About Dr. Johans

Carpal Tunnel Treatment - Dr. Johans in Boise

For thirty years, Dr. Johans has been at the forefront of providing exceptional care for carpal tunnel syndrome in the Treasure Valley. He is well-known throughout the region for his expertise and has established a practice that stands out from its competitors with a comforting atmosphere and personalized service. No one is ever in a rush at his office; patients are encouraged to take their time to discuss their condition and treatment options with Dr. Johans personally. 

As an experienced neurosurgeon and medical professional, Dr. Johans takes every step to ensure each person receives a precise diagnosis and the very best care available. In many cases, patients can achieve relief without surgery; however, when required, he is willing to pursue further interventions if necessary for maximum benefit.

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is an affliction of the wrist and hand that can be extremely painful and debilitating. It occurs when the median nerve, which passes from the forearm into the hand through a small space in the wrist called the carpal tunnel, becomes pinched or compressed. This can lead to numbness, tingling, weakness, and pain in various parts of the hand, especially on the thumb side of the palm.

In some cases, it can make simple daily tasks such as brushing teeth or opening jars difficult to manage. The condition is caused by repetitive motions over time that result in pressure on the median nerve and swelling of tissues in your wrist. Risk factors include age, occupational hazards (working with vibrating tools), medical conditions such as diabetes or arthritis, gender (women being more susceptible), and pregnancy. Treatments vary depending on severity but may include rest, anti-inflammatory medications, splints/braces, or surgery if necessary.

Patients who suspect they suffer from carpal tunnel syndrome should consider the following symptoms. They are judged in 3 stages ranging from mild, moderate, and severe.

  • Weakness when gripping objects with one or both hands
  • Pain or numbness in one or both hands
  • "Pins and needles" feeling in the fingers
  • Swollen feeling in the fingers
  • Burning or tingling in the fingers, especially the thumb and the index and middle fingers
  • Pain or numbness that is worse at night, interrupting sleep

Although some cases may improve independently, most carpal tunnel sufferers require medical intervention to prevent lasting damage. If someone notices the symptoms mentioned above and is not improving with non-surgical treatments, it is time to consult Dr. Johans. Intervention today could prevent irreversible nerve damage from developing in the future. He will assess how serious the condition is and do everything possible to explore non-surgical treatments before suggesting surgery.

Dr. Johans can test for the severity of a patient's carpal tunnel syndrome with the following tests:

  • Phalen's Maneuver: This medical test involves pressing the back of the patient's hands together for one minute and observing whether any tingling or numbness occurs in the fingers.
  • Durkan's Test: This involves flexing the patient's wrist downward for thirty seconds and then pressing down on their wrist with the thumb. If numbness, pain, or tingling occurs in the fingers, it can indicate carpal tunnel syndrome.
  • Tinel's Sign: To perform this test, a doctor will lightly tap over the median nerve at the base of the patient's wrist while observing if they experience any abnormal sensations in their fingertips. An abnormal response indicates carpal tunnel syndrome.
  • Scratch Collapse Test: In this test, a doctor will have a patient scratch their thumb against their index finger for five minutes to observe whether there is any difficulty controlling movement or loss of sensation in their fingers. If either symptom is present, it could point to carpal tunnel syndrome.
  • Sensitivity Test: This medical test measures how sensitive a patient’s fingers are when touched by an object such as a pin or cotton swab. If there is decreased sensitivity compared to other areas of the body, it may indicate carpal tunnel syndrome.

Surgery is often necessary to help prevent further damage and reduce medical issues in the long run. When there is progressive weakness or numbness in a body part, like a hand, it is almost always advisable to decompress the nerve to stop any worsening symptoms. In other cases, where the pain is more subjective to your personal pain level, it is unnecessary to have surgery unless the discomfort impacts your ability to function in everyday life or at work. This can include difficulty performing tasks due to the achiness, such as typing on a computer or using tools for labor. Surgery is usually the best option because it relieves pain and keeps physical abilities from deteriorating.

Carpal tunnel surgery is generally only necessary in cases where non-surgical treatments have failed to address the symptoms adequately. For those experiencing pain, wearing a wrist brace or taking anti-inflammatory medications can be a viable first step. If these measures fail to deliver relief after four to six weeks, then Dr. Johans may recommend that the individual undergo surgery.

However, it is important to note that these treatments are often only effective if the individual does not experience progressive neurologic loss or notable decreases in sensation or strength. Furthermore, additional forms of conservative treatment, such as physical therapy, may also be recommended before surgical intervention depending on the severity of the condition and other factors like age, general health, etc. It is time to get off the conservative non-surgical management once you start losing the function of your wrist or if the pain becomes unbearable.

If there is progressive neurological loss and pain in the wrist, the biggest goal of surgery will be to get pressure off the median nerve. Generally speaking, if it is not permanently damaged, it will prevent further weakness and numbness, maximizing your potential to regain your function. Dr. Johans can greatly diminish the amount of achiness from the nerve compression in your wrist.

All surgeries have potential risks and complications. We always weigh the potential risks versus the benefits to determine what is best for a patient. The potential benefits of carpal tunnel surgery can be immense, vastly outweighing the minimal risks.

