[Medical Insight 56th] Symptoms and treatment of "Wrist Tunnel Syndrome" by orthopedic surgeons.

□ Broadcast date and time: November 1, 2024 (Fri) 10:20 pm
□ Producer in charge: Lee Siwoo
□ Author in charge: Kim Bae-jung and Kim Hyun-jung
□ Cast: Choi Sung-joo (Orthopedic surgeon at Nowon-eulji Hospital)
□ Broadcast channel
IPTV - GENIE TV No. 159 / BTV No. 243 / LG Uplus No. 145
SkyLife Number 90
Cable - Delive No. 138 / Hyundai HCN No. 341 / LG HelloVision No. 137 / BTV Cable No. 152

* The text below may differ from the actual broadcast content, so please check the broadcast for more accurate information.


◆ Choi Sung-joo: Hello, I'm Choi Sung-joo, an orthopedic surgeon. The story I prepared today is symptoms and treatments for carpal tunnel syndrome.

◇ Voice actor Park Sang-hoon: A disease that should be suspected if you feel numbness in your hands while using a computer and smartphone. carpal tunnel syndrome Wrist tunnel syndrome, which is caused by the pressing of nerves, only causes numbness in the hand in the beginning, but when the symptoms worsen, the hand sensation becomes dull due to chronic symptoms. It is said that it is difficult to hold chopsticks, drop cups frequently, and open the bottle cap as a daily symptom. In the past, it occurred a lot in the 40s and 50s, but recently, the number of young patients in their 20s and 30s has increased rapidly. Let's learn more about self-diagnosis, prevention, and treatment of carpal tunnel syndrome.

<Understanding Diseases>
◆ Choi Sung-joo: Wrist tunnel syndrome. I'm sure there are a lot of people who have listened to it at least once. Recently, the number of patients with carpal tunnel syndrome is increasing. Not long ago, news came up that actor Nam Gyu-ri was diagnosed with wrist tunnel syndrome and treated. In the past, wrist tunnel syndrome was known to occur frequently in middle-aged women, obesity, and diabetic patients. Recently, the number of patients with carpal tunnel syndrome has increased a lot in the younger group due to professional and hobby activities. Wrist tunnel syndrome is also known as root canal syndrome. A disease caused by compression of nerves is called compression neuropathy. Wrist tunnel syndrome is the most common disease among compressed neuropathy. There is even a saying that there is a nearly 100% chance that it will relax even a little in its lifetime. In 2010, 120,000 patients were diagnosed with carpal tunnel syndrome in Korea. However, wrist tunnel syndrome is not a disease that hurts the wrist. To understand this, we need to look at the structure of our hands and wrists. The wrist has a tunnel-like structure that covers the wrist bone and above it with transverse ligaments. This is called the wrist tunnel or the root canal. Nine finger-moving tendons and one medial nerve pass through this tunnel. You can understand that nerves are like electric wires. It is a structure in which when nerves send signals, they receive sensations and exercise. However, for whatever reason, if the tunnel is pressed, the nerves will be damaged, sensory abnormalities will occur, and movement will fall.

<Why are nerves under pressure>
◆ Sungjoo Choi : So why are nerves under pressure? In elderly patients, wrist tunnel syndrome occurs due to thickening of wrist ligaments and pressing of the medial nerve. On the other hand, in young patients, hay fever becomes severe, and the pressure inside the wrist rises and the nerves are stimulated. There are various reasons for wrist tunnel syndrome.


<Causes of Disease>
◆ Sungjoo Choi: Let's look at which patients develop carpal tunnel syndrome. First of all, wrist tunnel syndrome occurs well when you get older. This is because the transverse ligament corresponding to the ceiling of carpal tunnel syndrome thickens with age. Hormones also affect carpal tunnel syndrome. Therefore, postmenopausal women, pregnant women, and people with thyroid symptoms also commonly develop carpal tunnel syndrome. It is known that carpal tunnel syndrome occurs more frequently in women than in men. The ratio corresponds to 3:1. Therefore, carpal tunnel syndrome is very common in middle-aged women. It's also influenced by the lines. Wrist tunnel syndrome is more common in diabetics, dialysis patients, and obese patients. There are also professional factors. Vibration stimulation exhausts the nerves very easily. Therefore, those who do a lot of electric work and drill work will develop more neuropathy, including wrist tunnel syndrome.

