What is carpal tunnel syndrome?

Carpal tunnel syndrome is a condition in which too much pressure is placed onshutterstock_86604217 the median nerve.  The median nerve is a nerve that supplies sensation to your thumb, index, long, and ring fingers.  It also activates the muscles at the base of the thumb.  There nerve gets compressed as it passes through the carpal tunnel, which is the space in your wrist surrounded by your wrist bones and the transverse carpal ligament.  The median nerve, as well as nine tendons, pass through this space.  Pressure on the nerve occurs secondary to fluid retention, swelling of tissue around the nerve, and inflammation.  In many cases the cause is unknown.

What are the symptoms of carpal tunnel syndrome?

Often people complain of numbness and tingling in the first 3-4 fingers, with the index and middle finger most often affected.  Often the numbness and tingling occur at times of rest and can awaken one from sleep.  Sometimes certain activities such as talking on the phone, driving, or washing your hair can bring on the symptoms.

How is carpal tunnel syndrome diagnosed?

In our practice it is most often diagnosed by history and physical exam.  On occasion, a nerve conduction test will be ordered to confirm the diagnosis.  However, as this test is uncomfortable and has a high rate of error we try to avoid this testing.

What is the treatment for carpal tunnel syndrome?

In most cases, the initial treatment is nonoperative.  A trial of splinting and steroid injections is attempted at first.  Most patients with carpal tunnel syndrome will respond to a steroid injection.  The length of response to this treatment varies. In some patients it is curative and in others it is very short acting.  This is a treatment as well as a diagnostic test.  If one responds to steroid injections then this treats the condition and confirms the diagnosis.  If the response to injection is suboptimal or short lived then the patient may need further evaluation.  Eventually, some patients require surgery.  In this case Dr. Graham prefers endoscopic carpal tunnel release although in some instances, such as when in office surgery is chosen, he will perform an open release.

Why choose Dr. David Graham in Victor, NY to treat your carpal tunnel syndrome?

All techniques of carpal tunnel release involve the division of the transverse carpal ligament to increase the space in the carpal tunnel. This can be done through either an open or endoscopic approach. Dr. Graham is facile with both techniques, but our preferred technique is endoscopic carpal tunnel release.  Dr. David Graham is the only surgeon in the area to utilize this advanced method.  This technique involves placing a small incision in the wrist and dividing the ligament from “the inside out” utilizing a camera.  This method avoids an incision on the sensitive area of the palm.  It has been proven to be less painful for patients and it allows an earlier return to work and other activities. In some instances, such as when the less expensive in-office surgery is requested or when a repeat carpal tunnel release is needed, then Dr. Graham will perform the traditional open carpal tunnel surgery.

What are the main risks of this surgery?

• Swelling, stiffness, and pain
• Infection
• Nerve Damage
• Wrist or thumb base pain “pillar pain”
• Residual numbness in fingers
• Recurrence

Post Operative Course

Day 1-2
• Keep dressing clean and dry
• Elevate hand above heart level for next 48 hours to prevent pain and swelling
• After 48 hours you may remove dressing and get incision wet in shower
• After showering apply antibiotic ointment and a bandaid
• Move digits as much as possible to prevent stiffness
Day 3-14
• Continue local wound care with antibiotic ointment and bandaid
• Continue to move digits.  You may lift whatever you are comfortable lifting.  There is nothing you can damage.
Day 14-3 months
• It may take wrist and hand this long for residual discomfort to resolve
• Continue to progressively use your hand
• It may take this long for symptoms to improve.  Nerve recovery can be slow
Driving?
You may drive when you are off narcotics and feel confident to control the car.  Most patients are able to drive within a week.
Time off of Work?
This is depends on the type of work you perform.  Many patients with office jobs only require a few days.  However, patients who perform heavy labor may require 4-5 weeks to recover.