Episode Transcript
Dr. Miller: Your primary care doctor is referring you for treatment of carpal tunnel to a specialist. We're going to talk about that next on Scope Radio.
Announcer: Access to our experts with in-depth information about the biggest health issues facing you today, The Specialists, with Dr. Tom Miller, is on The Scope.
Dr. Miller: Hi, I'm here today with Dr. Doug Hutchinson. Doug, tell us what happens when you receive a referral for carpal tunnel syndrome and I send you a patient that I think has carpal tunnel. What are the next steps?
Dr. Hutchinson: Well, of course, you're always right, so I wouldn't have to worry about any diagnostic situations at that point in time.
Dr. Miller: That's what my wife always tells me.
Dr. Hutchinson: Yes. In general, the story is that a patient will come to us and say, "I've got numbness and Dr. Miller: thinks I have carpal tunnel syndrome," and we'll talk to them merrily because what they tell us is happening to them is more important than anything else. Their history is the most important thing. We'll do a few physical exam maneuvers that will confirm our suspicions.
And if they're a typical patient who is complaining of numbness more than pain and who is 40 or 50 and not 20, then we're going to pretty much be able to diagnose this as carpal tunnel syndrome in our office without any further studies, without any need for electrical studies or other things that have been routinely done for this problem.
Dr. Miller: Which patients might need electro-diagnostic studies?
Dr. Hutchinson: In my opinion, those that need it are those that things don't fit, the nerve doesn't seem like it's the right distribution in the hand, they don't wake up at night with numbness, a splint doesn't help them, they think it's work related. Things like that are a little bit different than the normal and those are ones that we might want a little bit more information to make sure we're not missing something else.
A patient with a lot of neck pain as well as having carpal tunnel syndrome could easily have a compression of the nerve somewhere else, like in the neck, and it would be obviously smart to know the difference between this coming from the neck or from in the wrist since wrist surgery won't help the neck problem.
Dr. Miller: Let's say you agree with the diagnosis of carpal tunnel. How effective is conservative therapy using splints and other treatments?
Dr. Hutchinson: It's very effective, actually, and splints alone are the mainstay of our treatment and if a person can sleep at night and not wake up with numb fingers, they're going to feel a lot better, they're going to do better during the day, their hands are not going to hurt them and/or go to sleep on them as much during the day as well.
And they're going to get several years out of that type of treatment before they may get to the point where, despite splinting, they're still getting numbness and that's when they probably should talk about surgery.
Dr. Miller: Are there any other conservative measures aside from splinting? Are there any exercises?
Dr. Hutchinson: For the most part, in my opinion, there are not a lot of exercises that can help. Taking a vitamin B complex can be helpful for any nerve issues and that may benefit some people and again, it's probably going to delay things. It may delay things upwards of a year or two if you can get a little bit of symptom relief.
The other main thing we use is an injection of cortisone. An injection of cortisone, most of us feel, is not going to ever cure carpal tunnel syndrome but it could last even all the way up to a year of symptom free, so I use that a lot to get people to where they want to be for their surgery.
For example, if they're a big skier, they want to wait until ski season's over, that's a reasonably good thing to do. If they're going to go on vacation and they don't want to wake up every night with their hands numb, that helps them do that.
And the other major person for that is a pregnant female who will eventually not be pregnant. And therefore if we can make their symptoms diminish while they're in their third trimester then when they deliver the baby usually their hands get better and they won't need surgery. Some question about whether they'll need surgery in 10 years from now or not, but they don't need it right then which is not when they want it anyhow.
Dr. Miller: When conservative methods are ineffective, how effective is surgery?
Dr. Hutchinson: Surgery for carpal tunnel syndrome is, in my opinion, probably the best surgery on the planet.
Dr. Miller: No doubt.
Dr. Hutchinson: It makes more people happy and few people, very few people are unhappy. Every surgery has risks and every surgery doesn't work some of the time. This surgery is simple, fast, easy to get over, and many, 99% or so, of the patients are not just happy, they're ecstatic. They think it's the easiest and greatest thing they ever did from a surgical standpoint, and they wonder why the heck they waited with a splint on the last month or the last year or whatever of their lives. They feel as though they should have gone ahead and done it sooner.
Dr. Miller: Is there any new special technique that you use surgically now?
Dr. Hutchinson: There really isn't much new there for the last 20 years, we've been doing an endoscopic carpal tunnel release, which is decreasing the size of the scar. The truth is, when I was in training the scar was about four times the size of what it is now anyhow. So we've learned to get smaller scars, not spend much time; it takes about nine minutes to do a carpal tunnel release. The patient can be completely awake during that time.
We do most of our carpal tunnels with them, more or less, in a procedure room, not even in the operating room anymore because they can avoid the anesthesia hangover, they can avoid changing clothes, getting an IV. They can even avoid not having to eat something the night before. Some of my patients will come in with their cup of coffee in the morning, get their carpal tunnel done, and pick up their coffee and go back to work.
Dr. Miller: So is that surgery effective long-term? Does it recur?
Dr. Hutchinson: It's really effective mostly long-term and, on a rare situation, someone will need another redo carpal tunnel release down the road.
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