Dr. James Fedich is the Clinical Director and owner of Village Family Clinic and he gets a lot of questions. There are a lot of different conditions, but the most common condition he gets asked about these days is Carpal Tunnel Syndrome.
A big study that everyone has been talking about the last two years is sitting at a desk. It is the new smoking. We are all sitting at desks all day typing on computers, on the internet all night. Sitting is causing more health problems than smoking did in the 50's and 60's before we knew what that was doing to us. People are staying on their keyboards, typing all day and unfortunately, keyboards are in the improper positions which can irritate the carpal tunnel.
Have you heard of carpal tunnel syndrome?
It is probably the most misdiagnosed condition that we see in here. People think that anytime there is hand pain it is carpal tunnel syndrome. Or anytime there is any kind of numbness or tingling in the lower part of the arm that this may be carpal tunnel. Well, this is not necessarily the case. Proper diagnosis is very important. A lot the numbness in the hand can come from the shoulders, elbows, or neck. So it is important to rule that out.
But typically, carpal tunnel is numbness in the half of the hand with two fingers and the thumb. It is because the median nerve is the main nerve that runs through the carpal tunnel and goes only in the thumb side of the hand. So any numbness or tingling in the other two fingers cannot be considered carpal tunnel syndrome. There is another syndrome similar but carpal tunnel is kind of a buzz word. That’s the first important thing to understand.
One way to test at home if you have carpal tunnel is what we call "the old prayer test". Just hold your hands in prayer position for about 30 seconds. What that does is put a little stretch on the carpal tunnel. If you start getting tingling in the first three fingers, there is a good chance you have carpal tunnel syndrome. But it is important to get evaluated by a qualified doctor. You can have nerve issues in the elbow, shoulder or neck causing it as well.
The reason why we have carpal tunnel problems is that we have two bones in the forearm. The rest of the carpal bones are the wrist bones. The wrist is made up of eight small bones and through this tunnel pass a bunch of nerves and tendons that control all the fingers. So if you actually move your fingers, the tendons you feel all the way up in the forearm are actually what is moving. Those muscles have tendons that run all the way through the tunnel to the top of the fingers.
A tendon of each finger and a couple of nerves run through and it is a pretty small area. You end up typing or putting your wrist in this position for hours a day. That nerve gets swollen or irritated in there and that is what we call carpal tunnel syndrome.
You can see all the tendons and nerves running through that small space. And over the top is this retinaculum which holds it all in position and allows these nerves to pass through with some protection. And again, they get inflamed, causing carpal tunnel syndrome.
The most advanced, newest way we are caring for carpal tunnel in the clinic is cold laser therapy. Dr. Oz has called this cold laser the "no pill pain buster." The reason is that it gets through all sorts of pain and inflamation, but carpal tunnel is one of the first that we are doing cold laser on. It has been FDA-approved for over ten years.
We have the cold laser device at the office. MLA-30 is one of the first FDA-approved lasers. And what it does is send light waves up to the end of this probe which gets rid of all the inflamation and swelling around those nerves. We used to ultrasound these problems, and we often still do. We still have multiple ultrasound therapy machines here in the office, but the laser gets a deeper penetration. Ultrasound maximum penetration is about one and a half centimeters to two at the most. The laser goes five centimeters which is more than double where the ultrasound will get. It is also painless. You do not feel a cold laser and there is no messy gel or clean up. If anyone has ever had ultrasound, it can be quite a messy experience.
If you visit the office we can demonstrate the laser. All we do is put it in place over the carpal tunnel and turn it on. You will be able to see just a little bit of light as it is coming out. Mostly we put it skin on skin so you will not be able to see it but this is just for demonstration. And now for a series of cycles here, we just take a few minutes and we will be able to get rid of that inflamation in the carpal tunnel and get rid of that nerve pain for you.
A couple of things we do to treat carpal tunnels is administer B vitamins, which are known for their speed in healing the nerves. Even if we get the inflamation out of the nerves with the laser therapy, we can still sometimes have issues. So we recommend a good B-complex for most patients. A lot of carpal tunnel patients have difficulty sleeping at night. Their hands get numb while they are sleeping. They will curl their wrist or have some funny sleeping patterns, which puts pressure on those nerves while sleeping. Thus, carpal tunnel braces are sometimes recommended for those who have a lot of night pain. Those can be bought at any local pharmacy. They are a little hard brace that will kind of hold the wrist in the right position to allow that tunnel to be open and allow those nerves to heal for you.
It is important to diagnose the carpal tunnel properly and once it is diagnosed properly, it is a pretty quick 3-minute treatment. Carpal Tunnel Syndrome is something we treat a lot here at the clinic.