Compression of the median nerve at the wrist causes Carpal Tunnel Syndrome (CTS) . A patient with CTS will experience symptoms of numbness, tingling, weakness, and discomfort in the wrist and hand. Typically, CTS is caused by overuse of the tendons in the wrist. Repetitive motion causes irritation, swelling and added pressure to the wrist tendons.
Initial treatment for carpal tunnel syndrome usually involves wearing a splint on the wrist to minimize wrist movement. Continued overuse of the affected tendons should be discontinued through frequent breaks when performing repetitive activities. Proper posturing of the wrist joint should be incorporated in everyday tasks such as typing and computer work.
By adapting to an ergonically designed work station, pressure on the affected tendons may be minimized or eliminated. Specific exercises and stretches may also be recommended to increase flexibility in the wrist and fingers. To reduce swelling and relieve symptoms, nonsteroidal anti-inflammatory medication or an anti-inflammatory injection into the carpal canal may be recommended.
A carpal tunnel release may be necessary for patients who continue to experience symptoms despite this initial treatment. Carpal tunnel release is a surgical procedure which is designed to resolve CTS on a permanent basis.
When a patient experiences extreme numbing and weakening of the hand and fingers due to CTS, a surgical procedure called carpal tunnel release may be necessary. As the name infers, this procedure "releases" the pressure in the carpal tunnel through surgical cutting of the roof of the tunnel which is a ligament called the transverse carpal ligament.
Traditional Open Carpal Tunnel Release
Outpatient surgery for carpal tunnel release involves numbing the tissue around the wrist with a local anesthetic. The incision for the surgery is a small incision through the skin and underlying tissue at the base of the palm of the hand.
With the transverse carpal ligament visible, the surgeon will cut through the ligament with sharp scissors or a scalpel. Special care is taken to limit the cut to this ligament only leaving the median nerve and tendons below the ligament intact. With the ligament cut, the pressure on the median nerve will be relieved.
The skin incision will then be closed with stitches and a soft bandage will be placed over the surgery area. For about two weeks, the bandage should be kept in place and kept clean and dry. The bandage and stitches will then be removed at a follow-up visit with your doctor.
Endoscopic Carpal Tunnel Release
A new procedure, endoscopic carpal tunnel release, is a second option for relieving the symptoms of carpal tunnel syndrome. A tiny optic camera, an endoscope, located at the end of a long tube is utilized for this procedure. The endoscope is inserted into the carpal tunnel and used to view the nerves, tendons, and blood supply and effectively cut the transverse carpal ligament internally.
For insertion of the endoscope, an incision is made and a cannula is inserted in the wrist up into the hand. The cannula, a piece of plastic tubing, serves as a tunnel for the endoscope. The surgeon will then insert a hook-shaped knife through the cannula, place it precisely for accurate cutting, and then pull it back through a slit in the side of the cannula. The ligament will be cut through this precise procedure. Protection of the nerve and blood vessels is performed by the cannula during this procedure. Upon completion of the procedure, stitches are used to close the incision and a dressing is applied to the suture area
Doctor recommendations following surgery usually include restricting use of the hand and wrist for several weeks. The patient will notice the pain and tingling begin to disappear soon after surgery. The incision area may remain sore for several months as the tissues of the surgery site continue to heal. A recommendation of hand therapy performed under the guidance of a physical or occupational therapist may be made. Adherance to the recommendations of the doctor and therapist following the procedure is necessary to ensure proper recovery.
Patients are typically able to return to work within a few days and resume most recreational activities within 3-4 weeks.
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