Roger Khouri, MD is a world expert hand surgeon who has performed over 2,000 Carpal Tunnel Releases.
Many important structures traverse the carpal tunnel on their way from the forearm to the hand. In some predisposed people, the tunnel is rather narrow and slight swelling of the tendons inside this unyielding structure causes increase pressure that compresses the median nerve. This typically occurs at night when we normally accumulate fluid or after extensive use of the hand when the tendons swell.
When the nerve is compressed, the patient feels pain, tingling, pins & needles, numbness. With time, the nerve ceases to function well and the fingers become numb, the hand weak and more clumsy. Typically patients will complain that they are dropping objects from their hand or that they have trouble buttoning their clothes. When we find evidence that the nerve is not functioning normally, we recommend release of the carpal tunnel to relieve the symptoms, prevent more permanent damage and muscle loss.
To release the carpal tunnel we have to divide the transverse carpal ligament. The transverse ligament is a tough, inelastic structure that forms the roof of the tunnel. Cutting through the transverse ligament will release the built up pressure on the median nerve. There are two ways to achieve the release: The old open release and the more advanced endoscopic technique.
The endoscopic technique requires a tiny, less than 1 cm incision in the wrist. Through this tiny hole, we insert a camera and the operation is performed with the use of a large TV monitor. The camera has on its tip a tiny laser sharp blade that can simply divide the ligament without bothering any of the surrounding structures. The procedure takes less than 5 minutes, is often done under local anesthesia (with some minor sedation if needed), and leaves no scar. The patients are allowed to return to gentle use of their hand immediately after the procedure. But are warned not to use force for a month or so till the divided ligament heals in the more open position.
If your carpal tunnel symptoms are considered to be minor, a splint may be used to prevent further swelling in the wrist. The splint confines the hand to a neutral position and should be worn at night or during activities that may cause the wrist to swell more.
If carpal tunnel continues to swell regardless of the wrist brace then the next step would be a cortisone injection. Cortisone is a steroid that is used to treat inflammation. It does not treat pain associated with carpal tunnel. The shot is effective in shrinking swollen tissue and allowing the median nerve to circulate with less compression but the treatment is only a temporarily solution. Usually lasting 6 months at most. Doctors must limit how many injections a patient receives as the injection may cause complications with the patient's tendons.
The open release requires an incision in the middle of the palm, an extensive deep dissection that takes a long time to heal. Because of the inherent delay in the return of hand function with this invasive surgery, carpal tunnel surgery was considered a major operation till the advent of the endoscopic technique. When all other treatments have been completely exhausted surgery is the final stage. Carpal tunnel release involves cutting the transverse carpal ligament. This ligament is what holds everything together in the wrist. The transverse carpal ligament is wrapped around the wrist like a rubber band and is elastic in nature allowing flexibility for the median nerve within the carpal tunnel but as carpal tunnel worsens the ligament must be cut. Cutting the transverse carpal ligament will significantly relieve the area of pressure. After surgery the opening will be stitched up and naturally form scar tissue.
Stitches are taken out 10 to 14 days after surgery, the patient will be provided with a splinter to be worn daily for several weeks at a time. Patient must refrain from using the operated hand up to 3 months. Pain should disappear after surgery but If pain continues, expect a longer waiting period before pain and numbness disappears completely. If the operated hand is your non-dominant hand you may return to work within 1 - 2 days after surgery but most patients wait longer. If the operated hand is your dominant hand and work requires repetitive tasks it is strongly recommended to wait 6 - 12 weeks before returning your hand to normal tasks.
The main symptom of carpal tunnel is tingling in the fingers (except for the little finger).The sensation is similar to the tingling sensation experienced when your feet fall asleep. People suffering from carpal tunnel feel the constant need to shake their hand up at night. As carpal tunnel worsens, weakness in the hand makes it more and more difficult to form a fist. Grasping strength is reduced and manual task become painful to perform. Constant discomfort and stiffness in the hands.
Direct causes of carpal tunnel is not known but what is certain is anything that causes the surrounding tissues and tendons to swell, cutting circulation at the wrist could cause carpal tunnel. Other possible causes linked to carpal tunnel syndrome include:
Studies have shown that women have a much higher risk for carpal tunnel than men. This may be due to women having naturally smaller wrists. Women who are pregnant may also show signs of carpal tunnel syndrome due to the stress of bearing a child but these indicators disappear on its own after delivery. Carpal tunnel can also be inherited.
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