What is carpal tunnel syndrome?

• -Carpal tunnel syndrome is the result of compression of the median nerve at the wrist.
• -The median nerve provides sensation to the thumb, index, middle, and half of the ring fingers. It also gives motor function to muscles at the base of the thumb.
• -The transverse carpal ligament, the roof of the carpal tunnel, is applying too much pressure on the nerve when the contents of the canal become inflamed.

What are the common symptoms?

• -Numbness, tingling, and pain in the hand that can radiate up the arm
• -This progresses to become nocturnal, often causing frequent sleep disturbances and awaking from sleep, and positional, such as when driving a car
• -Over time symptoms can become constant and feelings of clumsiness or weakness in the hands may occur, caused by weakening of the hand muscles

Common treatment options

• -Ergonomic changes to workspaces/activity modification
• -Nighttime splints
• -Preventing flexion of the wrist, which puts extra stress on the median nerve
• -Cortisone injections
• -Reducing inflammation in the carpal tunnel
• -Surgery
• -Releasing pressure applied by the transverse carpal ligament
• -Nighttime splints

Cortisone injections

• -Cortisone injections are often given to help reduce inflammation within the carpal canal.
• -This medication is injected with a local anesthetic. This will provide pain relief from the injection for a few hours following. It is common to have increased soreness for a few days after the injection.
• -Onset of the medication may take up to a week before you begin noticing improvement. Symptom relief is variable, but averages from 1-3 months.
• -Diabetics should use cortisone with caution, as it can increase blood sugar levels.

Surgical treatment

• -Often before surgery, an EMG study is performed to evaluate the severity of median nerve entrapment
• -When other treatments have failed or symptoms are severe, surgical repair involves releasing the tight and thickened transverse carpal ligament
• Options Include:
• -Standard Open Carpal Tunnel Release
• -The transverse carpal ligament is divided through an incision in the palm, which releases pressure on the median nerve
• -This is an outpatient procedure performed under local anesthesia. We are able to give you some sedative medication through an IV to keep you comfortable.
• -The procedure takes about 15-20 minutes to perform
• -Endoscopic carpal tunnel release
• -This method uses a smaller skin incision and a camera, called an endoscope, to also divide the transverse carpal ligament, but from the inside out
• -This is an outpatient procedure performed under a light sedation. Once you are comfortable, we use an injectable local anesthetic to numb the region
• -The procedure takes about 15-20 minutes to perform

What are some of the associated risks?

• -Anesthetic
• -Infection
• -Numbness
• -Recurrence

Post-operative care

• -A soft dressing is applied after surgery. You will be able to use your hands for light activity later that day
• -Keep the surgical dressing and incision clean and dry. After 48 hours you may remove the soft dressing and your incision may get wet in the shower, but no soaking. Apply a band-aid to keep the incision clean if necessary
• -Approximately 10-14 days post-operative you will return to Dr. Choudhry’s office for a follow-up visit and suture removal

If you would like to schedule an appointment with Dr. Choudhry to discuss carpal tunnel syndrome and your medical needs – Request an appointment today! Read more about Orthopedic Associates newest top surgeon – Dr. Imran K. Choudhry M.D.