Transcription
Coming up today, it's a surgery patients can stay awake and watch themselves. How a few quick cuts can turn around years of weakness, numbness, and pain from carpal tunnel [Music] syndrome.
Good morning. I'm Jessica Level, and welcome to the Morning Medical Update. Think of how often you use your hands: eating, typing, turning a doorknob, gripping a steering wheel. Now imagine trying to do all of that while your hands are numb, or your fingers are tingling, or your grip is weak. That is the reality for millions of Americans living with carpal tunnel syndrome, and the best treatment option is also the only permanent option: surgery. Today, we are seeing how carpal tunnel syndrome surgery works, and we're hearing what a difference it has made for one man. We'll also learn about a newer, less invasive technique that lets patients get back to their lives much faster. And both of these techniques allow the patient to watch the surgery as it happens, if they are brave enough to take a peak.
And we are joined this morning by one of those brave patients, Lauren Mil Miller, alongside his surgeon, Dr. Charles Christopher Jaye. Uh, Dr. Jaye is a hand, nerve, and microsurgeon here at the University of Kansas Health System.
How long has it been since you two have connected?
It was about what, six months ago?
Ten months ago.
Ten, closer to 10. I think it was June sometime.
Okay, so we're getting there.
Yeah, yeah, getting there, making progress.
Uh, Dr. Jaye, a lot of people know that carpal tunnel syndrome has something to do with the wrist; that's what we hear about. But explain the anatomy of the wrist and exactly what carpal tunnel syndrome is.
Yeah, so the carpal tunnel itself is um, an area within the wrist that's bounded by the bones that make up the wrist itself and then a ligament on top of them. We have nine tendons and one nerve that run through there. All mammals have this ligament, um, and when you get anything that increases swelling or increases the volume inside of that tunnel, the nerve inside of it, which is really kind of the softest, spongious thing, gets pressed, and when it gets pressed, it falls asleep.
So when it comes to symptoms, a lot of people think of this must be something that's painful, but that's actually not the most common symptom. What are the more common symptoms?
Yeah, it usually starts with numbness, tingling. It's usually episodic when it first begins, um, and sometimes positional. Often times at night, if it's just kind of left to its own devices and you get more and more swelling, it becomes kind of continuous, and that's when you start seeing more profound weakness and then some of the pain symptoms that come with it as well.
I know I did, and maybe a lot of people have this image of an office worker sitting at a desk typing all day long, and that's the kind of person who might develop carpal tunnel. Uh, does typing cause this syndrome?
So they looked at that a lot, um, there does seem to be some correlations with uh, repetitive motions and certain movements, um, some of the OCC patients that actually have a higher degree of carpal tunnel syndrome than even the office workers in typing are people who use vibratory equipment. So sometimes construction workers, people using jackhammers, um, those type of uh, equipment. So it's using the wrist, not necessarily the position of the wrist, because when I'm thinking of typing, we think of our wrist being kind of popped back like that, but it's really just stress.
Is it stress on the wrist?
It's a little of both, um, so anything that's going to cause uh, irritation, inflammation will contribute to it, and then positionally it can cause those episodic symptoms. So even just putting your wrist in that extended position for a while will make make them fall asleep.
So how does it progress?
So, um, the longer the nerve is being pressed, the decreased blood supply to the nerve, um, is what basically begins that uh, nerve damage itself. And so the longer the nerve has a decreased blood supply, the more upset the nerve is.
So most patients might not jump straight to surgery as an option, but what other therapies are out there, and then when would you consider a surgery?
Um, so when things start out and they're periodic, you can modify your activities, you can wear splints. A lot of patients will have their first symptoms at night, and so sometimes just wearing splints will keep the hand in a position that's neutral enough to allow that blood to flow and for their fingers not to fall asleep, um, but as things progress and start affecting activities of daily living, that's usually when I would uh, recommend considering being evaluated and perhaps even having the procedure.
All right, Lauren, you're our patient, so you're going to tell us what you are feeling. You were feeling this for years, um, tell us those symptoms.
