Carpal Tunnel Syndrome:
For patients who have not been able to find relief for their carpal tunnel syndrome symptoms, surgery may be their best option. We offer a minimally invasive procedure that has been performed on thousands of patients with excellent results. Our technique involves making a very small incision at the wrist and takes approximately 10 minutes to perform. Most patients who have had this procedure are back doing their normal daily activities within two to three days.
What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is a common condition affecting the thumb and next two fingers of one or both hands. Its symptoms usually first appear as episodic tingling and numbness associated with strenuous or repetitious wrist and hand motion such as: driving a car, knitting, typing, etc. If left untreated, this syndrome can progress until the patient feels a constant numbness and generalized weakness of the hand. This makes even simple tasks, such as buttoning a shirt or opening a jar lid, increasingly difficult. Carpal tunnel syndrome often awakens the sufferer during the night with burning sensations in one or both hands.
Who Gets Carpal Tunnel Syndrome?
Anyone can get carpal tunnel syndrome, but it is often associated with jobs and hobbies requiring repeated wrist and hand activities. This commonly includes carpenters, mechanics, musicians, painters, knitters, artists and golfers. However, it may not be related to any one particular activity.
Conditions associated with carpal tunnel syndrome can also contribute to its development. These include pregnancy, arthritis, diabetes, blood vessel abnormalities, tendonitis, obesity, nerve tumors or cysts and aging.
Which Occupations Seem to be Related to Carpal Tunnel Syndrome?
Musicians, meat packers/carvers, hair stylists, barbers, typists/word processors, bank tellers, welders, tree trimmers, mechanics, carpenters, plumbers, teachers, cashiers, electricians, and many more. People whose professions require the use of tools that require a tight grasp or have vibrating parts often develop carpal tunnel syndrome.
What Causes Carpal Tunnel Syndrome?
The syndrome can be the result of continued minor injury to the wrist or the contents of the carpal tunnel. This injury leads to swelling of the contents of the tunnel, and compression of the very delicate median nerve, which is trapped in this tunnel with other less affected structures like tendons. Nerve entrapment by this pressure causes tingling and numbness, and can also lead to nerve damage.
Nerve damage, in turn, causes atrophy of the muscles the nerve controls, such as the prominent muscles at the base of the thumb. When ignored over a period of months, the nerve injury can become permanent and irreversible. Some patients are more susceptible to carpal tunnel syndrome because they are born with a smaller carpal tunnel.
How Is Carpal Tunnel Syndrome Diagnosed?
In general, carpal tunnel syndrome is a clinical diagnosis. That is, the diagnosis is made by carefully listening to the patient. In addition to the history given by the patient, a diagnostic procedure known as an EMG (Electromyogram Study) is often required. This test measures the electrical integrity of the nerve and its connection to the muscles. It will also show the degree of nerve damage, and help eliminate other possible causes for the patient's symptoms.
How Is the Syndrome Treated?
Non-operative treatment consists of anti-inflammatory agents, wrist splinting, and occasionally steroid injections into the wrist. Behavioral adjustments to lifestyle that may be augmenting symptoms are helpful in the early stages.
When non-operative treatment fails, the mainstay of treatment is the carpal tunnel release. This involves cutting the transverse carpal ligament to relieve the pressure on the nerve. This is the standard of care worldwide, and there are several different surgical approaches to achieve this goal. We choose to make a one-half inch incision in the wrist crease. We then use a specially designed instrument that allows us to reach under the ligament and cut it from beneath, preserving all other structures.
We have performed this procedure on several thousand patients. We have published our statistics in internationally recognized medical journals and our statistics are at least as good as those of surgeons who use other surgical approaches. Only two to three stitches are required to close the incision, and 24 hours later, a band-aid is the only visible evidence of surgery.
What are the Results of Carpal Tunnel Release Surgery?
Immediately after surgery, there is usually a varying degree of discomfort, which is alleviated by taking non-aspirin products and propping the wrist on pillows at night. You may use plenty of ice – more helpful than pain pills – on the days and weeks following the procedure. You may use your hand or hands as much as comfort will allow. Overdoing your hand function, however, will cause some additional soreness which is remedied by rest and ice.
One week after surgery, your sutures may be removed. By three to four weeks after surgery, most patients will have resumed all activities of daily living, including return to work.
As with any surgical procedure, there are possible complications. Why trying to get a nerve out of a tight spot, that nerve or its branches may be injured. Fortunately, this is extremely rare in carpal tunnel surgery.
Expectations after Surgery
Some symptoms resolve quickly after carpal tunnel release treatment. These include the numbness and tingling that comes and goes throughout the day and the numbness and burning that occurs at night. However, complete numbness may not resolve immediately after surgery; if sensation does return, it may take months or even years.
If you have significant atrophy or muscle loss in the thenar muscles, this too may not return. If it does, it may take years. Many of our patients have associated tendonitis and arthritis to complicate the picture. Pains and aches coming from these entities will not change.
In general, however, carpal tunnel release is one of the most successful and effective surgical procedures performed.