications yourself. It's common for people to try to "work through" the pain, thinking that it's better to work it than rest it. This kind of approach to pain probably stems from the idea that you have to "work through" the conditioning pain of getting into a higher intensity exercise like running. The first time you run a half mile, it hurts; your lungs, your feet, your legs. But as you continue to run and run longer distances, it gets better. This is not the philosophy to take with the pain you experience in a tendon or joint as the result of a certain activity or after that activity. Learn to recognize the difference and address it. Rest it. Ice it. Take Aleve or Advil (if your doctor says it's okay). Then modify it!
Wednesday, May 26, 2010
Adult Repetitive Strain Disorders, Part One
Post provided by Barbara Bergin, MD
Why do we get repetitive strain disorders?
- Because our bodies wear out and we do a lot of repetitive activities. As our population ages we're seeing more and more of these disorders. I see a different set of repetitive strains in younger aged individuals, mostly related to participation in sports. Of course an older person can get repetitive strain disorders from playing sports, but they can also get them from hanging up clothes in the closet and getting milk cartons off the top shelf of the refrigerator. Just because you go out and throw a ball a little, doesn't mean the milk carton wasn't the culprit. And just because your grandson can throw the ball to you all day, doesn't mean you can return it all day.
What are repetitive strain disorders?
- There are some very common disorders. They include:
- impingement syndrome: a disorder of the rotator cuff tendons. I also group shoulder bursitis and rotator cuff tears (partial and complete) with impingement syndrome.
- greater trochanteric bursitis: a disorder of the fluid filled sac that is on top of that prominent bone on the side of the hip. I see this more often in woman than in men. It's related to the shape of our pelvis and the way we move.
- plantar fasciitis: a common disorder of the foot, also seen more commonly in women. It results in pain on the bottom of the heel and is commonly called a heel spur. It's not due to an actual heel spur.
- lateral epicondylitis: Also known as tennis elow.
There are many other, less common repetitive strain disorders involving just about every tendon and muscle in the body.
What can I do about repetitive strain disorders?
- Rest: This doesn't always mean putting it in a splint, cast or brace. It usually means modifying the painful activity. As soon as you notice pain due to some repetitive activity and you can reproduce the pain by doing the activity, you should modify it. That might mean bracing the extremity involved. It could mean stopping that activity altogether. More often it means changing the way you do the activity; lessening the number of times you do it, decreasing the intensity of the activity, modifying the way you do it. For example, if I have pain in my shoulder when I get a large milk carton out of the top shelf of the refrigerator, I will start buying 1/2 quart containers and lower the shelf on which I put the larger bottles!
- Anti-inflammation: This can range from the application of ice to prescribing medications.
- Exercise: This might include some stretches or some strengthening exercises depending on the condition and the level of pain you are experiencing.
Why do we get repetitive strain disorders?
- Because our bodies wear out and we do a lot of repetitive activities. As our population ages we're seeing more and more of these disorders. I see a different set of repetitive strains in younger aged individuals, mostly related to participation in sports. Of course an older person can get repetitive strain disorders from playing sports, but they can also get them from hanging up clothes in the closet and getting milk cartons off the top shelf of the refrigerator. Just because you go out and throw a ball a little, doesn't mean the milk carton wasn't the culprit. And just because your grandson can throw the ball to you all day, doesn't mean you can return it all day.
What are repetitive strain disorders?
- There are some very common disorders. They include:
- impingement syndrome: a disorder of the rotator cuff tendons. I also group shoulder bursitis and rotator cuff tears (partial and complete) with impingement syndrome.
- greater trochanteric bursitis: a disorder of the fluid filled sac that is on top of that prominent bone on the side of the hip. I see this more often in woman than in men. It's related to the shape of our pelvis and the way we move.
- plantar fasciitis: a common disorder of the foot, also seen more commonly in women. It results in pain on the bottom of the heel and is commonly called a heel spur. It's not due to an actual heel spur.
- lateral epicondylitis: Also known as tennis elow.
There are many other, less common repetitive strain disorders involving just about every tendon and muscle in the body.
What can I do about repetitive strain disorders?
- Rest: This doesn't always mean putting it in a splint, cast or brace. It usually means modifying the painful activity. As soon as you notice pain due to some repetitive activity and you can reproduce the pain by doing the activity, you should modify it. That might mean bracing the extremity involved. It could mean stopping that activity altogether. More often it means changing the way you do the activity; lessening the number of times you do it, decreasing the intensity of the activity, modifying the way you do it. For example, if I have pain in my shoulder when I get a large milk carton out of the top shelf of the refrigerator, I will start buying 1/2 quart containers and lower the shelf on which I put the larger bottles!