Well, um, for years I had, um, I had, um, found my hands going to sleep when I D when I was driving my car, especially for long distances. Next to banjo playing, driving is my favorite pastime, so, um, I was concerned about this, and I'd always have to shift positions to keep my hands from going to sleep. But, um, that wouldn't wouldn't have driven me to uh, to consult a doctor, much less do do have an operation, um, but uh, finally it got to the point where my hands would go to my hands would go to sleep in the middle of the night and so painfully that they would wake me up, um, and at the same time I noticed that my banjo playing, the F movement of my fingers got not so much painful, but just less enjoyable and and not not the ease that you not the ease and you know where I used to be able to play for five or six hours a day, I'd have to give up after a half an hour, and that's what ultimately was the last straw and drove me to ask my doctor about it. And then there were other times that it would just kind of come and go, so it wasn't continual, or would it stop. Those two main things, driving and and playing, were were where I would mainly notice it.
Are you are you able to play the banjo again, most importantly?
Well, I'm uh, I'm recovering, let's put it that way, um, because, um, for uh, being out of practice for two years, I haven't haven't got my original chops back, but they're getting there.
We're getting there.
Okay. Oh yes, so something you did, and we appreciate it, you let us take a camera inside while Dr. Jaye was performing the surgery, um, and this is kind of interesting, um, as we can see it doesn't require an operating room. You just go in and you're sitting there. Um, Lauren, did you watch Dr. Jaye while he did his work? I could see looking. What was that like? Did you have to look away, or were you all into it?
No, no, I'm fascinated by such things, and U so I I would I I would have brought it up if they hadn't uh, you know, to uh, to have a look at this and watch what's going on. Yeah, not not often you get to see what doctors are doing o down there or over there when they're they're working on you, so that was kind of a cool cool uh, experience for you.
Well, yes, it was. And was Dr. Jaye explaining what he was doing?
Uh, yes, in advance and while he was talking. So I I had a little lesson on on carpal and tunnels and and operations and all all all the all the while he was slicing, he was explaining what he was doing and what it was I was seeing and so on and so forth.
So Dr. Jaye, from a doctor's perspective, tell us what you're doing in there.
Yeah, so really the critical element of this surgery is to release that ligament. You're not actually taking anything out, um, so really kind of philosophically, I think that you know, Perfections more um, when we have nothing left to take away rather than nothing left to add. So the less you can do, you know, collaterally make a cut through the skin and divide that ligament, um, that's really the the important part of that that operation. So it's just getting down to the ligament and just cutting it down the middle, increasing the volume of that tunnel and letting that nerve breathe, so to speak.
So Lauren, you had surgery on one wrist, then you recovered, then you went back in to have surgery on the other wrist. How long did that recovery take?
Well, uh, I would say uh, my first wrist was uh, my left wrist, and uh, that um, was virtually back to normal in inside of two weeks, um, went through I I it seems there are several stages of recovery, the the fat fingers and the and uh, so forth, and it went through them all, but very very quickly U so I signed up for the next wrist.
So did this surgery cure, if you will, carpal tunnel for Lauren?
Um, for most people it does cure it in the sense that you usually don't need any additional intervention. The nerve itself is a type of tissue that has kind of a a middle amount of regeneration. So in folks who have um, kind of prolonged or very severe symptoms, sometimes the the nerve itself can't regenerate or wake up completely during one's life, but for most folks with episodic symptoms or it's not been going on for years and years, it does end up curing them.
And that was my question. Somebody like Lauren, this has been going on, you don't know what it is, you kind of push through. How important is it for somebody to identify what it is and get in for some type of treatment, um, as far as them being able to bounce back and get full motion back?
Yeah, um, it is something that doing it earlier rather than later is is important. If symptoms truly are episodic and they go away completely with more conservative measures like splinting, um, then it's not necessarily important that they do surgery right away, but once it does start interfering with their activities of daily living and it's waking you up from your sleep, it's making a difference in your life, then doing a surgery is is probably a great time to do that.
