By Scott A. Putney, MD
Carpal tunnel syndrome occurs as a result of a compression of the median nerve at the wrist. This nerve supplies sensation to the palm, thumb and some of the fingers, and is partially responsible for movement of these areas. The compression can cause pain, numbness and tingling in the hand and wrist. Compression is caused by inflammation in the tendons that bend the fingers. The inflammation in the tendons causes the linings to enlarge, which pinches the nerve. Over time, this causes muscles in the pad of the thumb to atrophy, leading to a limited ability to bring your thumb across your palm. If the nerve compression continues for too long, the sensation in the fingers can be permanently lost.
Initial Treatment of Carpal Tunnel Nerve Entrapment
Our initial visit will consist of a thorough physical exam as well as questioning about the nature of the symptoms. If we determine that carpal tunnel nerve entrapment is the cause, our treatment begins by asking patients to wear splints at night. Splinting prevents pain and numbness from waking them at night and also helps with a variety of other symptoms.
After that, we may recommend steroid injections in the wrist. These injections reduce the inflammation in the lining of the tendons and provide relief from many of the main symptoms of carpal tunnel syndrome. While this works well for immediate relief, its rarely a permanent solution. If the pain is severe, surgery is usually the next recommendation.
Types of Nerve Entrapment Surgery
There are two types of surgery for nerve entrapment relief: endoscopic or open. You and your doctor can work together to figure out which option is best for your needs. Both surgeries have been shown to have equivalent outcomes. Endoscopic surgery has a slightly higher complication rate but a lesser recovery time.
The carpal tunnel is bony on three sides and is ligament on one. This means that, in either surgery, the ligament is divided – in order to create more room. In open surgery, the surgeon has a direct view of the ligament, while endoscopic uses a smaller incision and a camera to see. Recovery time varies, but for sedentary jobs, people can typically return to work between 48 and 72 hours, while for manual labor recovery typically takes 2-3 weeks. Full strength is reliably restored by 3 months with either type of surgery.
What to Expect After Carpal Tunnel Surgery
The recurrence rate after surgery is less than 10 percent, and most patients start feeling an immediate relief of pain. Numbness and tingling, however, may continue even after surgery, especially when pre-operative symptoms were severe. In general, its likely that 95 percent of the symptoms that were relieved by injections will be improved over the long-term by surgery.
Surgery for nerve entrapment relief is a great solution for patients suffering from carpal tunnel syndrome.
Call us today to schedule a consultation with an orthopedic surgeon in order to get the best treatment for your pain.