- Anti-inflammation: This can range from the application of ice to prescribing medications.
- Exercise: This might include some stretches or some strengthening exercises depending on the condition and the level of pain you are experiencing.
Friday, May 21, 2010
Austin Medical Relief for Haiti has a website!
www.austinhaiti.org
Check it out and please send to anyone who would like to know more about what we do, who we are, and how we are helping restore hope and health to Haiti. We are in need of donations for our continuing medical projects in Haiti. Currently we are working with MOH to build a hospital on MOH property. Donations will be directed towards the completion of the hospital and the hiring of medical workers in the US and Haiti to help staff and run the hospital. Spread the word!
Check out the new video, courtesy of Seema Mathur!
http://surfacetoairstudios.com/haiti/haiti.html
Check it out and please send to anyone who would like to know more about what we do, who we are, and how we are helping restore hope and health to Haiti. We are in need of donations for our continuing medical projects in Haiti. Currently we are working with MOH to build a hospital on MOH property. Donations will be directed towards the completion of the hospital and the hiring of medical workers in the US and Haiti to help staff and run the hospital. Spread the word!
Check out the new video, courtesy of Seema Mathur!
http://surfacetoairstudios.com/haiti/haiti.html
Tuesday, April 27, 2010
Friday, April 23, 2010
Peace with your Pain
Post provided by Barbara Bergin, MD
I’ve been an orthopedic surgeon in Austin for 23 years and as my practice and I have aged I have come to believe in a different set of rules and expectations for both me and my patients than I had when I first hung up my shingle. Here’s the bottom line: humans weren’t meant to last as long as we do. As an organism we just weren’t put together to stay around for 80 years. The average age of death for Americans is over 80.
Look at the archeological record. No one is finding fossils of old cavemen and cavewomen. Women died in childbirth. If a man sprained his ankle he was dinner for a bigger predator! People died when they were 20. We see these documentaries on octogenarians who run the Boston marathon or some little group of Japanese mountain people who look like they’re 40 when they’re 100, and we think we should be able to be like that. But what they don’t show you are the 10,000 people who tried to train for the Boston marathon and couldn’t because of stress fractures, iliotibial band syndrome and degenerative meniscus tears.
So, what’s my point here? Do I just not want to see any patients? No, I love to see patients. It’s what I do! But the point is…we’re hunter-gatherers, and were made to last about 20 years.
I find myself giving this lecture over and over to my many patients who suffer from degenerative disorders of their bones and joints, as well as those patients who suffer from repetitive strain disorders.
No cave man/woman ever lived long enough to suffer from greater trochanteric bursitis, shoulder rotator cuff impingement syndrome, plantar fasciitis or degenerative meniscus tears.
If it’s frustrating for me to treat some of these conditions, it is certainly frustrating for my patients to have them. I’ve personally experienced many of these repetitive strain conditions. Frankly we have to learn to have a certain level of peace with them. We have to look at pain from a different perspective. We’re lucky to have lived long enough to experience these conditions. If we are fortunate enough to be treated and saved from a heart attack, we may live long enough to experience some other disease. It could be a rotator cuff tear. It could be cancer.
Sometimes my patients ask, “Why am I having these problems? My grandparents and my parents didn’t have them!” There are several reasons for this:
-We may not inherit the same set of genes each of our parents had. Just as your eyes or your hair might not look exactly like either of your parents, your muscles, tendons and joints may not be the same either.
-We live differently than our parents and grandparents. As a whole, we are more active than our parents were. We started playing organized sports at a younger age. We do some crazy, harmful exercises our parents didn’t even think to do. We continued playing sports late into life. As a whole we are larger and heavier than our ancestors. And we live longer so unfortunately, we have longer to suffer!
-Our expectations are different than our forefather’s were. Our grandparents did not have an expectation of being treated and “cured” of their aches and pains. So why complain? Why go to the doctor? Everyone tells us that we can be cured. There is treatment. And there is! But because of that, we have an expectation of wellness and therefore we complain.
You will most certainly be able to think of a situation which contradicts my analysis. My parents are both in great shape and they’re out tango dancing without an ache or pain. Well, in my most educated opinion…that’s just good luck…for me and for them!
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