And you recently started started using a new surgical technique, and we watched you do it on another patient. Jamie Shirt says that her carpal tunnel pain got so bad that she couldn't stay asleep; the pain would literally wake her up every few hours. Lauren, you mentioned that that got so bad for you that it would wake you up in the middle of the night too, but in this case, she kept putting off surgery because she was simply busy with work and kids. That often happens, but then she heard about this new surgical technique.
I people that have had the traditional surgery, I was expecting, you know, one arm have it completely wrapped up, can't use it for x amount of time, then do the other hand. When I came in and Dr. Jaye told me, hey, there's this other option, and you can do them both at the same time, you'll be down and out, you know, for 48 hours or so and really way less limitations, way less time off work, I was like, wow, yeah, I'm kind of glad I waited in that aspect because yeah, it's I have a a baby, it's hard to be down and out, you know, for that long.
No doubt. Dr. Jaye, then tell us the difference between the technique, the new one you did on Jamie and what you did on Lauren.
Yeah, so this is kind of a logical progression in what we'd said before, like the the most critical element of the surgery is to like take that transverse carpal ligament and transect it, um, this is similar to what had been done previously with a camera, um, but now instead of using a very small camera and a bulky, expensive setup with, you know, all these different cameras in one's office, you can just use an ultrasound, um, and release that ligament from the inside. And we've got this video here. Uh, quick warning to viewers, it does include little cut and pokes and things like that, but yeah, just kind of walk us through the video here, what you're doing in there.
Yeah, so this this device has on it some balloons that move the nerve itself out of the way, um, and then this is all being watched on the ultrasound itself, and then at the tip is a small blade that cuts that ligament, and you're watching that blade as well as the nerve at all times, uh, making sure that you're not injuring the things you don't want to and that you're getting a cut through the ligament that you want, um, it has a very small kind of introducer, and so that there there's not even a stitch at the end of this procedure.
So what makes for a good candidate for this newer technique?
Um, I do evaluate the patient in uh, kind of pre-op or in the first visit to make sure anatomically, um, they're a candidate. Most people are, but every once in a while, someone's nerve or artery might be um, in an anatomic position that would preclude them from having this particular surgery uh, this surgery done in this way, um, and then folks that have had this uh, so severe that they're starting to get weakness or or their symptoms are profound, typically we would do it in an open fashion like Mr. Miller.
So Jamie mentioned something interesting that her symptoms for carpal tunnel got worse during pregnancy. Is there a connection between pregnancy and carpal tunnel syndrome?
Absolutely. So, um, it goes back to that tunnel itself. Anything that's going to increase swelling in that tunnel, uh, is going to, you know, make the nerve, the tendons swell and push on that nerve, um, so other conditions that can increase swelling in tissues that also correlate with carpal tunnel syndrome: hypothyroidism, um, or diabetes. Those are all things that are associated with carpal tunnel syndrome and pregnancy.
And pregnancy, I'm filing that under something that you learn new every day.
Very interesting. And in fact, a lot of folks who will have symptoms during pregnancy and it goes away are more likely to have carpal tunnel later in life as well.
Then I have to come find you. See you out.
Exactly. So we know recovery can be complicated in all sorts of ways. Lauren, after your surgery, you found out that you had some other nerve problems. How are your hands doing today? Tell us about those issues.
Well, my, um, my left uh, wrist was a perfect case uh, and recovered quickly. My story on my right wrist is rather different, uh, but, um, it was as though my surgery uh, allowed every other neurological problem my right arm ever had to uh, to come out and display itself. But I should say uh, the history of my right arm is uh, is a much more complicated one, um, uh, I've I've dislocated my shoulder at least a dozen times, um, and that that um, probably um, gave me experience with the with the uh, damage symptoms and also with u the with chiropracty, which is what I did about it, you know, I'd go back and get my arm reset and, um, so forth. So, um, yes, I I I felt in after the operation that I needed to see a chiropractor, which I which I did, and he relieved the the major symptoms, but, um, uh, and not instantaneously, but over the over the intervening months, uh, those the symptoms have have have just declined and are disappearing.
