Carpal Tunnel Syndrome
Carpal tunnel syndrome is a condition that causes weakness, pain, and numbness in the hand and wrist. My patients often describe worsening of symptoms when driving a car, reading the newspaper, or holding a telephone. These symptoms are also worse at night and often wake people up at night. This syndrome occurs because of increased pressure on the median nerve in the wrist. The pain of carpal tunnel syndrome occurs more often around the palm side of the wrist and hand and may radiate to the forearm, shoulder, and neck. The median nerve gives sensation to the fingers so many patients describe a tingling or numbness there. Many complain of dropping objects they pick up or difficulty buttoning buttons.
What is the Carpal Tunnel?
The carpal bones of the hand form a “C” shaped ring that is covered by a ligament. There are eight of these bones that vary in size and shape to make up the wrist area. This ligament and bony structures form the carpal tunnel through which the median nerve and nine tendons pass. These tendons flex the fingers and thumb. Any condition that affects the size of this tunnel can lead to carpal tunnel syndrome.
What Causes Carpal Tunnel Syndrome?
There are several factors that lead to carpal tunnel syndrome. Most commonly, it is thought that the syndrome is genetic, while repetitive, strenuous use of the hands often worsens the symptoms. Other conditions that can cause or worsen carpal tunnel syndrome include fractures, masses, severe bruising. Conditions that are associated with carpal tunnel syndrome include hypothyroidism, infections, arthritis, pregnancy, and diabetes.
How is Carpal Tunnel Syndrome Treated? The first line of treatment is non-operative. Wrist braces, activity modification and anti-inflammatories are usually the first step and can be helpful in many early cases. Surgery is often considered when you do not gain relief from these treatments. Worsening symptoms indicate a nerve at risk of permanent damage. The decision is based mostly on the severity of your symptoms and your desire to return to normal functioning. In the most severe cases, surgery is done much sooner because the other treatment options are not likely to help. Also, long-standing cases often require surgery when the disease has resulted in constant numbness and wasting of the thumb and finger muscles.
Carpal tunnel release surgery is one of the most common operations performed on the upper extremity and is among the safest and successful surgeries I perform. During the surgery, I will make a small cut in the palm of your hand. This will allow me to see the transverse carpal ligament of the carpal tunnel and divide this structure to increase the size of the tunnel and decrease the pressure placed on the median nerve. Once this is done, I close the skin and the ligament will start to heal and grow across the divided area. This new growth actually heals the ligament and more space is available for the nerve and flexor tendons. Once this is done, the skin is sutured and a sterile bandage is applied. The sutures will need to be removed in seven to ten days.
The endoscopic method for carpal tunnel release allows me to visualize the ligament with a small camera and the procedure results in a more speedy recovery. Other benefits of this procedure are less postoperative pain, earlier return to work, and earlier return of grip strength.
What Should I Expect during Recovery?
Immediately following your carpal tunnel release surgery, you will be instructed to frequently elevate your hand above your heart and move your fingers as well. This is done to prevent stiffness and reduce swelling. There is some pain, swelling and stiffness to be expected after the surgical repair. The dressing is removed in 3-5 days and normal use of the hand is allowed once you are comfortable. Minor soreness of the palm region is common but reliably improves over time.
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