Guest: Dr. Nathan Wei
Presenter: Neal Howard
Guest Bio: Dr. Nathan Wei (pronounced ‘way’) is a nationally known arthritis expert and former consultant to the National Institutes of Health. He is the author of more than 65 articles in peer reviewed literature and has appeared on NBC TV, CNBC, PBS, The Leading Experts Show, and has been featured in Arthritis Today, Women’s Day, The Washington Post, and Martha Stewart Living. He has international reputation for his expertise in regenerative medicine and innovative procedures.
Segment overview: Dr. Nathan Wei, MD, a board certified rheumatologist, talks about a unique approach to carpal tunnel treatment.
Health Professional Radio – Carpal Tunnel Release
Neal Howard: Hello and welcome to the program today, I’m your host Neal Howard. Thank you for joining us here on Health Professional Radio. Our guest in studio today is Dr. Nathan Wei, board certified Rheumatologist and he’s here with us in studio to talk about a very unique approach to carpal tunnel treatment. Thank you for joining us on the program today Doctor.
Dr. Nathan Wei: My pleasure.
N: Carpal tunnel syndrome, it’s one of those I guess epidemic type of diagnosis with computer, people working on keyboards all day and some of us driving in vehicles, repetitive motion or even in athletic setting. What is your experience with carpal tunnel syndrome?
W: In rheumatology, carpal tunnel syndrome’s probably one of the most common conditions that we see and in fact is the most common what we call peripheral nerve entrapment syndrome that we see. What it’s due to is excessive pressure on the median nerve, the major nerve that enters the hand and the pressure build up in this tunnel, this tunnel that allows the median nerve to pass into the hand can be due to number of reasons. You eluded to them to some of them with repetitive motion and athletic endeavors and things of that nature, different types of diseases such as the different types of arthritis and excessive amount of growth hormone in the system, pregnancy, that’s probably not a disease, I don’t think.
N: Yeah, there are those who would beg to differ.
W: But it is a condition where carpal tunnel syndrome does occur because of fluid that accumulates in the carpal tunnel. So anything that squeezes down on that median nerve s going to cause this condition called carpal tunnel syndrome.
N: I’ve heard of employers not hiring someone if they are developing carpal tunnel syndrome simply because of the nature of the work that they would be hired to do. Is carpal tunnel syndrome something that will stop at a certain level if you stop doing a certain activity or once there’s an onset is it progressive regardless?
W: Great question because the answer is maybe. If the repetitive motion is discontinued and the patient can rest their hands and wrists, there’s a chance that their symptoms will go away. Unfortunately though most people have to work for a living, so it’s very difficult to find a situation where the symptoms won’t continue because of what it is they do.
N: We’re talking a lack of motion or very little motion in order to get the benefit of rest because even if you’re not doing that particular job, just the stress on the joints of everyday living and moving is enough to keep these symptoms going.
W: Correct and there are very few instances where people can completely rest their arms.
N: So is surgery always the end game when it comes to the treatment of carpal tunnel?
W: Well it depends and the reason I say that is that sometimes conservative management with splinting to rest the wrist, physical therapy, injections and anti-inflammatory medications can alleviate carpal tunnel. But, yes, if those things don’t work then the treatment of choice has been surgical release of the carpal tunnel.
N: Are there any methods, say for instance a change in diet that can clear the tunnel out? Is that something that’s possible or are we talking a different type of tunnel?
W: There are no real supplements or medications that a patient can take that will actually cure carpal tunnel syndrome because the tunnel is enclosed with the floor of the wrist bones and a roof consisting of what’s called the transverse carpal ligament. It’s a real tough piece of tissue and so the amount of space in this tunnel is limited.
N: Now you’ve developed a very or rather I guess unique approach to traditional carpal tunnel treatment, is that right doctor?
W: Well actually I didn’t develop it, I have to give the credit to Danqing and Danzhu Guo, Chinese orthopedic surgeons who developed this minimally invasive technique because up until now people had to have either open carpal tunnel surgery meaning a slice up through the wrist and palm or endoscopic meaning a telescope is jammed into that carpal tunnel space to cut the ligament. The promise with both of these techniques, even though they’re effective the complication rate can be rather high. And the recovery period can also be fairly long so the search has been on to try to find methods where number one, the down time is minimal and number two the effectiveness of the procedure outweighs the complications.
N: Is there ever an instance where carpal tunnel is caused by something other than repetitive motion? Say some type of other inflammatory illness or maybe genetics or autoimmune is a cause for carpal tunnel symptoms?
W: Yes, because carpal tunnel syndrome is like fever. There are many different causes of fever, many different causes of carpal tunnel syndrome. Again, ranging from inflammatory conditions like rheumatoid arthritis or gout and so on and so forth. So anything that causes an increased pressure in that space will lead to carpal tunnel syndrome.
N: You talked about the complication rate, do you find that there’s more or less complication based on some factors such as age or advancement of the condition?
W: I think the complication rate is probably increased in those people who have had their symptoms for a long time. Because then it’s goanna be very difficult to get complete relief for that patient because extensive nerve injury is already occurred, thread carpal tunnel release and let me briefly describe it. We use ultrasound guidance to pass a thin metallic or metal impregnated thread around the transverse carpal ligament and uses thread to saw through the transverse carpal ligament. Using local anesthetic only, down time is minimal, complication rate is perfectly acceptable.
N: How can our listeners learn this new technique for themselves? Is there some place they need to travel to? Are consultants such as yourself dispatched around the country or maybe the world to teach this new technique?
W: If they’d like to learn more about this they can go to our website which is www.arthritistreatmentcenter.com.
N: The effectiveness of this technique must be proven or you wouldn’t be as excited about it as you are. But what about the cost effectiveness of it as opposed to traditional procedures or treatments?
W: Again, very, very good point. With any type of surgical treatment for carpal tunnel there’s tremendous cost involved. You have the operating room cost, you have the surgeon, you have the anesthesiologist. With the thread carpal tunnel release, it can be done actually in the office and so using local anesthetics so the cost is probably, I would say 1/3 of that for surgery.
N: It’s been a pleasure talking with you today Dr. Wei.
W: Thank you and it’s been my pleasure as well.
N: Thank you. Transcripts and audio of this program are available at healthprofessionalradio.com.au and at hpr.fm, you can subscribe to this podcast on iTunes. You’ve been listening to Health Professional Radio, I’m your host Neal Howard.