Well, and Dr. Jaye, that's brings up an interesting point. Are there things that have happened in your past to other parts of um, parts of your body that that lead into your wrist? Do those have any impact, and what could end up turning out to be carpal tunnel down the road?
Um, yes, so the nerves themselves start in the spinal cord and they go all the way, they go through our neck, kind of around the shoulder area and then all the way to the tips of our fingers, um, anything can put pressure on them, or I should say there's multiple areas that can put pressure on them, and more than one thing that can uh, be injurious to that nerve. So seeing somebody who is familiar with carpal tunnel syndrome or a hand surgeon specifically to um, to hone in on exactly where that nerve is being pinched or being compressed is important. So we have a variety of of um, exam uh, maneuvers that we'll do, uh, we look at specific symptoms, and sometimes we'll even get tests to look and see how that signal is being transmitted across that helps um, folks like Mr. Miller and and other folks who have maybe multiple spots of compression and not so much preclude or have rule them in for carpal tunnel surgery, but really frame expectations, um, because fixing a nerve at the level of the spine or other places is not always possible, um, and certainly a lot more difficult.
Anything we can do in our daily lives to prevent this from happening?
Um, just living a a healthy life. So avoiding things that cause comorbid conditions like diabetes, um, just you know, living an active daily life is about all you can really expect to do, um, there's a certain element of it's just kind of how you're made, and if anatomically uh, you have a relatively tight carpal tunnel and you have a little bit of swelling in there, it might be something that happens to you.
All right, just a reminder to our viewers that you can ask questions, use the chat on YouTube or Facebook, you can tweet us or email the Medical News Network. Information is right there on your screen. Let's get a check with Dr. Dan Hackinson, medical director of infection prevention and control.
Coob count down a little, down a little bit.
Yeah, we have down under 20. I think we had a 15 or 16, 15 active patients this week. So again, it had been in those uh, low to mid 20s for a few weeks. We are down now. Uh, we know that the latest CDC data regarding infection uh, like illness and people reporting to departments and Primary Care visits is plateaued, so hopefully we can continue to see numbers of hospitalized patients decrease, um, for all respiratory uh, viruses at this point.
So Hawk earlier this week, a panel of vaccine experts met, Asip, or the advisory committee on immunization practices. They advised the CDC on rules and recommendations, and there were a couple of highlights from that meeting, including talk of a spring booster. Uh, what did they discuss?
Yeah, at this point, um, this this is new, and I don't know when the full uh, this was an announcement like you said, uh, but basically what this this does say is that everybody over 65 now should get that second COVID-19 vaccine for this respiratory viral season. Previously, uh, the wording was may get an uh, another vaccine dose, but it has been changed, and we've talked about even since January there were stipulations on if people wanted to get a second dose. Mostly those were people who are moderately or severely immunocompromised; they were able to get a dose of uh, uh, a second dose of the updated COVID vaccine 8 weeks after their first dose. This new uh, stipulation I believe is 4 months after that first updated vaccine dose, uh, those over 65 uh, should get a new uh, a new vaccine dose.
And what did Asep say about hospitalization?
