Carpal Tunnel Diagnosis and Treatment
Carpal Tunnel Syndrome is a compression neuropathy caused by the compression of the median nerve in the hand and wrist. Carpal Tunnel Syndrome is a treatable ailment with a range of symptoms including: tingling, burning, or numbness in the hand generally at night, or a shooting pain from the wrist through the arm.
It is commonly, yet incorrectly, believed that the Carpal Tunnel Syndrome is caused by long hours at the computer keyboard, but actually, there are several factors that can cause this condition. The symptoms occur when the median nerve becomes compressed within the “carpal tunnel”, a passageway of ligament and bone surrounding the nerve at the base of the wrist. Contrary to most common beliefs, this compression is NOT caused by long hours of repetitive movement, such as at a computer keyboard, however, long hours at the computer keyboard can aggravate the symptoms. Carpal Tunnel Syndrome can also be caused by other factors such as injury, health conditions, or water retention.
Carpal Tunnel Syndrome can eventually grow in severity, decreasing a person’s grip strength and affecting their ability to form a fist, grasp objects, and perform certain tasks. Carpal Tunnel syndrome can subside on its own, however rare, treatment is often needed to correct the condition. In chronic cases, atrophy of the hand muscles and permanent nerve damage can occur if the condition goes untreated. Carpal Tunnel Syndrome can affect one or both hands and is more common in women than men.
Mild to moderate cases of Carpal Tunnel Syndrome can often be treated non-surgically. The mainstay of non-surgical Carpal Tunnel Syndrome treatment is night splints. Night splints, often resembling bowler’s braces, are worn at night and will often keep the symptoms at bay. Other treatment options include: changing work habits or working positions, taking more breaks or, exercising the hands and wrists during work. In moderate Carpal Tunnel Syndrome cases, where pain and numbness persist, oral or injectable steroids can help relieve the symptoms and are often predictive of how a patient will respond to surgery. It is important to note, however, that the non-surgical treatments are not curative.
Historically, the incisions for carpal tunnel surgery were so large and painful that hand surgery was only reserved for recalcitrant cases. As the trend in all surgical specialties evolves towards smaller incisions and “minimally invasive” surgery provided by professionals, carpal tunnel surgery has followed suit. The two most common approaches are the ‘mini’ open and the endoscopic approach. Regardless of which technique is chosen, the principle is to incise the transverse carpal ligament so that the median nerve will no longer be compressed.
There are 2 types of ‘open carpal tunnel’ incisions. The ‘traditional’ extends from the mid palm proximal (before) to the wrist. It is the incision that most people associate with the open approach, however, it is rarely used. Conditions requiring the traditional approach include recurrence and cases involving severe inflammation of the tissue surrounding the tendons and nerve in the wrist aka synovitis.
The mini-open approach is the more common open approach performed today. It utilizes approximately a 3cm incision on the palm and, if necessary, can be performed under local anesthetic. Dr. Fiore places a dry dressing which is kept in place for 48 hours. At this point the patient may wash his or her wound in the shower or sink, however, no baths or washing dishes is allowed until the wound has healed completely. No splint is utilized and the patient begins range of motion exercises for the fingers in the recovery room. The sutures are removed within 1-2 weeks after surgery.
Less invasive than the open approach, the endoscopic approach uses a 3mm camera. Endoscpic Carpal Tunnel Release Surgery can be performed through a single incision, known as The Agee Technique, or through two incisions, known as The Chow Technique. Dr. Fiore performs the Agee Technique because it uses a single 1.5 cm incision at the wrist. He prefers the Agee Technique because it keeps scars outside of the palm, which tends to be a more sensitive location, and also allows access to incise the fascia, the tight connective tissue over the median nerve in the forearm. A dressing consisting of a single gauze and a clear, waterproof dressing, known as a Tegaderm , are placed. The patient can get in the shower and get the dressing wet immediately, however, no baths or washing dishes are allowed. The dressing is removed in 48 hours and the wound can be washed in running water. If possible, during the surgery, Dr. Fiore will attempt to hide the scar in a naturally occurring crease in the wrist for a better cosmetic result. Most patients resume light activities such as typing the following day and are released to activities as tolerated one week post op.
Dr. Fiore specializes in the diagnosis and treatment of Carpal Tunnel Syndrome. He is board certified by the American Board of Surgery and fellowship trained in hand and microsurgery. For more information on treatment options, or to schedule a consultation, call Fiore Hand and Wrist at (281) 970-8002.
We are conveniently located within driving distance of Cypress TX, Katy TX, Spring TX, Tomball TX, The Woodlands TX, and Houston TX.
For more information please visit Handcare.org.