Carpal Tunnel Syndrome (median neuropathy)

The carpal tunnel is a structure in the wrist that contains the tendons that control the fingers and then median nerve, which innervates the thumb and first two fingers.

There are several conditions that may cause hand pain and numbness. 

When the carpal tunnel is too small and/or inflammation occurs in the tendons that run through it, the median nerve becomes compressed, causing symptoms such as pain, numbness, and tingling in the wrist, hand, and fingers.

Symptoms of Carpal Tunnel Syndrome

Symptoms of carpal tunnel syndrome include, but are not limited to, the following:

  • Tingling and numbness in palm, thumb, or first two fingers, especially during the night or in the morning. The sensation may cause people to want to “shake out” the hand.

  • Aching pain in the wrist and hand, with occasional shooting pains up the forearm
  • Weakness in the hands and fingers and trouble gripping or holding objects

 

Treatment options

Carpal tunnel syndrome is treated with nonsurgical methods such as splinting, ice therapy, and behavioral modifications. It can also be treated surgically with a procedure called carpal tunnel release.

The surgery for carpal tunnel syndrome—known as a carpal tunnel release or carpal tunnel decompression—creates more space for the nerve in the carpal tunnel by relieving pressure caused by a ligament.

Carpal tunnel release is small, outpatient procedure, but it is surgery nonetheless. It’s important to know what to expect before and after the procedure, and how to prepare for it.

The surgery takes less than an hour to perform and can be done under local anesthesia. Patients come in on the day of surgery and typically go home soon after the procedure.

Step-by-Step Description of Carpal Tunnel Release

Carpal tunnel release, when performed in the hands of an experienced surgeon, is a relatively straightforward surgery. Here is a step-by-step description of what patients can expect when undergoing this surgery:

  • During the procedure, the patient will generally lie down on their back with the arm out to the side and palm-up.
  • After sterilizing the hand, the surgeon administers an injection to numb the wrist, hand, and surgical area. The patient remains awake but may be sedated; general anesthesia is rarely used for carpal tunnel release.
  • Once the area is numb and the patient is comfortable, the surgeon may use a tourniquet. Surgery is most commonly performed in an open fashion through a single 1- to 2-inch incision in the palm. Some surgeons use an endoscopic approach using one or two small incisions and a video camera to guide their work.
  • In either procedure, the surgeon locates the transverse carpal ligament, which runs across the top of the carpal tunnel, and cuts it, taking care not to damage the median nerve or the tendons below the ligament.
  • The surgical instruments are removed, the area is washed, and the skin’s incisions are closed with stitches.
  • The surgeon covers the surgical site with a light bandage and will give instructions about when it may be removed.

Preparing for Carpal Tunnel Release

To prepare for surgery and help avoid complications, patients may be asked to do the following:

  • Tell the physician about all the medications, vitamins, and/or supplements being taken. This includes prescription and over-the counter medications.

  • Stop taking medications that can interfere with the blood’s ability to clot, such as ibuprofen or aspirin.
  • Quit smoking or other use of tobacco products.
  • Refrain from eating or drinking 6 to 12 hours before the procedure.
  • Arrange for a ride home after the procedure, since it will be performed on an outpatient basis and does not require a hospital stay.

Individuals who have questions about preparing for their carpal tunnel release procedure should ask their surgeon for specific instructions.

 

If you'd like to discuss this condition with one of our doctors, we would be more than happy to contact you.  You don't need a primary care physician referral for us to see you. 

 

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