Carpal Tunnel Syndrome

[00:00:07.320] Carpal tunnel syndrome is common. [00:00:09.160] It's one of the most common things we see. [00:00:10.960] At the most simple level, [00:00:13.560] it's just a nerve that's being pinched. [00:00:16.600] We have a nerve called the median nerve [00:00:18.200] that travels from the brain all the way to the fingertips. [00:00:21.520] It passes through a space in the palm here, [00:00:25.120] and that space is called the carpal tunnel. [00:00:27.080] There's a lot of things that live inside the carpal tunnel, [00:00:29.440] primarily that nerve, [00:00:31.280] but also all the tendons. [00:00:33.160] There's nine tendons that move your fingers [00:00:35.840] and those have to share the carpal tunnel with the nerve. [00:00:39.560] The problem is the tunnel gets too tight. [00:00:42.000] When the tunnel becomes too tight, [00:00:43.480] the little arteries that supply the nerve [00:00:47.080] become pinched off and the nerve doesn't work. [00:00:49.840] They can also occur because of those tendons. [00:00:51.880] The nine tendons that share that space swell up. [00:00:55.400] The pressure within the carpal tunnel rises [00:00:58.440] and the nerve doesn't get the necessary blood, [00:01:01.440] so it goes to sleep. [00:01:02.880] The most common symptoms of carpal tunnel syndrome [00:01:05.640] are numbness and tingling of the fingers, [00:01:07.760] primarily the thumb through half of the ring finger. [00:01:12.000] This side of the hand becomes numb. [00:01:15.960] It burns. [00:01:16.880] People will describe electric sensations or tingling. [00:01:20.360] Sometimes it can be severe pain. [00:01:22.200] I will see patients who haven't slept. [00:01:24.480] Other times its not as much pain, [00:01:26.120] it's just numbness [00:01:27.240] or they will complain of dropping objects [00:01:29.600] or not being able to feel when they button their shirt. [00:01:33.160] The symptoms can vary. [00:01:35.000] But to some degree, most of the time people have numbness and some pain. [00:01:38.680] We start treating carpal tunnel syndrome [00:01:40.880] with the minimally invasive or least invasive methods. [00:01:47.200] Anti-inflammatory medication is one. [00:01:49.760] A nighttime splint can be very helpful for patients. [00:01:52.640] We routinely try steroids. [00:01:55.600] Inside the carpal tunnel, [00:01:57.760] there's inflammation going on. [00:01:59.320] That's what's causing those tendons to swell. [00:02:01.240] If we can reduce that inflammation through the use of steroid, [00:02:05.080] either a pill or an injection, [00:02:07.320] oftentimes that will help. [00:02:09.040] Ultimately, if all of this fails, [00:02:11.160] then the treatment of choice is to open the carpal tunnel. [00:02:14.760] The recovery from carpal tunnel surgery has improved significantly [00:02:18.440] even in my 15-year career. [00:02:20.960] The recovery for the carpal tunnel surgery performed nowadays [00:02:25.360] and certainly the ones that are performed here, [00:02:27.480] it's much different. [00:02:28.800] We allow immediate use of the hand, [00:02:30.520] full range of motion. [00:02:32.400] I do not recommend the use of a splint. [00:02:35.400] We just put a soft bandage [00:02:36.880] and allow patients to go back to full use immediately. [00:02:40.600] There is a small incision, so we want to protect that and prevent infection. [00:02:44.680] That means keeping it dry for a matter of days. [00:02:47.200] I usually place two sutures [00:02:49.480] and those are left in place for about 6-8 days. [00:02:53.880] But return to most activities is immediate. [00:02:56.240] Return to heavy lifting activities [00:02:58.920] or working as a mechanic or a carpenter [00:03:02.080] will be on the order of a week or two [00:03:04.240] before I would recommend that you attempt that.