What Carpal Tunnel Treatment Is Right for Me?
Carpal tunnel syndrome is a condition characterized by compression of a nerve in the hand and wrist. The carpal tunnel itself is a space enclosed by a combination of bones and ligaments. Nine tendons and the median nerve travel through the carpal tunnel. The median nerve is the softest structure within the carpal tunnel. Anything that increases swelling and pressure within the tunnel can lead to compression of this nerve. It is the compression of this nerve that leads to the symptoms of carpal tunnel syndrome. The cause of increased pressure typically has many factors. It can be caused by arthritis, infection, bone spurs, cysts, injury, fracture or repetitive movement.
What are the symptoms of carpal tunnel syndrome?
Holding the wrist in certain positions can worsen the symptoms of carpal tunnel syndrome. Symptoms can include pain, numbness and tingling in the hand and wrist.
The symptoms typically involves the thumb, index finger, middle finger and ring finger. Although carpal tunnel syndrome can develop in just about anyone, it more commonly develops in women and is more common as you get older.
Symptoms can worsen at night, partially due to the position in which we sleep. Patients often awake with their hands feeling numb and tingly, sometimes requiring this to be shaken out for relief. In fact, one of the treatments to manage carpal tunnel symptoms would be to wear a splint at nighttime. The splint holds the wrist in a more natural position and decreases the pressure within the carpal tunnel.
Sometimes, symptoms can become so severe that they never really improve and become constant. Weakness and loss of muscle tissue in the hand and thumb can develop. Carpal tunnel syndrome can typically be diagnosed based on the clinical history and physical examination, though sometimes electrodiagnostic studies (EMG) are necessary for confirmation.
What treatment options are available?
There are many treatment options for patients suffering from carpal tunnel syndrome. These start with simple activity modifications, avoidance of activities that cause symptoms and anti-inflammatory medications. Additional treatments can include things such as nighttime bracing, occupational therapy and steroid injections. In cases which don’t respond to non-surgical treatment, I may discuss and recommend a standard surgical procedure known as carpal tunnel release.
A ligament is divided to give the carpal tunnel more space during a carpal tunnel release, thereby relieving pressure on the compressed median nerve. There are different techniques to accomplish this. I offer traditional open surgery and a newer and less invasive surgical option known as an endoscopic carpal tunnel release.
A small incision about a centimeter in length is made near the wrist with an endoscopic carpal tunnel release. A tiny camera is inserted into the carpal tunnel and the ligament is divided. It is an outpatient surgery,” and patients go home the same day, usually within a few hours of arrival. The surgery takes approximately 15 minutes, and I have received specialized training to perform this cutting-edge procedure.
What can I expect after surgery?
Patients often recover more quickly and return to work sooner with an endoscopic carpal tunnel release than the more traditional open release. The incision is smaller and is located a distance away from the ligament division, leading to less pain, less scarring and quicker recovery.
After surgery, you will have two stitches and a soft dressing on the hand. This allows for immediate and unrestricted range of motion to protect the incision until it is healed.
When should I consult a doctor?
Please make an appointment with me if you feel you are experiencing symptoms of carpal tunnel syndrome or need more information regarding endoscopic carpal tunnel surgery. I see patients at several locations. I have an office at Ochsner Baptist, Old Jefferson at Ochsner Main Campus and Slidell at Ochsner Northshore.