<Symptoms of Disease>
◆ Choi Sung-joo: The symptoms of carpal tunnel syndrome vary depending on the timing. At first, numbness is the main symptom. It gets worse at night. Some say you have to shake your hands to sleep. The nerves keep pressing, and if the period is prolonged, the nerves start to be damaged. First, changes in the sensory nerves appear. They also complain that I look like someone else's flesh. Some say it feels like you're wearing gloves. If the disease progresses further, it also affects the muscles. The muscles underneath the thumb are called the thumb muscles. As you can see in the picture, the picture on the left is the thumb of a normal patient. You can see the convexity. On the other hand, people with long-term relaxation of wrist tunnel syndrome have this thumb muscle atrophy. In the picture on the right, you can see the atrophy of the thumb. This thumb is in charge of a movement called confrontation, where the thumb is sent to the little finger. Therefore, people with wrist tunnel syndrome who have been relaxed for a long time have a very hard time exercising to touch their little fingers with their thumbs. The median nerve also manages the autonomic nerve. If the autonomic nerves are damaged, your hands will sweat less and your hands will have less resistance, so you will have a smooth palm. If you proceed further, there are patients who are not sick. If the nerves are pressed for a long time, they can reach a stage where they cannot recover. Therefore, if the disease progresses for a long time, you may not feel pain. If the symptoms of carpal tunnel syndrome persist for a long time and do not get sick at some point, it is possible that the disease has not healed but worsened, so I recommend you to visit the hospital. Then let's look at which parts of the senses fall off. The median nerve controls half of the thumb, index finger, middle finger, and ring finger. Therefore, patients with carpal tunnel syndrome complain of sensory changes in the area. And the median nerve goes to the fingertips and controls the back of the hand, so there are many patients who say that their fingertips are numb in the early stages of the disease or that their fingers are numb. Wrist tunnel syndrome can worsen if you use a lot of hands. When the wrist is bent or stretched as much as possible, the pressure increases within the wrist tunnel. Therefore, those who type with their wrists extended and those who catch them with their mice extended can experience worsening wrist tunnel syndrome due to increased pressure in the wrist tunnel. Likewise, carpal tunnel syndrome can worsen in housewives, hairdressers, skincare workers, chefs, and cyclists.

<Relationship with Smartphone>
◆ Sungjoo Choi : Recently, there are many cases of carpal tunnel syndrome related to smartphones in young people. This is because the posture of the hand is often bent when using a smartphone. Maintaining this position for a long time will keep the pressure in the wrist tunnel high and constantly strain the muscles of your fingers. When the muscles that move the fingers become tense, inflammation can occur around the area, which can increase the pressure of the wrist tunnel and worsen the symptoms of the wrist tunnel. So what should I do when I use my smartphone? When holding a smartphone, the wrist is called the comfortable and neutral position as much as possible. We need to try to stay neutral. In particular, if you lie down and use a smartphone, your wrist often stretches, so you should be careful. We should avoid using smartphones for too long. After using it for 20 to 30 minutes, it is recommended to rest through a light wrist exercise.

<Self-diagnostic method>
◆ Sungjoo Choi : Wrist tunnel syndrome can be diagnosed on its own. This method is to check if symptoms occur by artificially raising the pressure in the wrist tunnel. It's called the Palen test method. Bend your wrists and position your hands so that the back of your hands touch each other. In this position, the pressure in the wrist tunnel is increased. Taking this position for 30 seconds to 1 minute can cause numbness or pain with your fingertips. In this case, you may suspect carpal tunnel syndrome. Another self-diagnosis method is compression testing. There is a wrist wrinkle on the wrist, and it is a way to press the distal part right away from the wrist wrinkle. This is a method to check if symptoms occur by pressing for 30 seconds to 1 minute. Compression of the area with the wrist bent is more effective. However, when pressing an inaccurate area, false positive and false negative results may occur, so care should be taken.

<Patient Case>
◆ Sungjoo Choi: So far, we have looked into the symptoms and diagnosis of patients with carpal tunnel syndrome. I'll give you an example and explain it. The first patient is a 60-year-old female patient. Your thumb, second, third, and fourth fingers are numb. They say it's burning. They say it's worse at night after work. It is said that you can sleep only when you wake up at night and shake your hands. If you examine these patients in detail, they often don't get numb above the wrist. These symptoms are typical symptoms of carpal tunnel syndrome. The next patient is a female patient in her 70s. You came because you keep missing things. You said your fingers don't have much sensation. It used to hurt, but now the pain is gone. A close look at the hands confirms the atrophy of the thumb muscles. In this case, rather, the disease has progressed a lot. The sensory nerves are completely damaged, so they don't hurt. Since motor nerves are also being damaged, we can expect improvement through quick surgery. The next patient is a man in his 30s. He is a cook by profession. He's also a hard worker. They say that after working out, your fingertips feel numb. There was no sensory change or muscle atrophy. In this case, it is likely due to posture and work. I think this patient can be treated well with non-surgical treatment.

