Carpal tunnel syndrome is a common condition that causes pain, numbness, and tingling in the hand and arm. The condition occurs when one of the major nerves to the hand — the median nerve — is squeezed or compressed as it travels through the wrist.
The anatomy of the wrist and hand is delicate, making it easy for us to develop carpal tunnel syndrome.
Any injuries, inflammation, or structural changes of the wrist can put increased pressure in the Carpal Tunnel. This compresses the Median Nerve, creating symptoms that are known as carpal tunnel syndrome.
The symptoms of this condition include:
There are many potential causes of carpal tunnel syndrome:
Confirming a diagnosis of carpal tunnel syndrome requires a doctor first obtaining a patient history and confirming the existence of the syndrome’s symptoms. An exam is then conducted to see if the symptoms can be replicated:
In most cases, electrodiagnostic tests will also be ordered. These tests include nerve conduction velocity tests (NCV) and electromyography (EMG).
The best treatment of carpal tunnel syndrome will depend on the severity of nerve compression.
In severe cases of Carpal Tunnel Syndrome, and when significant symptoms persist despite conservative treatment, surgery will be needed.
Surgery for this condition is called a Carpal Tunnel Release. In this surgery the ligament over the top of the Carpal Tunnel, called the Transverse Carpal Ligament, is cut or incised, which increases the diameter of the Carpal Tunnel by approximately 29%. This takes the pressure off the nerve and relieves the symptoms of the syndrome. The skin is then closed.
This procedure is performed on an outpatient basis, with local standby or "twilight" anesthesia. A small dressing and splint are applied. The fingers are free and the patient can perform simple activities such as dressing and eating.
The hand must remain dry for two weeks while the incision heals. There is no heavy lifting or carrying for two weeks. At two weeks postoperatively, the sutures are removed and the patient may wash the hand. They may then progressively use the hand for heavier activities. They may return to work when comfortable performing activities. This is usually before 6 weeks.
Using this standard technique, the complications are very minimal. The possible problems that may occur are complications related to anesthesia, wound healing problems or infection, failure of the sensation to completely return, and soreness in the palm known as pillar pain.
In addition to the standard surgical technique described above, there are various” endoscopic" techniques for a Carpal Tunnel Release procedure, using one or two incisions. In these techniques an incision is made, a scope is introduced into the Carpal Tunnel, and a knife is used to cut the Transverse Carpal Ligament.
The theoretical short-term advantages of these techniques are smaller incisions, faster return to work and decreased discomfort in the palm. In no cases, however, do the authors of these techniques claim any significant long-term advantage over the standard technique.
There are also some disadvantages to these techniques. Visualization of the entire Carpal Tunnel and its contents are limited. This does not allow the surgeon to address all causes for the Carpal Tunnel Syndrome. Incomplete release of the ligament is a possible side effect of the procedure. This can result in the failure of symptoms to improve or actual worsening and the need for repeat surgery. Injury or lacerations of branches of the median nerve have also been noted.
All of these above complications from endoscopic Carpal Tunnel Release done elsewhere have been treated by us. Although trained to perform both techniques, I, Dr. Bowman, am unwilling to accept the increased surgical risks with endoscopic Carpal Tunnel Release for my patients. I prefer to perform the time tested standard procedure.