CARPAL TUNNEL SYNDROME
Table of Contents
What is Carpal Tunnel Syndrome (CTS)?
Carpal tunnel syndrome is a condition in the hand which is caused by compression of the median nerve as it passes from the wrist into the hand. Usually the median nerve goes through a small tunnel space called the carpal tunnel that is made by the bones in the hand, as well as a thick tendinous sheath called the transverse carpal ligament above it.
When there is inflammation in this tunnel, due to repetitive straining of the wrist, the median nerve is compressed, as it is the softest tissue within the tunnel.
What symptoms do I experience with CTS?
Compression of the median nerve causes numbness, tingling and pain in the thumb, index, middle and 1/2 of the ring finger. Over time and with increased severity, it can cause weakness in grip strength and wasting of the muscle at the base of the thumb.
How do I know if I have CTS?
There are several clinical tests that can be done to see if you suffer from carpal tunnel syndrome, but the most definitive and best way to determine if you, indeed have carpal tunnel syndrome is an electromyogram (EMG), also known as nerve conduction studies (NCS).
A neurologist sends electric signals down your arm to check if there is a delay or cessation of the signal along the median nerve at the carpal tunnel.
What is the management ?
Conservative management such as splinting, physiotherapy and steroid injections can help prevent further injury and abate the mild inflammation in the tunnel. However, if the condition is not controlled or the compression is very severe, prolonged conservative treatments may result in permanent nerve damage and irreversible muscle atrophy (wasting).
Surgical release is the most definitive way of treating carpal tunnel syndrome. Carpal tunnel decompression can be performed through an open release and an endoscopic release/minimally invasive method.
Dr. Chivers offers standard open release surgery and is one of only a few plastic surgeons in Ontario who also perform this surgery endoscopically.
Open carpal tunnel - requires a 3-5 cm incision made over the wrist at the palm. The surgery is performed separately for each hand as the grips strength is typically weakened after surgery. Recovery typically ranges from 4-6 weeks.
Endoscopic surgery - is recommended for patients with bilateral carpal tunnel syndrome. Typically 5 mm incision is made and an endoscope (a thin tube with a camera) is inserted into the incision to visualize the carpal ligament and microscopic instruments are used to cut the ligament through that same opening. The procedure time is longer than open release surgery, however, the recovery time is much shorter because there is significantly less trauma to the hand.
Resources for Endoscopic Carpal Tunnel Release
How soon is surgery recommended?
Patients should have the surgery as soon as possible if conservative treatment fails, if nerve conduction studies show a severe condition or if the compression is starting to cause muscle atrophy. Earlier surgery can prevent further deterioration.
When it is convenient, you should have your family doctor refer you to Dr. Chivers’ office at the Canadian Plastic Surgery Centre. You can obtain our contact information under the Contact Us page.
What will happen if I delay and/or chose not to have surgery?
You may experience a progression of your current symptoms and with severe progression, you may experience muscle wasting at the base of the thumb. It is suggested that patients have surgery as soon as their schedule permits to prevent further deterioration.
How long does it take for my hand function recover completely?
3-4 days is required for the incision to completely heal from endoscopic surgery or 10-14 days for open surgery. Depending on the severity of the nerve compression, it may require up to 6 weeks of exercise and physiotherapy for hand strength to return to baseline. For patients with chronic compression, it may take up to a year for the complete resolution of paresthesia.
What can I do to help with my recovery after surgery?
To help with the recovery and resolution of symptoms, you should try to use your hands as much as possible after surgery. You can purchase a wrist guard for support and studies have shown that supplementation with vitamin B6 can help with resolution of nerve compression symptoms.