<Non-surgical treatment>
◆ Sungjoo Choi: Next, we will learn about how to treat carpal tunnel syndrome. First, I will explain about non-surgical treatments. The first one is to fix the splint. It is recommended to use a hard one to fix the splint. It is a method of resting the wrist by using a splint to prevent the wrist from moving. It is known that it is effective only when maintained for more than a month, and the effect is equal even if worn only at night. The second is the correction of lifestyle habits. It is effective in patients with occupational-related wrist tunnel syndrome. For those who continue to use the mouse by bending their wrists, it will be helpful to use a mouse that can be used with their wrists open, or use the keyboard with their wrists propped up. Next, taking anti-inflammatory analgesics is helpful. I mentioned earlier that swelling of the tendon in the wrist tunnel can worsen the wrist tunnel. Anti-inflammatory analgesics improve inflammation and swelling in the wrist tunnel. Next is steroid injections. Steroid injection is a treatment that improves symptoms by inserting steroids only locally into the wrist. It is known as a very effective treatment, and once injected, the drug remains on the wrist for four to six months to help improve symptoms. However, it is necessary to be careful because it affects blood sugar control in diabetic patients, and in those with thin skin, the skin may turn white, so appropriate use is important.

<How to exercise good for diseases>
◆ Sungjoo Choi: Here are some good exercises for carpal tunnel syndrome. The following exercises are all stretching exercises that relax the tendons that bend the fingers. I'll show you a stretching exercise method that stretches the tendon that bends the thumb. It is a stretching exercise method that stretches 2, 3, 4, and 5 fingers. Stretching exercise, which stretches and turns the wrist to reduce the pressure on the wrist tunnel, is also helpful. It would be helpful if you implement this exercise method about 10 times for 10 seconds when you do it 2-3 times a day. However, this exercise method may increase the pressure of wrist tunnel syndrome, so if the symptoms worsen, you should stop exercising and consult with an expert.

<Surgical Treatment>
◆ Sungjoo Choi: Next, I will talk about surgical treatment. Surgical treatment is a treatment that cuts the transverse ligament that compresses the medial nerve. The yellow median nerve is dented by the transverse ligament of the thickened ceiling. At this time, if the horizontal ligament of the ceiling is relaxed, the nerves are decompressed and moved to a comfortable position. These surgical treatments do not require general anesthesia. The great advantage is that it can be operated with local anesthesia. The operation time is also as short as 20 minutes. On the other hand, it is known that the result is good, so I think it is a good treatment. I will explain the operation method in detail. Mark the surgical site and perform a skin incision. You can see that there is no blood even if you cut the skin. This is because the pressure band is applied to the side closer to the surgical site. The white structure you see in this state is the transverse ligament corresponding to the ceiling of the wrist tunnel. When the transverse ligament is incised, the tendons and nerves inside are revealed. When the transverse ligament is incised, the incision is made in the proximal distal area much more than the visible area. After sufficiently relaxing the nerves, the skin suture is performed.

<Surgery Curiosity>
◆ Sungjoo Choi: Patients have a lot of questions about surgical treatment. I've sorted out a few things. The first question is, does numbness and pain disappear immediately after surgery? To begin with, that's not the case. This is because nerves are tissues that take a lot of time to recover. Usually, symptoms of night pain and numbness improve within a month after surgery. Hand sensory abnormalities do not improve until three to six months later. You have to wait up to a year for the atrophy of your thumb muscles. Even after a year, the degree of improvement may not be complete. The reason is that there are cases where a completely dead nerve does not return. Many people are worried if I say this. Still, please rest assured that the operation of carpal tunnel syndrome is one of the very good surgeries. The second most frequently asked question is whether cutting the ligament in your wrist will cause your hand to lose strength. No. It's already been proven in several studies. Sometimes there are people who say their hands are weak, but most of them are temporary, so please feel safe. A lot of finger-curving tendons pass through the tunnel, but the muscles that move those tendons are much more proximal. Many people also ask about surgical methods using arthroscopes. Arthroscopic surgery has fewer scars and is less invasive, so many patients are asking. The minimum incision method shown earlier leaves a scar of 1 to 2 cm, and arthroscopic surgery leaves a smaller scar. However, each formula has its pros and cons, so I will decide after consulting with the experts. I'll show you a surgical procedure using arthroscopy. Make a small cut about 1cm into the proximal part of your wrist and insert an arthroscope through that cut. It is a method of observing the transverse ligament through the inserted arthroscope and incision of the transverse ligament.

