Carpal Tunnel Syndrome is a common, painful, progressive condition that is caused by compression of the median nerve at the wrist area. Common symptoms of carpal tunnel syndrome include numbness and tingling sensation in all the fingers except little finger; pain and burning sensation in hand and wrist that may radiate up the arm and elbow; and weakness in hand with diminished grip strength Exact causes of the condition are not known. However certain factors increase the risk of developing carpal tunnel syndrome and they include congenital abnormalities, repetitive motion of hand and wrists, fractures and sprains, hormonal imbalance, and other medical conditions such as hypothyroidism, rheumatoid arthritis, diabetes, obesity, gout, overactive pituitary gland, or the presence of a cyst or tumour in the canal.
Carpal tunnel syndrome may be treated by conservative approaches or surgery. The conservative treatments include:
- Treating underlying medical conditions
- Immobilization of the hand and wrist with a splint or wrist brace for 4-6 weeks
- Rest the hand for 2 weeks or more
- Ice packs to avoid swelling
- Avoid activities that tend to worsen the symptoms
- Medications such as non-steroidal anti-inflammatory drugs, diuretics, and steroid injections.
- Strengthening and stretching exercises once symptoms diminish
If conservative treatment options fail to resolve the condition, your surgeon may recommend surgical procedure.
Carpal Tunnel Release Surgery
Carpal tunnel syndrome can be treated with carpal tunnel release surgery. Traditional surgery involves up to a 2- inch incision in the palm and wrist area, whereas endoscopic surgery involves one or two half-an-inch incisions and the use of an endoscope. During the surgery, the transverse carpal ligament will be dissected to release the pressure on the median nerve and enlarge the carpal tunnel. Your surgeon will decide which options are best for you based on your general and medical conditions.
In endoscopic surgery a thin, flexible tube with a camera (endoscope) attached is to its end is employed. In single-portal technique a small incision is made in the wrist while in two-portal technique two incisions are made, one each at the wrist and palm. The endoscope is inserted through the small incision and helps the doctor visualize the internal structures at the wrist such as the transverse carpal ligament avoiding the need for a large incision.
When the ligament is located, a tiny cutting tool is employed to release the ligament. In the single-portal technique, a single small tube contains both the camera and the cutting tool, whereas in two-portal technique the camera and cutting tool are inserted through different incisions. After insertion of the cutting tools through the respective incisions, the transverse carpal ligament is cut. This releases the pressure on the median nerve and alleviates the symptoms of carpal tunnel syndrome.
The small incisions are closed with stitches. The ligament will heal with the development of scar tissue around the cut ends.
Patient having carpal tunnel release surgery can be discharged home the same day.
Your surgeon will suggest certain post-operative procedures for a better recovery and to avoid complications.
- Elevate the hand above heart level to reduce swelling
- A splint may be worn
- Ice packs to the surgical area to reduce swelling
- Keep the surgical incision clean and dry; cover the area with plastic wrap when bathing or showering
- Physical therapy may be ordered to restore wrist strength
- Eating a healthy diet and not smoking will promote healing
The majority of patients do not suffer any complications following carpal tunnel release surgery but as with any surgery, complications can occur and can include continued pain, infections, scarring, and nerve damage causing weakness, paralysis, or loss of sensation and stiffness in the hand and wrist area.