The carpal tunnel is a narrow rigid passageway of ligaments and bones in the base of the hand which contains the median nerves and tendons which are responsible for hand strength and function. When thickening and swelling from irritation of the tendons occurs, the carpal tunnel is compressed which can cause pain, numbness, tingling, weakness and loss of function in the hand and/or wrist. This is referred to as carpal tunnel syndrome.
Carpal tunnel syndrome can be caused by repetitive motion of the hand, trauma or injury, sprain or fracture, over activity of the pituitary gland, hypothyroidism, rheumatoid arthritis, work stress, and fluid retention due to pregnancy or menopause. This condition occurs in 50 out of 1000 people worldwide and is 3 times more likely to affect women between the ages of 30 and 60. Those with diabetes, metabolic disorders and nerve disorders are more susceptible and have a higher risk of developing carpal tunnel syndrome.
Most common activities causing carpal tunnel syndrome include:
Carpal Tunnel Symptoms Include:
Carpal tunnel pain can be alleviated through several methods to calm swelling and inflammation which is often the cause of carpal tunnel syndrome. Non-surgical carpal tunnel release includes the use of splints, hot and cold compresses, special modified devices in the workplace, changes to recreational activities, non steriodal anti-inflammatory medications such as ibuprofen or naproxen or corticosteroid injections. However, 50% of patients seeking carpal tunnel release will require carpal tunnel surgery.
Candidates for carpal tunnel surgery must have attempted carpal tunnel release through non surgical treatments for a minimum of 5-12 months, depending on the severity of the condition. If nerve damage is present particularly to the median nerve, then it may be necessary to undergo carpal tunnel surgery sooner. Signs of nerve damage include persistent loss of feeling and/or coordination in the fingers or hand with no strength in the thumb. When considering carpal tunnel release, two surgical options are available. Both types of carpal tunnel surgery are performed as out-patient procedures utilizing local anesthesia.
Open Carpal Tunnel Surgery
Carpal tunnel release performed through the “open” technique requires a small incision to be made at the base of the palm of the hand. The transverse carpal ligament is then cut to release the pressure on the median nerve, relieving the symptoms of carpal tunnel syndrome. The incision is then closed with stitches and the hand is wrapped.
Endoscopic Carpal Tunnel Surgery
Endoscopic carpal tunnel surgery is performed much in the same way as open carpal tunnel surgery; however, as with all endoscopic procedures, a thin, flexible tube with a camera attached is guided through a small incision – in this case either the wrist and palm or just the wrist. Tiny precise surgical tools are used to perform the same procedure leaving less scarring and causing minimal trauma to the body.
After carpal tunnel surgery, patients may experience pain and numbness in the hand and wrist. This may dissipate in as little as a few days, but may linger for up to a month or two before it fully subsides. Hands will be wrapped immediately after surgery until stitches are removed in 10-14 days. At that time patients will then be required to wear a splint for several weeks. It is important to avoid heavy use of the hand or hands for 3 months after carpal tunnel release.
With open carpal tunnel surgery, patients can return to work 1-2 days after surgery if the procedure was performed on the non-dominant hand, although many patients choose to take a week or two off to avoid high risk activities. Dominant hands typically require 6-12 weeks for a full recovery. For carpal tunnel release performed with endoscopic surgery, immediate recovery time is similar. However, many patients see full recovery in about 4 or 5 weeks. Physical therapy is useful to help speed up the recovery process.
The complication rate of carpal tunnel surgery is less than 1%, with a 70% satisfaction rate and a 90% change of improvement of carpal tunnel pain at night. Choosing a Carpal Tunnel Surgeon When selecting a surgeon to perform your carpal tunnel release surgery, it is important to select a doctor who is highly specialized in intricate procedures and has extensive expertise in hand surgery.
Both Dr. Tarick Smaili and Dr. Payam Jarrah-Nejad have undergone extensive training in hand surgery through Hand Surgery Fellowships. An added benefit to selecting a surgeon who is experienced in both hand surgery and aesthetic surgery is that the doctor is not only very skilled in the procedure they are performing, but they are also more aware and in tune to providing natural results with minimal scarring.