Risks of Carpal Tunnel surgery include:

  • Bleeding: Carpal tunnel surgery carries a risk of bleeding, which can occur during the procedure or afterward if the wound opens up. This bleeding can be minor, nevermore than half a teaspoon.
  • Infection: It is also possible for an infection to occur after carpal tunnel surgery due to bacteria entering the wound site. Dr. Johans has a proven track record of his patients never developing an infection from his procedures. If they do happen, it is typically a result of poor wound management. Symptoms of infection can include increased pain, redness, warmth in the area around the incision, as well as fever and fatigue.
  • Nerve damage: Additionally, there is a risk of nerve damage during carpal tunnel surgery, which can result in an inability to feel sensations in certain parts of the hand or weakness and numbness that may never fully resolve. Dr. Johans has never caused a nerve injury.

Less common risks from carpal tunnel surgery include injury to tendons or pain from accidental damage to small sensory branches. The minimal risks are vastly outweighed by the benefits patients experience after carpal tunnel surgery. Many patients have remarked how they wished they would have done the surgery much sooner instead of suffering from pain, numbness, and weakness for many years.

Carpal tunnel surgery is a procedure that can be done while you are awake, using local anesthesia. This means you won't need to be put under general anesthesia and can usually go home an hour after the operation. Before leaving the hospital, Dr. Johans will explain what medications you should take, which activities you should avoid during your recovery, and how to recognize any potential risks associated with the operation.

Patients undergoing surgery often experience a significant decrease in their preoperative pain. Though the incision site may be tender, the discomfort is usually mild compared to before. Many patients even feel an improvement in sensation and strength soon after their procedure. However, it can take some time to regain full strength and mobility, so Dr. Johans may initiate physical therapy as part of your post-op treatment, which will be discussed at the first follow-up appointment.

At the follow-up appointment, typically between 12 to 14 days after the initial surgery, Dr. Johans will remove the top layer of stitches placed in the patient. The first layer of stitches is deep in the skin and permanent, while the second layer resides on top of the skin and can be removed just a couple of weeks after surgery. Although palm skin has strong healing qualities, it is composed of many dead layers, which makes it relatively slow to heal. Patients must keep their wounds clean and dry during this period to ensure a healthy recovery process after surgery. With proper care, patients are expected to have a successful outcome from their surgery.

If you have had carpal tunnel surgery but your symptoms are not improving, it could be because the underlying issue was not actually related to carpal tunnel syndrome. Instead, it might be due to nerve compression in the neck that extends down into the arm. Alternatively, it could also mean that the surgery did not effectively remove pressure from the nerve. Although this is rarer, both scenarios will be considered by Dr. Johans when examining a patient's lack of improvement.

Returning to work after an injury can be highly variable based on a patient's line of work. For example, if the job involves a lot of manual labor, such as using tools or shovels, it may take around three months to allow the wound to heal properly. To ensure that you return to work safely, we will work with your employer from day one by looking for alternative jobs with lower demands, which would still allow you to complete your duties and complement the healing process.

Patients should expect to no longer be woken up at night with episodes of numbness or tenderness caused by carpal tunnel syndrome. There is a small chance they might be felt occasionally, but the chances are significantly reduced after surgery. To avoid these issues, take a break from activities that cause strain on this area of your body so that symptoms can subside. You should also be mindful of activities that place a lot of direct pressure on this region because the ligament, which normally protects the nerve, has been weakened, making it more vulnerable. Issues caused by vibrations or sleeping difficulties should be more manageable, so avoid direct pressure when possible.

Dr. Johans may recommend an electromyogram (EMG) nerve study on your arm nerves to diagnose accurately. This is because the source of your problem may be in the wrist or a spinal nerve near the neck. These tests help Dr. Johans ensure he accurately treats the appropriate area. An electromyogram measures the response of a muscle to see if it is being affected by any nerve entrapment.

The diagnosis of carpal tunnel syndrome is made by looking at a combination of factors, including medical history, physical examination findings, and additional testing. Although an EMG study that shows normal results does not rule out carpal tunnel syndrome, it can still help Dr. Johans decide on the diagnosis. If the problem relates to the median nerve in the wrist area, then a doctor may opt not to do an EMG test. But if there is confusion and more information is needed to make a decision, then this test can provide useful data for diagnosing carpal tunnel syndrome.

Carpal Tunnel Syndrome Treatment by Dr. Johans

Dr. Johans is a highly experienced, board-certified neurosurgeon and pain management specialist with exceptional expertise in neck pain, lower back pain, carpal tunnel syndrome, and cervical arthroplasty. He is a Diplomat of the American Board of Neurological Surgeons and Pain Management and a Fellow of the American College of Surgeons and the American Board of Neurological Surgeons.

If you have any of these conditions or suspect that you may be suffering from any other neurological disorder, please get in touch with Dr. Johans at 208-327-5600 for a consultation to discuss which treatment plan may be right for you.

Dr. Johans is committed to providing personalized care tailored to meet his patients’ needs and effective treatment options to achieve maximum relief from discomfort. Patients can trust that Dr. Johans with over 30 years of experience in neurological surgery and pain management treatments, will provide the highest standard of care available so they can get back on track with life as quickly as possible!

When Is Surgery Necessary?

Surgery Goals

Surgery Risks

Post Op Instructions

What is an EMG nerve study?