Yeah, so this is interesting. I think part of this is also why. So first of all, overall for the respiratory viral season for this year for COVID, um, there were uh, weekly 20,000 hospitalizations and 2,000 deaths. Again, that's weekly, um, that is much improved though from where we were the past few years. In addition, um, unfortunately, 95% of those people were not up to date uh, with the new vaccine uh, dosing, so that helps. Hopefully we will have um, improvements then in hospitalization rates when people are up to date. And we would say that about 4% of those people that were hospitalized did end up dying. Now, as far as the vaccine and efficacy, new data has come out uh, this past month on vaccine efficacy, um, this is looking at hospitalizations. Before we get to hospitalizations, we'll say that in early February, MMWR did say that those people that did get a vaccine were about 58% less um uh, likely to get symptomatic COVID infection within the first 60 days after that vaccine dose. So that is helping to prevent or reduce your risk of infection, um, and then yesterday, so late February, February 29th, MMWR did put out another statement or did put out more information showing that there was a 51% vaccine efficacy against emergency department and Urgent Care visits within the first 60 days after the vaccine, and then um, up to 39% vaccine efficacy up to 120 days after the vaccine. Again, that's just for going to the emergency department or urgent care to get uh, evaluated if you're sick, um, and that was for people everybody over 18, but if you looked at people over 65, 49% efficacy against going to the emergency department, and as far as hospitalizations go, um, that's even better data. So anywhere from 42 to 50% efficacy, meaning reducing your risk of going to the hospital, possible up to 50% uh, for all of those over 18, uh, but again, the most at risk includes those that are elderly as well, 54% vaccine efficacy, so reducing your risk of going to the hospital by almost 55% within the first 60 days if you are over 65 and 50% uh, at 120 days after that vaccine. So very good vaccine efficacy again, and looking at it in terms of reducing your risk of going to the emergency department or going to hospitalization, and then if you look at those numbers for the ages over 65, I think that is a lot of what uh, drove the uh, the committee to make that uh, change in that designation that people over 65 should get a second dose, and again, typically it's going to be four months from that first dose.
Yeah, a lot of high-level stuff when Aset meets, so thanks for breaking that down so we can understand it. HW appreciate it. Let's get to some questions from our viewers, and Diala says, Dr. Jaye, first of all, all just thank you for this great informative discussion. So I think we're learning a lot here this morning. Question from Paul: Do you think that there's going to be more carpal tunnel cases now that we're using a lot of cell phones and devices?
Yeah, it's um, our devices are definitely leading to other issues with our with our bodies, in particular upper extremities, uh, there's a lot of positions we put our hands in um, that are probably suboptimal for that nerve, and again, driving is a very common thing that kind of initiates this consultation, and so is texting, kind of cocking our wrists back like that.
Yeah, makes sense. Any circumstances where you wouldn't want to do surgery, or is it just pretty straightforward? You have it, you get it?
Um, I mean, it's always a conversation with a patient. Every person is a little bit different, uh, the nice thing about carpal tunnel surgery and carpal tunnel syndrome is it does tend to be very very effective, and patients do get uh, relief from the symptoms that they have, so, um, seeking somebody with hand training to have that nuanced discussion is always important, but most people are very good candidates.
Joe has a question, uh, she had CTR surgery in 2012. Says my middle finger locks at times now and can't always stretch it out all the way. Could carpal tunnel come back? Could my issues now contribute to having had a surgery, MH?
Yeah, so carpal tunnel can come back. You do create a scar um, over that tunnel, and about 5% of people in their lifetime might have symptoms again later, typically significantly later, a decade or two uh, later. Without seeing Joe, it sounds actually more like a trigger finger, which is actually not too dissimilar. It's swelling in the tendon that causes it, and then tendon kind of binding up on one of the pulleys, um, so you do frequently see them together. It's a little bit different problem, um, with potentially different fixes, but.
And I hear this surgery that you did with Lauren is goes pretty quickly. A question was how many surgeries of these can you do in a day, Dr. Jaye? Uh, not that you're trying to PO them out. I know people know I'm a bit of a pushover, so I tend to just add it on to whatever surgery day I have or any sort of um, clinic day that I have anyway, um, it's not uncommon to do 10 plus surgeries or something like that in a day, um, but it really again it's uh, you take as much time as it needs. It just happens to be something that it's pretty efficient.
Why can some people type all day every day without getting carpal tunnel syndrome? Again, you said it's it's a based on anatomy, right?
Yeah, exactly. And so kind of that combination of you've got that tunnel, and it's got to be filled with a certain amount of contents, so to speak, and some people have a little more space, and a
Little less swelling. Uh, question, Lauren, what was the endgame as far as your symptoms that made you want to go see a doctor?
