Endoscopic Carpal Tunnel Release

The “carpal tunnel” is a narrow passageway that runs from the base of the hand through the wrist

What is carpal tunnel syndrome and who develops it?

The median nerve, which controls our sense of touch in the palm, and touch and fine movement in the thumb and three larger fingers, passes through the carpal tunnel along with several tendons. If any of those tendons become irritated, or any other swelling encroaches on the space within the tunnel, the median nerve can become compressed. Compression of the median nerve may cause symptoms that range from tingling in the fingers to pain radiating up the arm.

Three out of every four people who develop carpal tunnel syndrome are women. Some researchers suggest that women develop the syndrome more frequently because of simple differences in anatomy — women have a smaller carpal tunnel than men. Other factors may also be important in determining the cause of the syndrome. Heredity, repetitive and forceful hand use, hormonal changes, and other medical conditions like arthritis and diabetes, have all been linked to carpal tunnel syndrome.

Carpal Tunnel

What are the symptoms of carpal tunnel syndrome?

The symptoms of carpal tunnel syndrome often begin gradually and typically stem from the thumb side of the hand. Initially, symptoms may be intermittent (on and off), but without intervention, they may become chronic (constant). You may feel tingling, numbness, and pain in your hand. This pain may also radiate through your wrist and up your arm. Pain associated with carpal tunnel may feel dull and nagging, or it may seem to shoot through your hand, wrist, and arm like an electrical current. Tasks that require small finger movements, like tying a shoe or fastening a necklace clasp, may become difficult. Sometimes flexing your wrist or shaking out your hand may temporarily reduce or relieve the discomfort.

In order to diagnose you properly, your doctor will consider your symptoms, examine your hand and wrist, and ask you to perform specific movements that reproduce the symptoms of carpal tunnel syndrome. Your doctor may also require you to have X-rays, an MRI (magnetic resonance imaging) or a nerve conduction test to look closely at the nerve function in your hand.

How is carpal tunnel syndrome treated?

Your doctor may recommend different treatment options depending on your particular symptoms and the severity of your condition.

Your doctor will likely recommend that you avoid engaging in any activity that causes symptoms or makes your symptoms feel worse. That may mean resting your hand and wrist for a couple of weeks. This initial “avoidance” therapy will help your doctor get a better picture of the extent and severity of your nerve compression.

Your doctor may prescribe or recommend the use of anti-inflammatory medications (like aspirin or ibuprofen) and cold packs that will help to reduce inflammation as well as reduce the pain associated with your carpal tunnel syndrome. Often a local injection of cortisone or lidocaine, or both, helps to further reduce inflammation.

A specially designed brace worn at night helps keep the affected wrist in a natural position that doesn’t compromise, or put extra pressure on, the median nerve. Your doctor may also want you to wear a splint to support your hand and wrist during the day while you’re engaged in routine activities, like working on the computer.

If you are still experiencing pain after all other conservative measures have been taken, your doctor may suggest surgery to help relieve your pain and restore your mobility. Surgery to relieve the symptoms of carpal tunnel syndrome involves releasing the carpal ligament. The surgeon makes an incision in the roof of the tunnel itself — sometimes referred to as the“envelope” — thereby enlarging the space and alleviating pressure. Today, this procedure can be performed with a very small incision and a tiny camera (endoscope) that enables the surgeon to see within the space. Be sure to talk with your doctor about the best treatment option for you.

Whether your doctor performs an open-release surgery or less-invasive surgery with an endoscope, you will likely be able to go home the same day. You may have a few initial restrictions and be given a few finger and hand exercises to ensure that your hand heals properly and functions well. Although recovery from surgery may take a few weeks, recurrence of the syndrome after surgery is rare. 1 in 10 people who undergo surgery to correct carpal tunnel syndrome choose not to return to their former job if it involved an activity that may have been linked to causing or aggravating their condition. Your doctor can help you determine how soon after surgery you can resume work.

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