Carpal tunnel release
What is carpal tunnel release?
Carpal tunnel syndrome involves numbness, tingling, pain or weakening of the hand due to a compressed nerve in the carpal tunnel, located on the palm side of the wrist. The symptoms of carpal tunnel are usually caused by repetitive motions of the hand and wrist, pregnancy, and some illnesses such as diabetes, hypothyroidism and arthritis.
The symptoms usually occur in all fingers but the pinky. This is a good indication that what you are experiencing is carpal tunnel syndrome. The pain can come and go at first, but as the condition worsens, it may become constant and radiate up the forearm into the shoulder area. If left untreated, carpal tunnel can cause weakness of the muscle on the thumb side of the hand, limiting range of motion.
Our physicians use a limited incision approach to treat carpal tunnel syndrome. The limited incision approach requires a much smaller incision when compared to traditional carpal tunnel release, allowing for less pain, faster recovery and less scarring.
What to expect
During the consultation with your physician, your hand will be examined and may require additional studies, such as:
- EMG – Electromyography (EMG) is a diagnostic test performed by a neurologist to assess the health of the muscles and nerve cells that control them. EMG results show nerve dysfunction, muscle dysfunction or problems with nerve-to-muscle signal transmission.
- Nerve conduction study – Also called a nerve conduction velocity test, a nerve conduction study measures the speed at which an electrical impulse is conducted through a nerve. This test can determine the extent of nerve damage. Nerve conduction study is usually conducted by a neurologist.
After physical examination and evaluation of the results of the diagnostic tests, your doctor will recommend a course of treatment, which may include a nonsurgical or surgical approach.
Nonsurgical treatment options are always explored first. These may include:
- Splinting – During periods of pain, wearing a splint and avoiding too much stress on the jointmay be enough to provide relief.
- Steroid injection – Used to minimize inflammation and manage pain, steroid injections usually take approximately 4 weeks to take effect.
- Hand therapy – Performed in conjunction with a hand therapist, hand therapy will include nerve gliding exercises and other modalities that will relieve symptoms.
Surgical treatments for carpal tunnel syndrome are simple and are usually done under local anesthesia with minor sedation in an outpatient setting.
- Open surgery - Duringopen carpal tunnel release surgery, an incision is made at the base of the palm of the hand and the transverse carpal ligament is cut, releasing pressure on the median nerve and relieving symptoms. Our surgeons specialize in limited carpal tunnel release surgery, which requires a smaller incision when compared to traditional carpal tunnel release, causing less pain and scarring and allowing for faster recovery.
- Endoscopic surgery - The incisions and surgical tools used inendoscopic surgery are very small. A small camera is also placed inside the incisions to guide the cutting of the transverse carpal ligament to release pressure on the median nerve.
Risks are rare with carpal tunnel release surgery and may include:
- Return of the pain
- Limited hand strength
- Nerve damage (occurs less than 1 percent of the time)
After carpal tunnel release surgery, your hand will be bandaged. The pain may disappear immediately or it may take a few weeks. You will need to return to your surgeon’s office within 10-14 days to have your stitches removed. While bandaged, you may use your hand for light activity. You will most likely be given exercises to do at home and you will gradually be able to increase the use of your hand.
How much improvement a patient gets after surgery is directly related to the severity of the carpal tunnel syndrome before surgery. Patients with milder and intermittent symptoms often get complete recovery. Patients who have had carpal tunnel syndrome for years or who have constant numbness, tingling and pain often have incomplete improvement after surgery, because the nerve has developed permanent damage. This is a strong reason to get treated early and not to let carpal tunnel syndrome become severe.