When confronted with the word "surgery" most people think of hospitals, anesthesia, stitches, long recovery, complications, etc. and that is why the thought of needing carpal tunnel surgery can be a scary thought. However, surgery is not the only option to relieve carpal tunnel pain, and even if you do need carpal tunnel surgery, you can take advantage of a minimally invasive, no-stitch technique called endoscopic release.
Causes of Carpal Tunnel Syndrome
First things first, let's talk about the causes of carpal tunnel syndrome (CTS) to better understand this condition and its treatment options. CTS is caused by pressure on a nerve called the median nerve at a specific location on your wrist that is known as the carpal tunnel. Like its name implies, this is a tunnel or space in your wrist that houses certain tendons – known as the flexor tendons – as well as the median nerve.
When the flexor tendons that pass through the tunnel outgrow that space, pressure builds up around the median nerve and this ends up causing pain and discomfort. People with CTS require one of two solutions: decrease the pressure created by the flexor tendons inside the tunnel, or increase the tunnel space to allow for the flexor tendons to fit comfortably. The former one can be achieved with carpal tunnel surgery.
There is no one activity that leads to developing CTS, but there are certain risk factors that increase the chance of a person developing this condition such as: previous injuries, inflammatory illnesses, repetitive motions, and pregnancy.
Symptoms of Carpal Tunnel Syndrome
You might be suffering from CTS if you experience the following symptoms:
- Wrist pain that might radiate to the forearm, arm, neck, or shoulders.
- Numbness and tingling on certain fingers.
- Weakness of grip.
- Severe nighttime hand pain.
Diagnosing Carpal Tunnel Syndrome
Before you can start looking into treatments and surgery options, you need to be sure that you indeed suffer from CTS.
The first step is to see a hand surgeon, also known as a hand specialist or orthopedic hand surgeon. It is very important that you talk to a hand surgeon about your symptoms, as opposed to talking to a primary care physician, because hand surgeons have the expertise require to properly diagnose CTS or identify your hand problem as a different, perhaps less known condition if that is the case.
Diagnosing CTS is not a straightforward task. Since this condition is a syndrome and not a disease, it cannot be diagnosed based on a single criteria or test, this is one of the many misconceptions about carpal tunnel syndrome.
CTS is diagnosed based on your medical history, a physical examination, and additional testing. Then, the hand surgeon will put all the pieces together to deliver a diagnosis.
Some of the physical tests that can be performed to help determine if you have CTS are:
- Tinel's test: the hand surgeon will tap over the median nerve to record any tingling or shock in the fingers as a result of the tapping.
- Carpal tunnel compression test: the hand surgeon will hold pressure on the median nerve to see if it causes a tingling sensation in the fingers.
- Phalen's test: the hand surgeon will ask you to bend your wrist 90 degrees to see if you feel tingling in your fingers.
Other testing used to aid in the diagnosis are:
- Electromyelogram / Nerve Conduction Velocity (EMG / NCV)
- Diagnostic steroid injections
Once a clear diagnosis has been reached, it is time to start considering the treatment options with the help of your hand surgeon.
Carpal Tunnel Surgery and Other Treatments
As mentioned before, the course of treatment for relief depends on each individual's needs and should be decided with the help of a trained hand surgeon.
Non-surgical treatments usually aim at reducing the inflammation inside of the tunnel. Some non-surgical treatments are:
- Non steroidal anti-inflammatory medications
- Oral steroids
- Steroid injections
- Physical or Occupational therapy
Non-surgical treatments, however, do not treat the root of the problem and therefore don't necessarily resolve the symptoms for certain people.
Surgery can be performed in two ways, as an open procedure, or as the minimally invasive no stitch release.
Endoscopic Carpal Tunnel Release Surgery
- Performed with a small endoscope.
- Does not require stitches.
- Leaves a small scar, about three to four millimeters.
- Little to no post op pain.
- Use of the hand on the same day.
Open Carpal Tunnel Release Surgery
- Performed by making a large incision of about three to four inches.
- Requires staples or stitches.
- Leaves a scar.
- Potential post op pain.
- Generally needs one to three months of therapy to fully heal.