What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome (CTS) is the most commonly diagnosed and treated entrapment neuropathy. The syndrome is characterized by pain, numbness, and weakness in the 'median nerve distribution' of the hand. The median nerve, which runs from forearm into the hand, controls sensations to the palm side of the thumb and fingers (although not the little finger). It also sends impulses to some small muscles in the hand that allow the fingers and thumb to move.
The carpal tunnel - a narrow, rigid passageway of ligament and bones at the base of the hand - houses the median nerve and tendons. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed resulting in the symptoms mentioned above. Although it has often been associated with previous trauma of the wrist, it is also common in late middle aged women, pregnancy, certain medical diseases like Hypothyroidism, and Diabetes. A new risk group has been identified in industrial workers whose hands and wrists are subjected to repetitive motion and trauma.
When Do you need a Surgical Intervention?
Carpal tunnel release is one of the most common surgical procedures in the United States. According to the American Academy of Orthopaedic Surgeons guidelines, surgical treatment is used after all other types of therapy have been utilized and exhausted or the patient elects to proceed directly to surgical treatment. Surgery is generally recommended if symptoms last for 6 months or if other treatments fail to resolve the symptoms within 2-7 weeks.
What is Carpal Tunnel Surgery?
Most common types of surgery for CTS are Open carpal tunnel release and Endoscopic carpal tunnel release. Both being often simple surgeries where the patient goes home the same day in some cases.
Open carpal tunnel release
General, regional, or local anesthesia can be used for the procedure. Surgery is performed with a tourniquet inflated around the arm to control bleeding in the operative field. A vertical incision of around two inches is made in the lower half of the palm of the hand. Next steps involve severing the band of tissue around the wrist to reduce pressure on the median nerve. Prior to closure, the tourniquet is deflated and the field is checked for bleeding which is controlled. No deep sutures are used. The skin is then sutured closed . A soft, sterile dressing is applied. The procedure is generally done under local anesthesia on an outpatient basis, unless there are unusual medical considerations.
Endoscopic carpal tunnel release
Endoscopic surgery may allow faster functional recovery and less postoperative discomfort than traditional 'open' surgery. However, the general consensus among surgeons is that it has a slightly higher risk of nerve injury. The surgeon makes two incisions (about 1/2 an inch each) in the wrist and palm, inserts a camera attached to a tube, observes the tissue on a screen, and cuts the carpal ligament (the tissue that holds joints together). This two-portal endoscopic surgery, generally performed under local anesthesia, is effective and minimizes scarring and scar tenderness, if any. One-portal endoscopic surgery for carpal tunnel syndrome is also available.
What to Expect after Carpal Tunnel Surgery
Although symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery can take months. However, lasting relief from pain and numbness can be expected in more than 90 percent of patients with carpal tunnel syndrome who are treated with open or endoscopic carpal tunnel release; patient satisfaction is often high. As with any other surgery, the risk of infection is there although quite low. Other complications include stiffness, nerve damage, and pain at the scar. Appropriate antibiotics for the infection, physical therapy to restore wrist strength, and time help alleviate most of these problems. In extreme cases, some patients may need to adjust job duties or even change jobs after recovery from surgery. The endoscopic technique is associated with a shorter interval before the patient returns to work and with less incisional pain. Recurrence of carpal tunnel syndrome following treatment is rare and often signifies wrong diagnosis. The majority of patients recover completely.