Carpal tunnel syndrome is the compression of the median nerve as it passes through the “carpal tunnel” causing symptoms of numbness and tingling in the hand and fingers
The carpal tunnel is a narrow passageway in the wrist, about an inch wide. The floor and walls of the tunnel are formed by small wrist bones called carpal bones. The carpal tunnel contains the median nerve and flexor tendons that bend the fingers and thumb.
- numbness and tingling in the hand including the thumb, index, and long finger
- wrist pain
- awakening at night with numbness
- hand weakness
A thorough history and physical is the most important diagnostic tool. However, sometimes finding the source of numbness may require an EMG, which is a nerve conduction study completed by a specially trained physician.
Conservative management may include the use splints, therapy, anti inflammatory medications possibly including a steroid injection.
Surgical intervention is usually successful in alleviating symptoms. Operations can either be done “open” or endoscopically. Open carpal tunnel release can be either done under full anesthesia, sedation, or under local anesthesia. Endoscopic carpal tunnel release is done under general anesthesia or with a combination of sedation and local anesthesia.
Open carpal tunnel operations have the advantage of direct visualization of the underlying structures, the possibility of using only local anesthesia, and the ability to assess for the rare anatomic variant. The dressing is more bulky than that of an endoscopic release and must remain dry until removal.
The advantages of the endoscopic carpal tunnel release include less pain, faster return to activities and work, and the use of less pain medication. Teton Hand Surgery patients will also have a very small waterproof dressing applied and usually no sutures to remove. Often patients with symptoms on both sides will have them operated on simultaneously.
All revision carpal tunnel operations are done under general anesthesia as the operation may be prolonged and tedious. Nerves are freed of any adherent scar tissue and protected with a collagen wrap to prevent future scarring.
The recurrence rate following carpal tunnel release is around 4% and in revision cases its is closer to 25% of patients that have improved to baseline following their operation.