Carpal Tunnel Syndrome results when the median nerve that passes through the carpal tunnel, a tunnel created by the carpal bones and transverse carpal ligament of the wrist, becomes compressed or squeezed. When the nerve is squeezed and under increased pressure, the blood supply to the nerve is decreased and may cause a wide variety of symptoms. Most patients commonly experience the following symptoms:
Symptoms can range from mild to severe depending on the degree of nerve compression. Typically initial symptoms are intermittent or mild, but with long term compression (months to years) the axons or small “wires” within the nerve become damaged which can cause constant or even permanent symptoms. A full recovery of the nerve’s function can be expected with early recognition and treatment.
Treatment for carpal tunnel syndrome usually begins with conservative care for mild or moderate nerve compression. If patients present with more advanced carpal tunnel syndrome or failed conservative treatment, surgery is recommended.
Conservative treatment methods include wrist splinting and corticosteroid (“cortisone”) injection. A wrist splint is recommended particularly at night to help maintain the wrist in a neutral position and avoid the extremes of bending the wrist in flexion or extension with sleep. These extreme positions of wrist flexion or extension cause further increase in pressure around the nerve which leads to symptoms of carpal tunnel syndrome. Injections for carpal tunnel syndrome can be both diagnostic and therapeutic. Patients with carpal tunnel syndrome can expect to experience improvement or complete resolution of symptoms following injection. However, injections may not provide a long term cure for carpal tunnel syndrome and symptoms can recur.
Surgery has been proven very effective in the treatment of carpal tunnel syndrome. Surgical release involves dividing the transverse carpal ligament (“roof” of the carpal tunnel) which decreases pressure around the nerve. For mild or moderate carpal tunnel syndrome, patients can expect complete relief of symptoms and full recovery of the nerve. However, for advanced or severe carpal tunnel syndrome, symptoms such as weakness and persistent numbness can become permanent despite surgical release. Carpal tunnel release for severe cases will prevent the nerve from further damage, improve or eliminate symptoms of pain and tingling, and allow for some recovery of nerve function over months.
Surgery can be performed as either an open carpal tunnel release or an endoscopic carpal tunnel release. Despite the differences in surgical technique, both surgeries are equally effective in the treatment of carpal tunnel syndrome. Both “mini” open carpal tunnel release and endoscopic carpal tunnel release are offered at the San Antonio Hand to Shoulder Orthopaedic Center. Each surgical technique will be discussed in detail to help patients understand and choose their procedure. With EITHER procedure, most patients are able to return to most routine activities of daily living, including some work positions, within a few days to 1 to 2 weeks from surgery.