12 March 2008

Carpal Tunnel Syndrome

So, maybe now that a local newspaper has talked about it, my patients are more likely to believe me.  It still amazes me how many patients walk into my office and start the conversation with, "I have carpal tunnel syndrome, and I use the computer at work.  So, I need you to write a letter saying that this is work related."  

Some are more willing than others to listen.  Some initially get angry at me, "But my PCP told me..."  (My apologies to the PCPs that are well educated on the cause and effect relationships of CTS.)  The truth is that we still know very little about this syndrome.  We know that heredity is a big factor, as is hypothyroidism; we know that retired and disabled people are often just as likely to get it as anyone else.  We have recently found that people that are manual laborers--bakers, custodians, construction workers--are more likely to get it, and there are multitudes of computer programmers and the such that have no signs of carpal tunnel problems.  So no, just because you sit at a computer all day long does not mean that that is why you have carpal tunnel problems.

I spend MUCH time with each patient, explaining anatomy, pathology and their treatment options; trust me, they are thankful for that.  Unfortunately, there are still many physicians that are also poorly educated about this common problem.  I get so many referrals for "hand numbness" that is straight out of the text book, and it is obvious that the referring doc hasn't a clue.  These patients should stop by their friendly neurologist first for a baseline EMG, then come to me for treatment.  It's OK, we end up ushering them along, eventually, but sometimes they feel like a pinball--being pinged between different doctors.  


Dr. Rob Oliver said...

You should read Dr. Morton Kasdan's writings on this in the hand literature. Mort was one of my professors at Louisville and was one of Dr. Harold Kleinert's 1st proteges. He was almost militant in trying to disociate occupation and carpal tunnel symptoms

DrB said...

As it should be--thanks!