Carpal Tunnel Syndrome

A Guide to Choosing the Right Treatment

 What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome is an abnormal compression of the median nerve as it passes through an enclosed space in your wrist (the “Carpal Tunnel”).

The median nerve is responsible for sensation in your thumb, index finger, middle finger, and part of your ring finger. It also controls the muscles at the base of your thumb.

What are the Symptoms of Carpal Tunnel Syndrome?

The symptoms of carpal tunnel include wrist and hand pain, night pain, numbness in the thumb, index finger, middle finger, and ring finger, as well as thumb weakness.

What Causes Carpal Tunnel Syndrome (CTS)?

For most patients, the cause of Carpal Tunnel Syndrome is unknown.

It has long been thought that repetitive motions such as typing lead to CTS. While this is debatable, people who frequently use their hands for work certainly may notice the symptoms more frequently.

Other risk factors for CTS include diabetes, pregnancy, obesity, hypothyroidism, and smoking.

Nonoperative Treatment

Night-Bracing

For many patients, Carpal Tunnel Syndrome can be treated nonoperatively.

The mainstay of nonoperative treatment is night-bracing. At night, most people unintentionally sleep with their wrist flexed, putting extra pressure on their median nerve. Bracing keeps the wrist straight overnight and can relieve night-time pain and even daytime symptoms.

Dr. Shulman’s team performs brace fittings in the office.

Injections

Patients with mild or recently developed symptoms can also benefit from a local injection of steroid into the carpal tunnel. Steroid injections may not be indicated for patients with advanced disease.

Wrist_brace.jpg

Operative Treatment

When conservative measures fail, or when patients present with advanced disease, a surgical release of the carpal tunnel is indicated. All surgeries for carpal tunnel syndrome rely on the same principle: decreasing pressure on the median nerve by incising a tight band of tissue overlying the median nerve known as the Transverse Carpal Ligament.

Types of Carpal Tunnel Release Surgery

Wide Awake Mini-Open Carpal Tunnel Release (WALANT Technique):

  • What is WALANT (Wide Awake Local Anesthesia No Tourniquet)?

    • Patients receive an injection of numbing medicine instead of general anesthesia

    • Standard carpal tunnel release performed though 2-3cm incision in palm

  • Benefits of WALANT:

    • No need for anesthesia, IVs, preoperative antibiotics, preoperative clearance

    • Patients can drive themselves home

    • Can eat and drink normally – no preoperative fasting necessary

  • What to expect after surgery:

    • Hand based soft dressing for 3 days

    • After 3 days, bandages removed and patients can wash hand and shower

    • Can return to everyday tasks immediately, limit heavy lifting for 10 days

    • Sutures removed 10-14 days after surgery

Endoscopic Carpal Tunnel Release

  • What is an Endoscopic Carpal Tunnel Release?

    • Surgery performed beneath the skin through a 1cm incision in the wrist crease

    • A camera is used to visualize anatomic structures and perform the surgery

  • Benefits of Endoscopic Surgery:

    • No dressings- can get incision wet immediately

    • Can perform a release on one arm or bilaterally

  • What to expect after surgery:

    • “Liquid Band-Aid” Plastic Surgery style closure – no sutures or dressings

    • Immediate return to normal activity

    • Postoperative visit 7-10 days after surgery

 
 
comparison CTR.jpg