Treatment of Carpal Tunnel syndrome

April 24th, 2007

Carpal tunnel release is for the most part, a very successful procedure, regardless of the technique used, so long as the diagnosis is supported by clinical exam. While nerve studies are frequently diagnostic, studies may be normal up to 15% of the time. So--if you have numbness or tingling in the thumb, index, long, and part of the ring finger, and if the exam shows irritation when your median nerve is tapped at the wrist or when the wrist is flexed, then in many instances, the nerve study results may be immaterial.

I do not perform carpal tunnel release with endoscopic techniques primarily because the literature and my 14 years of experience have shown that outcomes are equivalent at 6 months regardless. Most importantly,there is more risk of nerve or blood vessel injury with the endoscopic techniques.

From my standpoint, if I can provide a very favorable outcome in over 95% of patients with a small interthenar incision (see pictures below), then it's not worth any risk of a complication to change.

A cortisone shot may help in many cases, so I will frequently recommend starting with one as opposed to proceeding directly to surgery, although for more severe cases, an injection may not be feasible. (see viseo of what to expect with an injection)

After surgery, which is performed under a local with or without sedation, you will be in a small bandage for 1 week. Sutures will be removed at 2 weeks. In many cases a single visit with the therapist, if any, will suffice. I prohibit forceful gripping for 4-6 weeks, and in most cases return to work is possible between 3-8 weeks--often much sooner if you perform strictly sedentary work. Discomfort in the palm may last anywhere from a few weeks to 3 months.

Related Photos:

Carpal tunnel syndrome causes numbness in the thumb, index, long, and part of the ring finger

Within the carpal canal, the median nerve and 9 flexor tendons pass beneath the transverse carpal ligament. This ligament is released during surgery to take pressure off the nerve

A small interthenar incision leaves an almost invisible scar

Related Videos:

Outcome after successful carpal tunnel surgery

A carpal tunnel injection is frequently helpful