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Pillar Pain
515 Plays3 months ago
Miranda and Josh delve into the topic of Pillar Pain, a common issue after carpal tunnel surgery. They discuss what it is, its causes, and their go-to treatments. Tune in for practical advice and expert tips from seasoned hand therapists!
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Transcript
Introduction to Hand Therapy Academy
00:00:06
joshmacd
Hi, I'm Josh McDonald.
00:00:08
mmateri
And I'm Rhonda Materia, and we are Hand Therapy Academy.
What is Pillar Pain?
00:00:12
joshmacd
We're going to talk today about pillar pain as a complication after carpal tunnel release um and some of the symptoms, maybe be what we do for it. So Miranda, what is pillar pain?
00:00:24
mmateri
Yeah, so um car we know carpal tunnel release procedures are one of the most common procedures formed um in the United States, that is anyways. So, um pillar pain is basically a pain that occurs after carpal tunnel. We don't really know why it occurs, but it's like a hypersensitive, um really tender pain in usually in the hypothenar and that the thenar eminence, like kind of around the borders of where that transverse carpal ligament attaches from.
Potential Causes and Pre-surgery Supplements
00:00:54
mmateri
um
00:00:54
mmateri
And so it usually is basically where you can't put weight through your hand um It can last up for nine months. You're kind of like what the heck's going on? Why they even have this surgery? um But usually it's something that will go away It's just something that is very poorly understood um by the medical community Like why does it occur? Who does it who's more likely to get it? We don't know those factors There's things that you can do to reduce reduce it um like I think there's a paper that was published, I was probably been like seven, eight years ago where they were saying, if you take an alpha lipoic prior to the surgery, which is, um, a natural supplement, that you can get over the counter. If you take that prior to surgery, it can reduce the likelihood of developing pillar
Managing Patient Expectations
00:01:35
mmateri
pain. Um, so those are, that's one thing you can do prophylactically, but what do you do after you have a patient that does have pillar pain or what are you telling your patients that have pillar pain?
00:01:46
joshmacd
Yeah. Um, first off, we try to like talk down the frustration because a lot of times, like you said, patients are like, why did I have the surgery? This is almost worse. And so we say, listen, this is a kind of a fluky thing. It's rare. It doesn't happen a ton. It's just unfortunate, but let's work on getting you out of it. So some of it's kind of like talking them down. They'll get really frustrated with the surgeon, say the surgeon did a bad job. And like, that's, that's not necessarily even how that works.
Post-surgery Scar Management Techniques
00:02:12
joshmacd
So. um So yeah, we try to do a lot of like scar management stuff, all assuming the wound from the surgery procedure is stable and closed and ready for it. ah We try to do a lot of that cross friction massage. We try to do um some of the the more surface level scar management stuff, even like the um silicone gel sheeting and some of that stuff. Even though that's not gonna help our scar below the surface, it's still useful for softening that bulk and and density that is
00:02:43
joshmacd
on the outer epidermis.
00:02:46
mmateri
Yeah, I think those are very helpful um techniques. And I think that, I think that's kind of weird with these patients too, that I thought of when you're talking is that they could have one side done and it'd be perfectly fine. And then do the other side and get the pain on that side. And you know, they say like, well, is it because of joint, and the inflammation around it is because the nerve is having a hyperactive response. that We just really don't know.
00:03:06
joshmacd
Yeah, yeah.
Exploring Myofascial Release and Ultrasound
00:03:08
joshmacd
um I'm also a big fan of myofascial release efforts to to that area um for a lot of different diagnoses, but for that as well. And so whether it's doing some work with like a tennis ball, something soft and forgiving, and doing some like loading through that, as like tennis ball on a towel at the table, hand on the tennis ball very, very lightly, and then they get to decide how much load to add to help break up some of that adhesion, um even like stretching and some of the normal like wrist extension stretching stuff just to kind of break up the fascial adhesions that are happening in there that everything's tightening around it. Maybe as a part of the diagnosis, maybe secondarily, but trying to keep that from just getting junkier and junkier.
00:03:08
mmateri
So.
00:03:50
mmateri
Yeah, that's very helpful. And I'm going to go ahead and put a dirty word out there. Um, sometimes I like to use ultrasound for this.
00:03:58
joshmacd
What?
00:03:59
joshmacd
You are not allowed to say that. I know.
00:04:00
mmateri
I know, I know, I know.
00:04:02
mmateri
No one likes it when we talk about ultrasound, but I feel like this is one thing that it actually helps with.
00:04:09
joshmacd
Yeah, yeah.
00:04:10
joshmacd
And yeah, yeah.
00:04:10
mmateri
And I know, I know everyone's going to be like, there's no research supporting it.
00:04:13
mmateri
I know, I know, but it takes like three or four minutes and I do think it helps a little bit.
00:04:19
joshmacd
I cannot remember the last time I pulled out my ultrasound machine, but there are some diagnosis that I don't get often that that is, you know, if it works and it makes patients feel better, there's no problem with pulling it out. And
Alternative Treatments and Patient Feedback
00:04:32
joshmacd
and to the people that are triggered, and I'll call triggered anytime we mention the name ultrasound sometimes honestly we just let a post happen with ultrasound just because there's so much triggering and the post looks like it does great on the instagram algorithm but think about how many things we do that don't have research around them there's no research that says ball rolling is great for wrist mobility there's no research that says that the three-way wrist
00:04:57
joshmacd
is great for strengthening, but we know those things exist, so so it's okay to do some things that maybe have the experiential benefit, but not the actual like research side, because they still have make patients feel better.
00:05:08
mmateri
Right. And yeah, and your expert opinion, right? That's like a level five.
00:05:11
joshmacd
Yeah.
00:05:12
mmateri
So it's at the bottom of the pyramid. But I do think um you know, and if the patient doesn't like it, so what you don't do it again, it's pretty harmless.
00:05:20
joshmacd
Yeah, yeah.
00:05:23
joshmacd
IASTIM is another one. Again, is there a ton of research out there? Not yet. um Negative pressure IASTIM or cupping. Again, something with not a ton of research out there on it. And that's another one that people get triggered about and like, oh, I can't believe you guys do research-based stuff. You shouldn't be mentioning cupping. Just because there isn't research yet, or because it's not supported in the research doesn't mean patients don't feel better with it. So I actually like doing cupping over on most of my carpal tunnel release patients that are still having some pain and stiffness. I
Engagement and Community Outreach
00:05:51
joshmacd
like doing it over that area because it really is this decompressive load and patients say, that feels great. So yeah, we do that a bunch.
00:05:58
mmateri
Yeah, definitely agree with those.
00:06:00
joshmacd
Yeah, yeah. So there's only so much we can do for pillar pain, range of motion, working scar tissue, maybe some myofascial stuff, fascial connective tissue, all those things. If you guys have ideas, if there's something that you just love for doing with that population, let us know in the comments below, or you can reach us at on our social media platforms, Hand Therapy Academy or info at handtherapyacademy.com.