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Carpal Tunnel Syndrome

Treatment Options for Carpal Tunnel Syndrome

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Updated April 11, 2014

carpal tunnel treatment surgery

Surgical treatment of carpal tunnel syndrome creates more room for the nerve by cutting the tight ligament.

Image © Medical Multimedia Group

Carpal tunnel syndrome treatment usually begins with simple steps, and moves to more invasive options if the symptoms of carpal tunnel syndrome persist.

The initial carpal tunnel syndrome treatment steps include:

 

 

  • Anti-Inflammatory Medications
    Anti-inflammatory medications or NSAIDs (e.g. Motrin or Advil) can decrease inflammation in the carpal tunnel and can also decrease carpal tunnel syndrome symptoms.
  • Wrist Brace
    The brace helps to stabilize the carpal tunnel in its neutral position. The carpal tunnel is at its widest diameter in this position and the nerve is least compressed. Wearing the splint at night is especially important, as well as during activities that tend to irritate your carpal tunnel syndrome.
  • Cortisone Injection
    The cortisone injection works by delivering a powerful anti-inflammatory medication directly to the source of the problem. Steroids shoulder be injected sparingly, and if the carpal tunnel syndrome returns, surgery may be considered.

    Injections of cortisone into the carpal tunnel work about 80% of the time. However, this relief is often temporary, and the symptoms may return. Recent research has shown that the carpal tunnel injection is probably an effective treatment for at least one year in many patients. The injection can also be very helpful in situations where the diagnosis of carpal tunnel syndrome is unclear.

When symptoms of carpal tunnel syndrome fail to improve despite appropriate treatment, surgery may be an option. Surgical treatments are effective in the treatment of carpal tunnel syndrome. The most common procedure is the carpal tunnel release. A carpal tunnel release involves making an incision in the fibrous sheath around the carpal tunnel. By releasing tension in the carpal tunnel, the pressure is removed from the nerve.

 

Carpal Tunnel Surgery

If a carpal tunnel release is done, it is most commonly performed by a "open" technique. To perform an open carpal tunnel release, your surgeon makes a 4 centimeter incision down the middle of the palm. Your surgeon carefully dissects the tissues down to the carpal tunnel. The carpal tunnel is opened up to relieve the pressure on the nerve. The surgery only takes about 15 minutes, and can be performed under local, regional, or general anesthesia.

A carpal tunnel release can also be done through a minimally invasive incision with a camera called an endoscope. In this procedure called an endoscopic carpal tunnel release, a small (about 1 centimeter) incision is made by the wrist. Through this incision, a small camera is inserted into the carpal tunnel. A small knife attached to the camera is then used to release the carpal tunnel.

Both procedures are effective in the treatment of carpal tunnel syndrome. Many surgeons prefer the open carpal tunnel release because it is easy to ensure there is adequate relief of tension around the nerve. Furthermore, by seeing the nerve, there is a comfort surgeons have in ensuring the nerve is not injured. That said, the most common complications from carpal tunnel surgery are because of an incision in the palm of the hand. The endoscopic surgery has fewer problems with incisions, so some surgeons prefer this technique. It is important that no matter what procedure is performed, it is done by a surgeon with experience in the technique they prefer.

Complications of Carpal Tunnel Surgery

The most common complications of surgical release of the carpal tunnel are problems with pain in the palm of the hand. A common problem called pillar pain can develop after carpal tunnel surgery when there is pain near the base of the thumb as a result of the surgery. Infection is possible, and it is important to follow your surgeons instructions to keep the wound clean while it is healing. Nerve injury is an uncommon, but serious complication. Nerve injury usually results in an injury to one of the branches of the median nerve. This may lead to permanent weakness of the thumb.

Sources:

Adams, BD. "Endoscopic Carpal Tunnel Release" J. Am. Acad. Ortho. Surg., May 1994; 2: 179 - 184.

Osterman AL, Whitman M, Porta LD. "Nonoperative carpal tunnel syndrome treatment" Hand Clin. 2002 May;18(2):279-89.

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