Education: Carpal Tunnel Syndrome
Carpal tunnel syndrome is the result of compression of the median
nerve as it travels through the wrist to the hand. The tunnel is composed
of the bones of the wrist that form a “U” shape, and a
tight ligament that makes up the roof. There is little extra room
in this tunnel and any pressure will squeeze down on the nerve. Without
definitive treatment, the nerve slowly dies causing progressive and
permanent loss of feeling in the fingers and muscle control of the
thumb. The symptoms include numbness and tingling in the hand and
a sense of loss of circulation. These symptoms may increase with holding
a car steering wheel, reading a book or newspaper or even holding
on to bus or subway pole.
Non surgical treatment consists
of splinting and when indicated, a cortisone injection. If symptoms
do not improve, surgery is indicated. The right hand shown in this
picture underwent minimal incision open technique four weeks ago.
The incision is placed in a natural skin crease to improve the cosmetic
effect. The usual procedure is done as an out patient under local
anesthesia. The operation may take less than 15 minutes. A post operative
bandage and splint is worn for one week. The stitches dissolve on
their own and do not require removal. While many patients can return
to work rather soon, for some the healing response in the palm causes
pain that limits gripping activities for a number of weeks.
While this procedure is straightforward, it is not risk free. Complications
overall are infrequent but real and include delayed healing, prolonged
stiffness, injury to neurovascular structures, need for surgery and
failure to improve because of underlying nerve damage. Before considering
surgery it is important to have a full and frank discussion with the
surgeon to review the risks benefits and expectations of the procedure.
There are several surgical techniques. It has been suggested that
endoscopic surgery has a faster recovery. Critics argue that there
is less visualization of the nerve with greater chance of injury to
the nerve at surgery. The procedure takes longer. In the end the functional
result is not better and the cosmetic result is also no better than
the newer minimal open techniques.