Um, it was uh, the problem I had playing that's most important to me. Yes. When I uh, when I uh, had less and less enjoyment doing that, I knew something was was wrong.
Yeah. Dr. Jay, do you hear that a lot? It takes somebody finally going, "Wait a second, I can't do something that I really love doing." You know, a lot of we put up with pain and we brush things off, but it usually takes that one "aha" moment.
Exactly. And that's again paying attention to your normal activities of daily living. And once this starts interfering with that, it's it's usually time to to have that looked at.
So how do you know it's carpal tunnel and not something like arthritis?
So a lot of uh, different exam findings and and symptoms. And again, seeing somebody—most primary care physicians can can triage something like arthritis versus carpal tunnel syndrome and and refer you appropriately. Um, but you know, really discerning whether it's carpal tunnel, which is pressure on the median nerve at the wrist versus pressure at the elbow versus something in the spine—usually seeing a specialist is your best your best bet.
As we wrap up today, what's the biggest takeaway from this conversation? What do you want folks to know?
Um, carpal tunnel is extremely common. There's guesses all across the board, but it's probably about 10% of people have carpal tunnel symptoms sometime in their life, and about 5% of people have a carpal tunnel release. It doesn't have to be done in the operating room, you know, with you know, hours of being in the hospital, being knocked out, that kind of anesthesia kind of hungover feeling. It can be done safely in the office under local-only conditions, and now can even be done bilaterally using this ultrasound that is becoming um, available to patients. Several different options out there to choose from and to talk with your doctor through.
Y, Dr. JY, thank you. Lauren, thank you for being with us today and just sharing your story. Just wrap us up and tell us what do you want people to take away from your from your personal story.
Well, I should say um, I I'm very pleased that I uh, how things went. I'm glad that I brought it up to my primary care physician. I'm glad she referred me to the the the UKU Med centers Emi U uh division who told, confirmed that I had a severe case of of carpal tunnel syndrome. And um, I enjoyed my interaction with the university and the doctors all throughout.
So tell us more about this banjo real quick. Do you play with a band, and are you getting back on the road? What's happening?
Well, my wife plays the concertina, and our current musical project is the—what—the concertina. It's what is that? Am I learning all sorts of new things today? A little uh, a very very simple accordion, I'll put it that way. So um, uh, we're working on a on a duet. I used to go to bluegrass festivals, but uh, I'm more homebound these days. She needs her bandmate back up and running, so so we're glad that you're you're on the way.
Lauren, thank you so much for being with us today. Um, I'm gonna let Hawk give us a final thought.
Yeah, great story uh, today, and thanks Dr. Jaye. Again, was just saying how it's good to see him twice in one week almost for this for the show. So uh, but overall, want to continue to endorse and give that message out about vaccines. Um, vaccines are safe; they're efficacious. We see how they can help reduce your chance of going to the emergency department, going to the urgent care, going to the hospital. If we're talking about uh, the COVID updated uh, vaccine, remember if you are over 65, you should get that updated uh, vaccine dose. It is um, 4 months after your first one. Uh, but also we are seeing um, other illnesses that are popping up now, particularly measles at this point in time uh, in Florida and some other places as well. Vitally important to stay up to date with your vaccines to help keep you and your family safe. Uh, we know that they are—the vaccines themselves are safe and they do protect against the disease and the side effects and uh, the pathogenic effects of those diseases as well.
So Hawk, thank you so much. Thanks to our guest today and to our viewers as always for being with us. Have a great Friday, great weekend. We'll see you back here on Monday.
Coming up Monday on the Morning Medical Update: Caffeine is a drug, and whether we admit it or not, most Americans are addicted. I'm Jessica Level on the next Morning Medical Update. How does your coffee habit impact your gut, your heart, and your sleep? Plus the deadly effects of concentrated caffeine—what to watch for in the nutrition facts. Monday at 8. Subscribe to our Morning Medical Update and Open Mics with Dr. Ste's podcast. Now everywhere podcasts are [Music] available.