Transcription:

Bill Klaproth (Host): With how much we rely on our hands, there’s no wonder hand and wrist pain can be so disabling and frustrating. When this pain interferes with typing on your computer, spending time on your hobbies, or even getting yourself ready in the morning, it may be time to see medical advice. That’s where Dr. Ian Crabb comes in, an orthopedic surgeon at Columbus Orthopedic and Sports Medicine Clinic. Dr. Crabb, thank you for joining me today. Can you start off first by telling us a little about yourself?

Ian Crabb, MD (Guest): Yes, good morning Bill. Thank you so much for having me on your show. I grew up in New York City and went to medical school at New York University. I served in the United States Navy. I went after my medical school and residency training in orthopedics, I served in Naples, Italy for two years where I rain the navy hospital in Naples. Then from there, I was transferred to San Diego. I did a year of hand surgery and a year of sports medicine at the San Diego Naval Medical Center. Then we ended up moving to Omaha, Nebraska and have lived in Nebraska since then. I've been in the practice of orthopedic surgery now for 26 years. The specialty area that I have gravitated towards has been hand and wrist surgery.

Host: Very good. What are some of the procedures you specialize in?

Dr. Crabb: Well the hand surgery is an interesting subject because it really grew up as a specialty during World War II because there were nerves and arteries and tendons and bones in close proximity. Because of this, a surgeon that was confident in operating on all of these different tissues was required otherwise we had to get many different specialties involved and they were all too close to work together. So, hand surgery developed really from war injuries in World War II.

Today we see, obviously, still see traumatic injuries that occur. But arthritis can manifest itself in the hand. There’s 27 joints. All of those can go wrong in different patterns and in different ways. There’s carpal tunnel, which many people are familiar. Then there’s a host of other mechanical problems, tendon issues, and other things that can cause pain and disability.

Host: Well speaking of some of those things, we are here today to talk about hand conditions. So, what are some of the most common conditions you see?

Dr. Crabb: Yeah. One of the most common probably is carpal tunnel syndrome. Carpal tunnel syndrome has about 140 known contributing factors. So, in any case, there are many causes of why a person has carpal tunnel. The symptom that someone should be aware of is the feeling of numbness and tingling in the fingers, especially the thumb, index, and middle finger. Often times it will wake a person from sleep or go numb when they're driving, cause them to have clumsiness in using the hand. If these symptoms occur, then we can do a fairly simple procedure to allow more for the nerve and have really traumatic results.

Another procedure that’s very common is triggering of the fingers where the fingers lock or catch and have a mechanical catch when they try to grab or use their hand. That often comes with carpal tunnel, which is why I mentioned them together.

Host: Okay, gotcha. When it comes to treatment for these conditions then, is surgery the only option?

Dr. Crabb: Well there’s often non-surgical treatment and you have to put that in the perspective of the patient. What their occupation or their ubication is, what other medical conditions they have. One of the nice things they have about surgery, and one of the things that I enjoy the most, is often with a very simple surgical procedure, you can get a fairly dramatic improvement in function.

Host: Well, that’s really good news and good to hear. So, have you seen any new conditions popup since you began practicing?

Dr. Crabb: There really aren’t a lot of new conditions. Humanity hasn’t changed much. There are some different stressors. Although, during the 1990s it was very popular to blame carpal tunnel on computer use and that type of thing, but that really has proven not to be a causal agent. We’re still concerned about some of the heavy industry where people are using wizard knives or high production environments. These factors can contribute to carpal tunnel and other tendon problems. One of the interesting things is we see much less rheumatoid arthritis than we used to. It seems to be fading out, which is a good thing for our patients.

Host: So, I'm wondering with the increase in computer and cell phone usage, have you seen an increase in certain hand related conditions? It’s interesting to hear you say that there’s less arthritis, but we’re using our hands on our phones. They’re all kind of crunched up all time. So, does cell phone usage, how does that play into hand conditions today?

Dr. Crabb: Honestly, I really haven’t seen cell phone use cause any condition. I will tell you though we have had a few cases of people that play video games for many, many hours, those people can develop tendonitis’s or conditions related to that. So, it’s been more the video games that I've seen that in.

Host: Oh, that’s interesting. I didn’t even think about that. So, if someone is experiencing pain in their hand or wrist, when should they contact a medical professional?

Dr. Crabb: Well, in general for most chronic conditions, if the pain is there for a week or two and it seems to not be resolving, then I think that would be a reasonable time to mention it to their family practice doctor. Or if they have a significant pain or significant loss of function to be seen right away.

Host: So, let me ask you this. You were talking earlier about small surgeries can take care of this. When someone goes in, are these generally done outpatient? So, you were talking about carpal tunnel syndrome and trigger finger.

Dr. Crabb: Yes. This actually brings up really the thing I’m most excited about currently. The surgeries are virtually all done outpatient, but over the past several years, there’s been a push to simplifying outpatient hand surgery. So most of my surgeries now are done under just straight local anesthesia. So, it means there’s no IV, there’s no fasting before the surgery, there’s no tourniquet during the surgery, and we strive for a rapid return to function. So, we’ve really tried to make this much less of an event for people. I feel like we’ve really come a long way in that area.

Host: What is the general recovery time then when someone has this type of surgery?

Dr. Crabb: Sure. For most of the soft tissue procedures about the hand, we take the stitches out at a week. By two weeks, we allow them pretty much to do whatever they like. For the boney procedures or more complex procedures, then it’s typically a six to eight-week recovery time frame.

Host: Does this generally take care of it then? Is the person completely pain free? I know each person is different. But on the pain scale, how much are you able to affect that with the surgery?

Dr. Crabb: Again, that’s what’s so exciting really. When a person has a single digit that is not operating properly, very often that makes the whole hand not function well. The patient will come in and they don't even really know why, but they can't grip, or they can't do certain things. We can identify a single problem, fix it, and sometimes have tremendous improvement in function. Obviously, that’s not always the case. Sometimes a person, unfortunately, has multiple issues and they cannot be simply resolved with a single surgery or procedure. Many hand cases can, and that’s really exciting for us.

Host: Yeah. That definitely is exciting. So, after the surgery then, through lifestyle changes or someone changing the way they—they have carpal tunnel—the way they use a mouse and a keyboard then, are they able to then manage this throughout the rest of their life generally?

Dr. Crabb: Very often, yes. Absolutely.

Host: Dr. Crabb, I appreciate your time today. Is there anything else we should know about common hand conditions?

Dr. Crabb: I think the main message is that patients will often feel that they're not that big of deal and kind of ignore them. When, in fact, they really are causing them functional loss. So, I guess it’s to encourage patients not to ignore their relatively minor problems because many of them can be fixed relatively easily. They can move on and do more than they could before.

Host: Absolutely. Well Dr. Crabb, thank you so much for your time today. For more information on hand conditions and treatment options, head over to the Columbus Community Hospital Website columbushosp.org. That’s columbushosp.org. This is Columbus Community Hospital Healthcasts from Columbus Community Hospital.

I’m Bill Klaproth. Thanks for listening.