Angie Holmes is a self-proclaimed gorilla waitress at the Fort Worth Zoo. The 40-year-old has taken care of some of the zoo’s largest residents for 15 years. It’s a physically demanding job that Angie loves. She gets to feed, clean, train and even move gorillas from area to area within the facility.
The work requires that Angie have good upper body and hand strength to open 60-70 lb. doors and lift heavy bales of hay, among other things. The demands of the job weren’t something Angie gave much thought to until she started experiencing burning and tingling in her right hand. It became an issue in managing the gorillas and when she slept. Soon, activities of daily living were also impacted.
“It was things like eating, going out with friends and having my arm at a certain level; my hand would fall asleep mid-meal,” Angie says.
She sought the help of Timothy Niacaris, M.D., an orthopedic hand surgeon at Texas Health Hand & Upper Extremity Specialists, a Texas Health Physicians Group practice in Arlington. After a thorough evaluation and nerve conduction testing, Niacaris discovered the culprit.
“She had findings very similar to many patients with carpal and cubital tunnel syndrome,” he explains. “One of the signs we look for is irritability of the nerve that we can tell by tapping it. This is similar to what happens when you hit your funny bone, but these patients have a much more pronounced response to this.”
Carpal tunnel syndrome occurs when the nerve that runs from the forearm into the palm of the hand becomes pressed or squeezed at the wrist. If left untreated, the muscles at the base of the thumb may shrink and waste away. Some people with severe cases of carpal tunnel syndrome may not be able to determine between hot and cold by touch, leading to burns on their hands. Cubital tunnel syndrome is a similar nerve compression syndrome that occurs in the elbow region. Angie was diagnosed with both disorders.
The Road Back to Zoo Keeping
The first course of treatment was for Angie to wear a splint at night while she slept, but the non-operative treatment only provided temporary relief. Surgery was needed on both her right wrist and elbow. Angie decided to have the two procedures done at the same time.
“One of the things she was very interested in was the fact that I offer an endoscopic minimally invasive carpal tunnel surgery,” Niacaris says. “The reason this was important to her at the time was that she really wanted to get back to work as soon as possible.”
The endoscopic approach to Angie’s hand surgery meant only a small incision needed to be made at the wrist through which a camera was inserted to provide a clear view of the issue. In Angie’s case, the ligament that was pressing on the nerve in her wrist was cut to release the pressure and promote blood flow to the area. A fairly similar technique was used to treat the compressed nerve in Angie’s elbow.
The endoscopic procedures allowed Angie to regain function in her wrist quickly with minimal postoperative pain. The only “rule” Niacaris had for her during her recovery was to refrain from picking up anything heavier than a coffee cup for at least the first week.
Although it wasn’t required, Angie chose to do occupational therapy on her hand to increase her grip strength and help move her recovery along so she could get back to the business of gorilla keeping.
“My life now is great; I’m back with the animals,” Angie happily reports. “I’m able to be fully engaged in all of their care. With driving, it’s not uncomfortable anymore. I can go on road trips and not have my hand fall asleep. I bring groceries in; my husband loves it.I can do it myself.”
“I would definitely recommend Dr. Niacaris and Texas Health Hand & Upper Extremity Specialists. They changed my life. He’s an amazing doctor. He listened to what I had to say and we made a plan together. His staff was super helpful. The future looks bright,” she adds.
Experiencing numbness or tingling in your upper extremities? Find a hand specialist that can assist with your nerve pain.