Carpal Tunnel Syndrome
About Carpal Tunnel Syndrome
Bounded by bones and ligaments, the carpal tunnel is a narrow
passageway on the palm side of the wrist. This tunnel protects a main
nerve (the median nerve) to the hand and nine tendons that bend the
fingers. Pressure placed on the nerve produces the numbness, tingling,
pain and, eventually, hand weakness that characterize carpal tunnel
syndrome.
Treatment of Carpal Tunnel SyndromeNew England Hand Associates specialists have extensive experience caring for carpal tunnel
syndrome (CTS). Teams
of medical specialists including orthopedic surgeons, plastic surgeons,
neurosurgeons, and neurologists carefully diagnose and determine the
proper treatment for the stage of carpal tunnel syndrome the patient is
experiencing.
Diagnosis
A physical examination by the doctor is often sufficient to identify
the presence of carpal tunnel syndrome. Nerve tests can confirm the
diagnosis or rule out other causes for the problem.
Treatment Options
The goal of treatment for CTS is to reduce the swelling and pressure
on the median nerve. Fortunately for most people who develop carpal
tunnel syndrome, proper treatment usually can relieve pain, numbness
and tingling, and restore normal function of the wrist and hand.
Treatment may include the use of splints or braces, anti-inflammatory
medications, cortisone injections or surgery.
Surgery
Carpal tunnel release is one of the most common surgical procedures in the United States. Generally recommended if symptoms last for 6 months, surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve. Surgery is done under local anesthesia and does not require an overnight hospital stay. Many patients require surgery on both hands. The following are types of carpal tunnel release surgery:
Open release surgery, the traditional procedure used to correct carpal tunnel syndrome, consists of making an incision up to 2 inches in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel. The procedure is generally done under local anesthesia on an outpatient basis, unless there are unusual medical considerations.
Endoscopic surgery may allow faster functional recovery and less postoperative discomfort than traditional open release surgery. The surgeon makes two incisions (about ½" 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.
Although symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery can take months. Some patients may have infection, nerve damage, stiffness, and pain at the scar. Occasionally the wrist loses strength because the carpal ligament is cut. Patients should undergo physical therapy after surgery to restore wrist strength. Some patients may need to adjust job duties or even change jobs after recovery from surgery.
Recurrence of carpal tunnel syndrome following treatment is rare. The majority of patients recover completely.
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