Carpal tunnel syndrome is a condition brought on by increased pressure or a pinched nerve at the wrist. Symptoms may include numbness, tingling, and pain in the arm, hand, and fingers. There is a space in the wrist called the carpal tunnel where the median nerve and nine tendons pass from the forearm into the hand. Carpal tunnel syndrome happens when pressure builds up from swelling in this tunnel and puts pressure on the nerve. When the pressure from the swelling becomes great enough to disturb the way the nerve works, numbness, tingling, and pain may be felt in the hand and fingers.

WHAT CAUSES IT?

Diagnosis - A detailed history including medical conditions, how the hands have been used, and whether there were any prior injuries is important. An X-ray may be taken to check for other causes of the complaints such as arthritis or a fracture. In some cases, laboratory tests may be done if there is a suspected medical condition that is associated with CTS. An NCV or nerve conduction study and EMG or electromyogram may be done to check for other sites of nerve problems as well as to evaluate the carpal tunnel.

SIGNS & SYMPTOMS

Carpal tunnel syndrome symptoms usually are pain, numbness, tingling, or a combination of the three. The numbness or tingling most often take place in the thumb, index, middle, and ring fingers. The symptoms usually are felt during the night but also may be noticed during daily activities such as driving or reading the newspaper. Patients sometimes notice they have a weaker grip, occasional clumsiness, and may drop things. In severe cases, sensation may be permanently lost and the muscles at the base of the thumb slowly shrink (thenar atrophy).

TREATMENT:

Symptoms can often be relieved without surgery. Identifying and treating medical conditions, changing the patterns of hand use, or keeping the wrist splinted in a straight position may help reduce pressure on the nerve. Wearing wrist splints at night may relieve the symptoms that interfere with sleep. Anti-inflammatory medication taken by mouth or injected into the carpal tunnel may help relieve the carpal tunnel symptoms.

When symptoms are severe or do not improve, surgery may be needed to make more room for the nerve. Pressure on the nerve is decreased by cutting the ligament which forms the roof (top) of the tunnel on the palm side of the hand. Incisions for this surgery may vary, but the goal is the same - to enlarge the tunnel and decrease pressure on the nerve. Following surgery, soreness around the incision may last for several weeks or months. The numbness and tingling may disappear quickly or slowly. It may take several months for strength in the hand and wrist to return to normal. Carpal tunnel symptoms may not completely go away after surgery, especially in severe cases.

ENDOSCOPIC SURGERY TREATMENT:

A new endoscopic procedure is now available as an alternative to traditional open carpal tunnel surgery. The procedure is performed using a device called the Carpal Tunnel Release System. It allows the release of the carpal ligament through a small incision at the base of the wrist. A small endoscope and camera project an "inside view" of the carpal tunnel onto a video monitor. The surgeon watches the screen and is able to precisely cut the ligament with a blade, simply by pulling the trigger.

BENEFITS:

What are the Benefits of Endoscopic Surgery vs. Traditional Open Surgery? "Open" carpal tunnel release has been performed for many years and has proven to be very effective in the treatment of CTS.

The MicroAire Endoscopic method, has been performed successfully in thousands of cases and is also effective in treating CTS.

The primary benefit of endoscopic surgery vs. open surgery is a significantly shortened recovery period. While individual results may vary, most patients return to normal daily activities within days after endoscopic surgery and return to work earlier than those who undergo the open method. Recovery of hand strength following open surgery can takes weeks or even months while the palm heals.

There is also less pain and scarring with the MicroAire endoscopic procedure. Only a very small scar, concealed in a wrist crease, remains after healing.

WHAT CAN I EXPECT AFTER SURGERY?

With either open or endoscopic surgery, the incision will be sutured. Your wrist and hand will be dressed, and gentle hand exercises will begin soon after surgery.

The time it takes before you can resume normal activities and return to work will vary with each individual. This is a decision that should be made in consultation with your doctor.

DISCUSSING YOUR OPTIONS:

If you need carpal tunnel surgery, Dr. Hainer will help you make an informed decision by explaining your surgical options and the risks associated with both the open and endoscopic procedures. If you choose the endoscopic procedure, Dr. Hainer will also explain that there is a very small chance the procedure would have to be converted to the open method.