Carpal Tunnel Syndrome & Surgery

The compression of the median nerve, a key nerve in the wrist, causes a painful and progressive condition known as carpal tunnel syndrome. The syndrome can be corrected by the release of pressure on the carpal tunnel. A well-known medical procedure in the U.S. is carpal tunnel release surgery. According to the American Society for Surgery of the Hand, severe cases of carpal tunnel symptoms may not go away completely after surgery.

Symptoms

• Symptoms for carpal tunnel syndrome progress gradually and can include tingling, burning or numbness in the fingers and palm of the hand. Fingers can also feel swollen and useless. There may also be a decrease in grip strength, making it hard to grasp small items or make a fist. If untreated or chronic, muscles may waste away at the bottom of the thumb. If the symptoms progress, surgery may be suggested to correct the nerve damage.

Diagnosis

• An examination of the shoulders, neck, arms and hands can assist in determining if the condition is carpal tunnel syndrome. There are specific tests (Tinel's and Phalen's) used to determine if carpal tunnel syndrome is present. Electrodiagnostic tests, used in nerve conduction studies, can also determine if the syndrome is present. Once diagnosed, a person should seek treatment. Surgery may be the only option if there is extensive nerve damage.

Treatment

• The first way carpal tunnel syndrome can be treated is to rest the wrist and hand for approximately two weeks to make sure the condition does not worsen. If this treatment does not help, a physician may first try non-surgical treatments, but
  surgical treatments are the most common.

Non-surgical Treatments

• A doctor may try one of three non-surgical treatments: drugs, exercise or alternative therapies. Various drugs can release the swelling and relieve the pain associated with carpal tunnel syndrome. Aspirin, ibuprofen or any other nonprescription pain relievers might ease short-term symptoms. Diuretics (water pills) can decrease swelling, and corticosteroids (prednisone) can be taken by mouth or injected directly into the wrist to relieve median nerve pressure.

  Corticosteroids should not be taken without a physician's prescription. Strengthening and stretching exercises may be helpful if a person's symptoms are lessened. Chiropractic care and acupuncture are alternative therapies that may also be effective non-surgical treatments.

Surgical Treatments

• For symptoms lasting for six months or longer, surgery is recommended. This process involves releasing the pressure on the median nerve by cutting the band of tissue around the wrist. There are two types of surgery options used for carpal tunnel release: open release surgery and endoscopic surgery.

  Open release surgery is the traditional process used to improve or correct carpal tunnel syndrome. It is done by making a slit or cut of up to 2 inches in the wrist to enlarge the carpal tunnel by cutting the carpal ligament. Generally the open release surgery is performed as an outpatient procedure and under local anesthesia, with the exception of unusual medical considerations.

  In endoscopic surgery, the surgeon makes two half-inch incisions in the palm and wrist. A camera attached to a tube is then inserted and used to observe the tissue and cut the carpal ligament. The endoscopic surgery may cause less discomfort and faster functional recovery than the open release surgery. This procedure reduces scarring and is also performed under local anesthesia.