Dr Bryan Betty: Carpel Tunnel

What is Carpal Tunnel and who gets it? 

- One of the most common hand conditions. 

- Pressure on something called ‘median nerve’ that goes through the wrist. 

- The nerve goes through a narrow ‘tunnel’ (carpal tunnel) in the wrist, and when it gets compressed, you can develop symptoms. 

- 1-5% of the population get it at some point. Twice as common in women as men. 

- Most often seen in those between 30 and 60 years of age. 

- Increased risk with pregnancy, diabetes, wrist injury, obesity, and repetitive wrist activities such as manual labour and sport. 

  

How do you recognise it? 

- People often start to notice it at night: wake up with a tingly or numb hand and have to shake the hand out. Especially prominent in the thumb, and index, and middle fingers. 

- Sometimes described as electric shock, sometimes holding the steering wheel of car, holding a newspaper. 

- May be described as pain, and people often get discomfort up the forearm. 

- Can cause hand weakness and cause people to drop things. 

  

How do you diagnose it? 

- Your doctor will take careful history. 

- Examine the wrist 

- Order a nerve conduction study which shows if the nerve is being compressed. 

- Sometimes an Xray or blood tests are ordered to check for any underlying condition like diabetes.   

  

What do you do about? 

- It depends on the severity. 

- Often it involves avoiding activities that make it worse, resting the hand if repetitive movements make it worse. 

- Using a wrist splint to keep wrist straight – especially at night to alleviate symptoms. 

- If it’s severe and ongoing, then refer to the orthopaedic surgeon, who do a simple operation to relieve the pressure on the nerve. 

 

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Episode Transcript

Speaker 1 (00:07):
You're listening to the Saturday Morning with Jack team podcast
from News Talks AB.

Speaker 2 (00:13):
It is that time on a Saturday morning where we
catch up with our doctor, doctor Brian Betty, and this
week we are talking carpal tunnel, which I know next
to nothing about. Good morning, Brian.

Speaker 3 (00:23):
Oh Ciro Jack.

Speaker 2 (00:24):
So, carple tunnel is one of the two most common
conditions to affect people's hands.

Speaker 3 (00:30):
Yeah, Look, we see it all the time in general practice,
and it's a condition that's caused by something called the
medium nerve. It's a nerve that runs down the arm
and it goes through the wrist and as it goes
through the risk it goes through this narrow tunnel called
the carpol tunnel, surrounded by bone and ligament, and it
gets compressed and as it gets compressed, it starts to

(00:50):
cause symptoms. So we know about one to five percent
of the population get it at some point, and it's
twice as common a woman as men, and that's the coast. Structurally,
their risk is slightly narrower than the men's wrists happens
between the ages about sixty and there's certain things that
put you at increased risk. So that's pregnancy diabetes, fireroid conditions,

(01:14):
and actually repetitive manual labor. So things like using jackhammers
or hammering all day can actually start to cause the problem.

Speaker 2 (01:23):
That's interesting. So how do you recognize it?

Speaker 3 (01:25):
Well, Look, I suppose the commonest thing that people say
to me when they come in. They start to describe
they're waking up at night and they're noticing that their
hand is very tingly or numb and they have to
shake it out to get the feeling back into the hand.
And that's often what we start to see. Now it's
often with the palm aspect of the thumb, the index finger,

(01:47):
and the middle finger. They start to notice this in
and occasionally people sort of say, well, look I start
to get this electric shock thing when I'm holding a
steering wheel or holding the newspaper. Now, over time, the
pain can start to go up the arm up towards
the elbow, and if you leave it, the hand starts
to become weak. So people describe they can't sort of

(02:08):
hold onto cups and they may drop things. We'll feel
a bit clumsy. So it can progress over time and
start to infare with grip with the hand.

Speaker 2 (02:17):
So how do you diagnose it?

Speaker 3 (02:19):
Well, look. Often it's just a really careful history. So
it's that thing when someone comes in and says, I'm
waking up at night and having to shake up my
hand and you start to think, well, you know, is
this carpul tunnel. It can be other things, but that's
the most common one. So we often examine the wrist
and we'll do this thing where we sort of push
the wrist over and hold it, and by putting it
into this ninety degree position holding that, people start to

(02:42):
get the numbness and the fingers I've just described. Now. Specifically,
we'll often order what's called a nerve conduction study. So
this is where they put electrodes on your arm. They
put an electric shock down the arm, and what they
see is the electric shock slows down as it goes
through the wrist, and that pretty much tells us that's
exactly what's going on. Now. If we are concerned about

(03:04):
another condition like diabete, is the thire or something like that,
we may order some blood tests and occasionally we'll do
an X rate to look for arthritis and things like that.

Speaker 2 (03:13):
Yeah, that's got to cleve a little test, isn't it.
Doing the you know, the electric measure down the arm.
So what do you do about it? If you are
diagnosed with a couple of times, yeah.

Speaker 3 (03:21):
Well look a look. It depends on how bad it is.
So often just avoiding activities that trigger it may be
a good thing to do, like if you're hammering or whatever,
just don't hammer and you know, just just stop that.
And often we'll say, look, go to the chemist and
get a risk sprint splint. So this is a splint
you put onto your wrist. You often wear it at
night and it just keeps your wrist straight so your

(03:42):
wrist doesn't flop over. Because it's flopping over that causes
the pressure on the nerve and often that just stops
the symptoms. So just a risk splint is a very
simple thing you can do and wear it at night
and the problem goes away. However, progressions progresses past that,
and you start to get the weakness and the pain
up the arm, and it's happening during the day. We

(04:02):
send you off to an orthopedic surgeon and they do
something called a car tunnel release where they under local
anesthetic they just cut the ligament that that goes across
what's called the carpal tunnel. Releases the pressure and pretty
well one hundred percent of the time the problem is cured.
So yeah, done deal.

Speaker 2 (04:21):
So yeah, very very soon there is something you can do.

Speaker 3 (04:24):
Yeah, that's absolutely yeah, well.

Speaker 2 (04:26):
Very good, you know, and I I knew next to
nothing about carpal tunnels. Thank you very much for that.

Speaker 3 (04:35):
Oh good, Jack, no problems.

Speaker 2 (04:37):
Really appreciate your time. That is doctor Brian Betty with
us this morning.

Speaker 1 (04:41):
For more from Saturday Morning with Jack Tame, listen live
to news talks that'd be from nine am Saturday, or
follow the podcast on iHeartRadio.