What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome (CTS) is a condition that occurs due to compression of the median nerve at the wrist. It is like a pinched nerve at the wrist. Symptoms may include pain, numbness, and tingling in the arm, wrist, hand and fingers. The carpal tunnel in the wrist is where nine tendons and the median nerve pass from the forearm into the hand. Swelling in the carpal tunnel becomes great enough that it affects how the median nerve works and in turn, causes the symptoms described above.
What causes Carpal Tunnel Syndrome?
Often the cause of carpal tunnel syndrome is multi-factorial. There are several causes for pressure on the nerve: joint dislocations, fractures and arthritis can narrow the carpal tunnel; swelling of the lining of the flexor tendons; as well as keeping the wrist in a bent position for a long period of time. Patients who are pregnant also get symptoms of CTS due to fluid retention from the pregnancy. However, often times the symptoms go away after delivery. Some medical conditions can predispose a person to CTS: diabetes, rheumatoid arthritis and thyroid disease.
What are the signs and symptoms of CTS?
Carpal Tunnel Syndrome symptoms usually include numbness, tingling, and/or pain of the arm, hand and wrist. The thumb, index, long and ring fingers often experience the numbness and tingling. Patients will often experience these symptoms during the night but can sometimes notice them during daily activities. Clumsiness, weaker grip, and a tendency to drop things can result. Sensation may be permanently lost in severe cases and progressive loss of the thumb muscles can occur. As with all medical conditions, these signs and symptoms may vary between patients.
Diagnosis of Carpal Tunnel Syndrome:
A detailed history from the patient is very important in the diagnosis of CTS. It is important to find out the patient’s medical history, how they use their hands and whether they have had any injuries in the past. To confirm the diagnosis, an electromyography (EMG) and nerve conduction study (NCV) may be done.
What are the Treatment Options?
Conservative Treatment (without surgery): Reducing activities that cause continuous exertion or repetitive use of your hands, or keeping the wrist in a neutral position may help reduce the swelling within the carpal tunnel and relieve pressure from the nerve area. Wearing wrist splints at night may relieve the symptoms and accommodate a better night's rest. Anti-inflammatory medication taken orally or injected into the carpal tunnel may help reduce the swelling and relieve symptoms.
Surgical Treatments: When symptoms are severe or do not improve with non-surgical treatments, surgery may be elected to enlarge the carpal tunnel by cutting (releasing) the ligament to allow more room for the median nerve. Traditional Open Surgery In this procedure, an incision made through layers of skin, fat, fascia, and muscle, to identify and divide the transverse carpal ligament. During traditional open carpal tunnel surgery, the ligament is exposed through the palm and then cut by the surgeon
Endoscopic Surgery
A new endoscopic procedure is now available as an alternative to traditional open carpal tunnel surgery. The procedure is performed using a device called the MicroAire Carpal Tunnel Release System. It allows the release of the carpal ligament through a small incision at the base of the wrist. A small endoscope and camera project an "inside view" of the carpal tunnel onto a video monitor. The surgeon watches the screen and is able to precisely cut the ligament with a blade, simply by pulling a trigger. During small-incision endoscopic carpal tunnel surgery, the ligament is released without having to cut through the skin and muscles of the palm. Both open and endoscopic carpal tunnel surgery have the same goal-to ease pressure on the median nerve by dividing the ligament and enlarging the carpal tunnel.
What are the Benefits of Endoscopic Surgery vs. Traditional Open Surgery?
"Open" carpal tunnel release has been performed for many years and has proven to be very effective in the treatment of CTS. The endoscopic method, has been performed successfully in thousands of cases and is also effective in treating CTS. The primary benefit of endoscopic surgery vs. open surgery is a significantly shortened recovery period. While individual results vary, most patients return to normal activities of daily living within days after endoscopic surgery and return to work earlier than those who undergo the open method. Recovery of hand strength following open surgery can take weeks or even months while the palm heals. There is also less pain and scarring with the endoscopic procedure. Only a very small scar, concealed in a wrist crease, remains after healing.
What Can I Expect After Surgery?
With either open or endoscopic surgery, the incision will be sutured. Your wrist and hand will be dressed, and gentle hand exercises will begin soon after surgery. The time it takes before you can resume normal activities and return to work will vary with each individual. This is a decision that should be made in consultation with your doctor.