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.