Carpal tunnel syndrome is the most common peripheral compression neuropathy in the upper extremity. Carpal tunnel syndrome is caused by compression of the median nerve at the carpal tunnel of the wrist. The carpal tunnel is comprised of a valley of carpal bones covered by a strong thick ligament through which the median nerve and flexor tendons run.
Typical symptoms are numbness and tingling in the thumb, index and middle fingers. As the disease progresses patients usually notice that their hands are numb and tingle at night making it difficult to sleep. Numbness may make it difficult to feel and manipulate small objects. In advanced disease the muscles of the hand become weak and start to atrophy.
Diagnosis begins with the patient’s history and a physical exam. Some patients will require an EMG, which is a special nerve test. Other patients will need a diagnostic carpal tunnel injection before a diagnosis can be made. All of these tools are used in conjunction to make the correct diagnosis.
If your carpal tunnel syndrome is mild and found in the early stages it can be treated conservatively with night time wrist splinting. If this fails to decrease symptoms or symptoms return after a course of splinting it may be necessary to proceed with surgery. Surgery is very effective and well tolerated. Surgical release of the transverse carpal ligament or carpal tunnel is completed either via a mini-open 2cm incision in the palm, or via an endoscopic approach through an incision in the wrist. I will discuss which option is best for you at the time of your visit.
Your incisions will be covered in a light dressing that you will leave in place for 2 days. In 2 days you may shower and get your incisions wet. You may recover your incision with a bandaid after that. You may not submerge the incisions under water for 3 weeks. You may use your hands for all activities that you can tolerate immediately after surgery without risk for damaging the surgery. With the exception of heavy lifting greater than approximately 5 lbs for 2 weeks. I routinely tell patients, “let your pain be your guide,” if it hurts, don’t do it. Your first post op visit will be in 2 weeks at which time your sutures will be removed.