<Prevention of Diseases>
◆ Sungjoo Choi: So far, we've learned about carpal tunnel syndrome. It would be nice if it could prevent any disease. Age and occupational factors should be considered for prevention. In particular, if wrist tunnel syndrome worsens due to occupations and hobbies, it can be improved through lifestyle correction and wrist stretching mentioned earlier. Wrist tunnel syndrome starts with numbness in the hands, night pain, and abnormal sensation in the fingertips. If you have these symptoms, you should suspect wrist tunnel syndrome and consult an expert early.

<Medical AI Q&A>
◆ Sungjoo Choi: Viewers have asked me a lot of questions about how to treat carpal tunnel syndrome. Shall we check it out together?

◇ Y-ON (AI Anchor): I was diagnosed with carpal tunnel syndrome, and my doctor told me to do extracorporeal shock wave therapy. Will it work?

◆ Choi Sung-joo: I think we should first explain the mechanism of extracorporeal shock waves. Extracorporeal shock waves are known to reduce pain by reducing inflammatory factors around damaged tissues. It is also known to promote the formation of new blood vessels in the area and nourish them to increase the ability to heal the human body. Extracorporeal shock waves are a new treatment recently introduced. It will take time for the evidence to build up. There are many reports that it is effective, but it is not yet a treatment accumulated from carpal tunnel syndrome. I think personal opinions should be applied differently from person to person. It is expected that extracorporeal shock waves will be less effective in people with worsening wrist tunnel syndrome due to thickened ligaments in the ceiling of the wrist tunnel. I recommend you to talk to an expert for more information.

◇ Y-GO (AI Anchor): My mother had surgery a month ago and the swelling won't go away. Do you think it's okay?

◆ Choi Sung-joo: Yes. It's a question that a lot of people ask. I just showed you a little bit in the surgery video. It has a wider incision inside than the scar seen from the outside. Therefore, it is a common condition for swelling to remain around the surgical scar. The swelling may remain for up to three months or longer.

◇ Y-ON (AI Anchor): I thought it was carpal tunnel syndrome, but it's called hay fever. How are hayitis and carpal tunnel syndrome different?

◆ Choi Sung-joo: I think I should tell you about hay fever first. Hayitis refers to the development of inflammatory tissue around tendons, that is, tendons. Hayitis can occur for various reasons. You can think that hay fever can worsen carpal tunnel syndrome. The tissue that develops hay fever will stick to it. If hay fever develops within the wrist tunnel, it can worsen wrist tunnel syndrome because it acts to increase pressure within the wrist tunnel.

◇ Y-GO (AI Anchor): It's been 2 months since I had surgery and my wrist still hurts. Is it a side effect of surgery?

◆ Choi Sung-joo: The first symptoms that get better after surgery for carpal tunnel syndrome are numbness, night pain, and discomfort at the fingertips. If there is some improvement in this area, you can rest assured first. If you experience pain in your wrist, you can consider surgical site pain. There are people who have pain in that area for up to six months. However, studies have shown that most of the surgical pain improves after six months, so you don't have to worry. Some people complain of painful pain when pressed into the area around the surgical scar. The reason for this can be explained as follows. Inflammation easily occurs at the end of the incisional transverse ligament. The marked part corresponds to this. Inflammation may remain in that area, and pain may remain when pressed. However, as I said earlier, most of the pain improves after 6 months, so you don't have to worry.

◇ Y-ON (AI Anchor): The symptoms are severe in normal times, but especially at night. What's the reason?

◆ Choi Sung-joo: Due to the nature of the human body, inflammatory reactions tend to get worse at night. It would be good to think of coughing and runny nose worse at night when you have a cold. In patients with carpal tunnel syndrome, inflammation in the carpal tunnel worsens at night, worsening symptoms.

<Remember this>
◆ Choi Sung-joo: Neglecting carpal tunnel syndrome can also cause pain, but it can also slow down your senses and lead to paralysis. If you feel symptoms in the self-diagnosis method I explained today, please do not endure the pain unconditionally and discuss the treatment with a specialist. I hope my story today helped you to live a healthy and happy life. Thank you.